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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
Q

E6 protein product

A

inhibits cell death

26
Q

Low risk HPV

A

6,11,42,44

genital warts, infection transient, low grade CIN

27
Q

High risk HPV

A

16,18,31,45

persistent infection and high risk of high grade CIN and cancer

28
Q

How does high risk HPV –> high grade CIN?

A

viral DNA integrates in host cell genome
over expression of viral E6+7 proteins
deregulation of host cell cycle

29
Q

CIN description

A

invisible to naked eye

dysplasia -squamous epithelium and abnormal change

30
Q

Treating CIN

A

LLETZ
Thermal coagulation
laser ablation

31
Q

Following up after CIN treatment

A

LBC at 6 months for cytology and high risk HPV
both negative - return to recall
either positive - colposcopy

32
Q

cervical cancer epidemiology

A

2500/UK/year and 1200 death

10th most common cancer in women in Scotland

33
Q

6 risk factors for cervical cancer

A 
HPV 16&18
peak age 45-55 
multiple partners 
early age of intercourse 
older partner 
smoker
34
Q

5 symptoms of cervical cancer

A 
PMB 
post coital bleeding 
abnormal bleeding 
pain 
discharge
35
Q

Diagnosing cervical cancer

A

clinical, screening - aim to detect pre cancer, biopsy

36
Q

Most common type of cervical cancer

A

squamous

37
Q

stage2,3,4 of cervical cancer

A

2 - vagina upper 2/3
3 - lower vagina, pelvis
4 - bladder, rectum

38
Q

mets of cervical cancer

A

lymphatic - pelvic LN

blood - liver, lungs, bone

39
Q

staging by cervical cancer

A

EUA, PET-CT, MRI

40
Q

treatment of cervical cancer

A

1a1: type 3 excision or hysterectomy
1b-2a: radical hysterectomy or chemo/radio
2b-4:chemo/radio

41
Q

What is removed in radical hysterectomy

A

uterus, cervix, upper vagina
parametria
pelvic LN
ovaries conserved

42
Q

chemo

A

5 cycles of cisplatin

43
Q

radio

A

external beam x 20 fractions

44
Q

caesium insertion

A

24 hours

Year 3 Repro (JK) (33 decks)

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