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Yr 3 - Reproduction > Cervical Screening Symposium > Flashcards

Cervical Screening Symposium Flashcards

1
Q

What cancers are largely caused by HPV?

A

Cervix
Penis
Vulva/vagina
Anus

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2
Q

How does HPV infect?

A

Passes into micro-abrasions in the epithelium - invade basal cells

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3
Q

How does HPV infection become pre-cancerous?

A

Virus DNA with cell DNA invades other cells
Leads to more damage and disorganisation
Grows to full thickness

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4
Q

How are people immunised against HPV?

A

2 dose regimen

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5
Q

What is the SCCRS?

A 
Scottish Cervical Call Recall System
Smear taker enters request details
Vials sent to lab (added to SCCRS)
Patient details received, vials stained
Cytology lab puts results on SCCRS
Woman + GP receive results
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6
Q

How does the cervix change in puberty?

A

Increased vascularity and interstitial fluid

Glandular epithelium metaplasia to squamous epithelium

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7
Q

Why does vaginal glandular epithelium undergo metaplasia in women going through puberty?

A

Response to increased acidity in the vagina

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8
Q

Which part of the cervix is susceptible to HPV? Why?

A

Transitional zone

Large amount of cell turnover here

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9
Q

How are women screened for cervical cancer?

A

Smear every 5 years

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10
Q

How are cervix samples tested?

A

Liquid based cytology
HrHPV test
(If +ve) - Reflex Cytology

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11
Q

How does the HPV test work?

A

Identifies HPV type using viral DNA and RNA

High risk type > specific genotyping

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12
Q

How are cervical cytology samples tested?

A

Cells scraped from transformational zone
Look for dyskaryosis
Look for underlying CIN

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13
Q

What is CIN?

A

Cervical intraepithelial neoplasia

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14
Q

What is dyskaryosis?

A

Abnormal cells

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15
Q

What are the different epithelium of the cervix?

A

Endocervix - columnar epithelium

Ectocervix - squamous epithelium

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16
Q

How are cervical samples processed?

A

Thin layer of cells with PAP smearing

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17
Q

What features suggest dyskaryosis?

A

Nucleus:

  • Increased size
  • Increased Nuclear:cytoplasmic ratio
  • Variation in size/shape
  • Coarse irregular chromatin
  • Nucleoli
18
Q

What do different grades of dyskaryosis reflect?

A

Degree of underlying CIN

19
Q

What do Koilocytes suggest?

A

HPV infection

20
Q

How do HPV tests and Cytology differ?

A 
HIV test: 
 - Cervical cells
 - Identifies infection
 - Sensitive
Cytology: 
 - Cervical cells 
 - Cellular changes (grading)
 - Specific
21
Q

What happens next if a patient has a negative HrHPV?

A

Routine recall in 5 years

22
Q

What happens next if a patient has a positive HrHPV?

A

Cytology normal - repeat in 1 year

Dyskaryosis: refer to colposcopy

23
Q

What is the process for colposcopy?

A

Education and Advice
Magnification + light on cervix
Acetiv acid + iodine

24
Q

What is the benefit of colposcopy?

A

Identify limits of lesion
Biopsy site
Showing CIN/metaplasia

25
Q

How is CIN managed?

A

Low grade - return

High grade - treat

26
Q

What is the function of HPV E7 protein?

A

Prevent cell cycle arrest

27
Q

What is the function of HPV E6 protein?

A

Inhibit cell death

28
Q

Which cells does HPV infect?

A

Basal cells

29
Q

What is Koilocytosis?

A

Cells with wrinkled nucleus and perinuclear halo

Multinucleation

30
Q

What are the main low risk types of HPV?

A

6, 11, 42, 44

31
Q

What are the main high risk types of HPV?

A

16, 18, 31, 45

32
Q

What do low risk HPV types cause?

A

Genital warts
Low grade CIN
Transient infection

33
Q

What do high risk HPV types cause?

A

High grade CIN/Cancer

Persistent infection

34
Q

How does high grade HPV cause CIN?

A

Persistent infection
Viral DNA integrates into host cell genome
Overexpression of viral E6 and E7 proteins
Deregulation of host cell cycle

35
Q

How does high grade CIN present histologically?

A

Neoplastic/undifferentiated cells fill full thickness of epithelium

36
Q

What is CIN?

A

Disorganised proliferation of abnormal cells in squamous epithelium
Precursor to cancer

37
Q

How is CIN treated?

A

LLETZ
Thermal coagulation
Laser ablation

38
Q

How is CIN treatment followed up?

A 
Confirm treatment was effective
Prevent invasive cancer
Reassure the woman
Increased risk of cervical cancer
Follow up LBC at 6 months (cytology - high risk HPV)
39
Q

How is the patient managed if her follow-ups are both negative?

A

Return to recall (every 5 years)

40
Q

How is the patient managed if either of her follow-ups are positive?

A

Return to colposcopy

Yr 3 - Reproduction (37 decks)

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