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Cervical Screening Symposium Flashcards

1
Q

What virus is associated with cervical cancer?

A

HPV

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2
Q

What is the incidence of HPV?

A
  • Peak prevalence 15-25yrs
  • Prevalence declines with age
  • 10% overall
  • ~30% prevalence in young women
  • Lifetime risk of exposure up to 75% from serological studies
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3
Q

What cancers does HPV have an association with?

A
  • Cervical
  • Anus
  • Penis
  • Vulva/vagina
  • Oropharynx
  • Mouth
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4
Q

What is a squamous intraepithelial lesion?

A

An abnormal growth of squamous cells detectable on smear

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5
Q

What are abnormal cells in the cervix detected by biopsy and histological examination classified as?

A

Cervical intraepithelial neoplasia (CIN) and is graded 1-3

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6
Q

What types of HPV is associated with cervical cancer in Europe?

A

Types 16 and 18

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7
Q

What are the possible outcomes of CIN1?

A
  • Regression
  • Remain unchanged
  • Progression to CIN2, CIN 3 or cervical cancer
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8
Q

What is the UK HPV immunisation programme?

A
  • Introduced in September 2008 and developed since
  • Offered to girls born after 1 September 1990
  • Currently a 2 dose regime
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9
Q

What are the steps in the Scottish Cervical Call Recall System?

A
  • Smear taker enters request details onto SCCRS database
  • Vials sent to lab receipt logged on SCCRS
  • Patient details received from SCCRS, vials processed, slides stained and screened
  • Cytology lab results put on SCCRS database
  • Woman and GP receive results
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10
Q

What is the cervical screening programme in Scotland?

A
  • Women aged 25-64 years
  • 5 yearly smears
  • Liquid based cytology
  • test for high risk HPV
  • If positive, triage with cytology
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11
Q

What is an HPV test?

A
  • Molecular test on cells sampled from cervix
  • Identifies high risk type HPV viral DNA or RNA
  • Any high risk type leads to type specific genotyping
  • Works on LBC samples
  • Technology used includes hybridisation and PCR
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12
Q

What is cervical cytology?

A
  • Microscopic assessment of cells scraped from the transformation zone
  • Look for abnormal cells (dyskaryosis)
  • Indicate that woman has underlying cervical intraepithelial neoplasia - CIN

Currently all smear samples but from 2020 only HPV +ve

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13
Q

What type of epithelium is found in the endocervix?

A

Columnar epithelium

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14
Q

What type of epithelium is found in the ectocervix?

A

Stratified squamous epithelium

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15
Q

What type of epithelium is find at the transformation zone of the cervix?

A

Squamo-columnar junction

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16
Q

How are cervix cells stained?

A

Stained by Papinicolaou method

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17
Q

What is dyskaryosis?

A

Abnormal cells showing the earliest signs of malignancy in its nucleus whilst retaining relatively normal cytoplasm

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18
Q

What are the nuclear features of dyskaryosis?

A
  • Increased size and nuclear:cytoplasmic ratio
  • Variation in size, shape and outline
  • Coarse irregular chromatin
  • Nucleoli
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19
Q

How is dyskaryosis graded?

A

Graded low or high grade dyskaryosis - reflects degree of underlying CIN

  • Low grade (+ borderline)
  • High grade
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20
Q

What do loilocytes reflect?

A

HPV infection

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21
Q

What does HPV test identify?

A

HPV infection (could be transient or CIN associated)

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22
Q

What does cytology identify?

A

Cellular changes

  • Low grade (persisting infection/CIN1)
  • High grade (CIN2/3)
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23
Q

What happens if a cervical smear is hrHPV is negative?

A

Routine recall in 5 years

24
Q

What happens if a cervical smear is hrHPV is positive?

A
  • Cytology normal; repeat test 1 year

- Dyskaryosis: refer to colposcopy

25
Q

What is colposcopy?

A

-Magnification and light to see cervix
-Exclude obvious malignancy
0Use of acetic acid =/- Iodene: to identify lesion limits, select biopsy site and define area to treat

26
Q

What are the options for management of dyskaryosis?

A
  • Punch biopsy to make a diagnosis and can return for Treatment if CIN2/3
  • Or “See and treat” at first visit
27
Q

What HPV related pathology can affect the transformation zone of the cervix?

A
  • HPV infection
  • Precancerous changes cervical intraepithelial neoplasia (CIN)
  • Cervical carcinoma
28
Q

How does HPV infection affect the transformation zone of the cervix?

