Cervical Smear

Question 1

What is cervical intraepithelial neoplasia?

Answer 1

Presence of atypical (large nuclei, irregular) cells within squamous epithelium
CIN I (mild dysplasia) - found in lower third of epithelium
CIN II (moderate dysplasia) - lower 2/3rds
CIN III (severe dysplasia) - occur full thickness of the epithelium and is carcinoma in situ

Question 2

What is the epidemiology of CIN?

Answer 2

Peak incidence at 25-29 years

Mainly under 45

Question 3

What causes CIN?

Answer 3

HPV 16, 18, 31 and 33
OCP
Smoking
Immunocompromise

Question 4

What HPV types does the vaccination treat?

Answer 4

16

18

Question 5

How is cervical cancer screened for?

Answer 5

25-49 every 3 years
50-64 every 5 years
>65 only if haven’t had smear in a while or have had recent abnormal result

Identify cellular not histological abnormalities

Question 6

If a smear shows mild/borderline changes what happens?

Answer 6

Test for HPV

• if high risk type present then colposcopy
• if no high risk then return to routine recall

Question 7

If a smear shows moderate changes what happens?

Answer 7

Colposcopy

• if CIN I then 6 month smear
• if CIN II or III transformation zone is excised via diathermy

Question 8

If a smear shows severe changes what happens?

Answer 8

Urgent colposcopy

Question 9

If a smear shows cervical glandular intraepithelial neoplasia what happens?

Answer 9

Colposcopy

- if normal then hysteroscopy