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Year 3 Repro (JK) > Cervical screening symposium > Flashcards

Cervical screening symposium Flashcards

1
Q

HPV prevalence

A

peak age 15-25 and declines with age
30% in young women and men, 10% overall
75% lifetime risk of exposure

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2
Q

HPV can be linked to what kind of cancers?

A

CERVICAL , anus
penis, vulval, vagina
mouth, oropharynx

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3
Q

What is SIL?

A

abnormal growth of squamous cells detected on smear

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4
Q

What is CIN?

A

abnormal cells in cervix detected by biopsy and histology

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5
Q

primary and secondary prevention of HPV/CIN

A

vaccines

cervical screening

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6
Q

UK HPV immunisation programme

A

1st Sep 2008 given to girls born after 1st Sep 1990
bivalent vaccine - 16&18
Sept 2012 - quadrivalent 16,18,6,11 - genital warts
Sept 2014 - 2 dose regime

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7
Q

How are people invited to cervical screening?

A

invitation in post to book appointment for cervical screening at GP from 25 years old

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8
Q

Process of cervical screening

A

LBC
cells from transformational zone - squamocolumnar
25-64
high risk HPV

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9
Q

What happens if minor changes are seen in the smear?

A

referred to colposcopy

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10
Q

HPV test

A

molecular test on cells sampled from cervix
high risk HPV viral DNA or RNA
hybridisation, PCR

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11
Q

change in cervical cytology samples in 2020

A

currently all, will be only HPV positive

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12
Q

dyskariosis

A

abnormal cells

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13
Q

endocervix

A

columnar epithelium

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14
Q

exocervix

A

stratified squamous

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15
Q

Lab processing method

A

thin layer of cells - 50 000
PAP stain
imager picks up points of interest and screener reads

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16
Q

abnormal cell characteristics

A

increased size and nuclear:cytoplasmic ratio
variation in size, shape and outline
coarse irregular chromatin
nucleoli

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17
Q

Koliocytosis

A

cells with wrinkled nucleus and perinuclear halo
multinucleation
reflect HPV infection

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18
Q

HPV test and cytology difference

A

HPV is positive or negative with cervical cells - machine detects infection and is sensitive
cytology is human interpretation of the cells and cellular change. specific

19
Q

HPV negative - what happens?

A

recall in 5 years

20
Q

HPV positive - what happens?

A

cytology normal repeat in 1 year

dyskariosis –> colposcopy

21
Q

colposcopy

A

magnification and light to see cervix
exclude obvious malignancy
acetic acid and iodine

22
Q

use of acetic acid and iodine in colposcopy

A

identify area for biopsy
identify limits of lesion
define area to treat

23
Q

Options for management - CIN

A

punch biopsy

return for treatment if CIN2/3

24
Q

E7 protein products

A

prevents cell cycle arrest

25
E6 protein product
inhibits cell death
26
Low risk HPV
6,11,42,44 | genital warts, infection transient, low grade CIN
27
High risk HPV
16,18,31,45 | persistent infection and high risk of high grade CIN and cancer
28
How does high risk HPV --> high grade CIN?
viral DNA integrates in host cell genome over expression of viral E6+7 proteins deregulation of host cell cycle
29
CIN description
invisible to naked eye | dysplasia -squamous epithelium and abnormal change
30
Treating CIN
LLETZ Thermal coagulation laser ablation
31
Following up after CIN treatment
LBC at 6 months for cytology and high risk HPV both negative - return to recall either positive - colposcopy
32
cervical cancer epidemiology
2500/UK/year and 1200 death | 10th most common cancer in women in Scotland
33
6 risk factors for cervical cancer
``` HPV 16&18 peak age 45-55 multiple partners early age of intercourse older partner smoker ```
34
5 symptoms of cervical cancer
``` PMB post coital bleeding abnormal bleeding pain discharge ```
35
Diagnosing cervical cancer
clinical, screening - aim to detect pre cancer, biopsy
36
Most common type of cervical cancer
squamous
37
stage2,3,4 of cervical cancer
2 - vagina upper 2/3 3 - lower vagina, pelvis 4 - bladder, rectum
38
mets of cervical cancer
lymphatic - pelvic LN | blood - liver, lungs, bone
39
staging by cervical cancer
EUA, PET-CT, MRI
40
treatment of cervical cancer
1a1: type 3 excision or hysterectomy 1b-2a: radical hysterectomy or chemo/radio 2b-4:chemo/radio
41
What is removed in radical hysterectomy
uterus, cervix, upper vagina parametria pelvic LN ovaries conserved
42
chemo
5 cycles of cisplatin
43
radio
external beam x 20 fractions
44
caesium insertion
24 hours

Year 3 Repro (JK) (33 decks)

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