A

-Infects basal layer cells
-Utilises host for replication
-As host cell matures,
different viral genes expressed

29
Q

What does the E7 protein product do?

A

Prevents cell cycle arrest

30
Q

What does the E6 protein product do?

A

Inhibits cell death

31
Q

What is koilocytosis?

A
  • Cells with wrinkled nucleus and perinuclear halo

- Multinucleation

32
Q

What are the low risk types of HPV?

A

6, 11, 42, 44, others

33
Q

What are the high risk types of HPV?

A

16, 18, 31, 45, others

34
Q

How do low risk types of HPV present?

A
  • Genital warts and low grade CIN

- Often transient and resolve

35
Q

How do high risk types of HPV present?

A
  • Persistent infection increases risk of developing

- High grade CIN and(more rarely) cancer

36
Q

How does HPV cause high grade CIN?

A

Persistent infection

  • Viral DNA integrates into host cell genome
  • Overexpression of viral E6 and E7 proteins
  • Deregulation of host cell cycle
37
Q

How does CIN present histologically?

A
  • Disorganised proliferation of abnormal cells in squamous epithelium (dysplasia)
  • Lack of maturation, variation in cellular size and shape, nuclear enlargement, irregularity, hyperchromasia, cellular disarray
38
Q

What is CIN a precursor of?

A

Invasive cancer

39
Q

How is CIN treated?

A
  • LLETZ
  • Thermal coagulation
  • Laser ablation
40
Q

Why is CIN followed up after treatment?

A

To confirm that treatment was effective
-Residual disease with in 2 years

To prevent invasive cancer

  • Recurrent disease 5% after 3-5 years
  • Detect occasional cancer
  • More at risk than the normal population

To reassure the woman

41
Q

How is CIN followed up after treatment?

A

Follow-up LBC at 6 months for cytology and high risk HPV

  • Both negative – return to recall
  • Either positive – return to colposcopy
42
Q

What is the incidence of cervical cancer?

A
  • 2500 cases per year in UK
  • 1200 deaths
  • 10th commonest cancer in women in Scotland
  • Good cure rate if detected early
  • BUT major cause of death in in women in developing countries
43
Q

What are the risk factors for cervical cancer?

A
  • Peak age 45-55 years
  • HPV relayed (16+18)
  • Multiple partners
  • Early age at first intercourse
  • Older age of partner
  • Cigarette smoking
44
Q

What are the symptoms of cervical cancer?

A
  • Abnormal vaginal bleeding
  • Post coital bleeding
  • Intermenstrual bleeding/PMB
  • Discharge
  • (Pain)
45
Q

How is cervical cancer diagnosed?

A
  • Clinical
  • Screen detected
  • Biopsy
46
Q

What is the histology of cervical cancer?

A

Tumour cells from epithelium invade into underlying stroma

  • Majority squamous carcinoma (80%)
  • Adenocarcinoma (endocervical) rising in relative incidence
47
Q

What is stage 1A cervical cancer?

A

Invasive cancer identified only microscopically

48
Q

What is stage 1B cervical cancer?

A

Clinical tumours confined to the cervix

49
Q

How can cervical cancer spread?

A

Local

  • Stage 2: Vagina (upper 2/3),
  • Stage 3: lower vagina, pelvis,
  • Stage 4 bladder, rectum

Metastases

  • Lymphatic: pelvic nodes
  • Blood: liver, lungs, bone
50
Q

How is cervical cancer staged?

A
  • EUA (especially rectal)
  • PET-CT
  • MRI
51
Q

How is stage 1a1 cervical cancer treated?

A

Stage 1a1:

-Type 3 Excision of the cervical TZ or hysterectomy

52
Q

What is a radical hysterectomy?

A

Removal of

  • Uterus, cervix, upper vagina
  • Parametria
  • Pelvic nodes

Ovaries conserved

53
Q

How is stage 1b-11a cervical cancer treated?

A

Stage 1b - 11a:

-Radical hysterectomy or chemo-radiotherapy

54
Q

How is 11b-1v cervical cancer treated?

A

Stage 11b - 1V:

-Chemo-Radiotherapy

55
Q

What treatments are available for cervical cancer?

A
  • Radiotherapy- External Beam x 20 fractions
  • Chemotherapy- 5 cycles of cisplatin
  • Caesium Insertion (24 hours)

Reproduction (34 decks)

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