Chapter 22: Cervical Screening And Cervical/Vulval Cancer Flashcards
You are a trainee intern in general practice with Saskia, an asymptomatic 26 year old nulliparous NZ European woman. Saskia had a routine cervical screening test taken last week and has been told that the result is “not absolutely normal”. The smear is reported as “ASCUS” and she asks you what this means. From the following options, which is the MOST APPROPRIATE response to explain ASC-US?
Some cells in the basal third of the epithelium of the cervix are atypical. There is a moderate risk of her developing cervical cancer in the next few years.
Some cells in the cervix are showing enlarged nuclei and increased division. There is a moderate risk of her developing cervical cancer in the next few years.
ASCUS stands for abnormal squamous cells of undetermined significance. These are unlikely to be precancerous. A follow up smear in 12 months is recommended.
Some of the cells covering the cervix show increased mitotic activity. There is a moderate risk of her developing cervical cancer in the next few years.
There are atypical cells in the squamous epithelium of the cervix that have a moderate risk of malignant progression
ASCUS stands for abnormal squamous cells of undetermined significance. These are unlikely to be precancerous. A follow up smear in 12 months is recommended.
You are a trainee intern in general practice with Maeve, a 26 year old nulliparous Pākehā woman. Maeve has been advised that a routine cervical screening test taken the previous week was reported as showing a low-grade squamous intraepithelial lesion LSIL (CIN 1). Maeve asks you what would have happened if she hadn’t had her smear taken. From the following options, what is the MOST APPROPRIATE response to her about the natural history of CIN1?
The abnormal cells become more active in about 30% of women, with progression to a more advanced precancer - but rarely cancer. You will probably need a LLETZ treatment.
This smear result is due to infection with a HPV virus, and always resolves as your immune system gets rid of the virus within around 6-12 months.
The abnormality nearly always progresses to a high-grade squamous intraepithelial Neoplasia (HSIL, or CIN2/3), meaning that you are likely to need treatment.
The smear result likely indicates infection with the HPV virus without significant precancerous changes, and these appearances will most likely resolve as your immune system gets rid of the virus
The smear has shown low-grade abnormal cells which often become more severe, with about 25% progressing to invasive cervical cancer. You should be referred to colposcopy.
The smear result likely indicates infection with the HPV virus without significant precancerous changes, and these appearances will most likely resolve as your immune system gets rid of the virus
You are a trainee intern in general practice with Awhina, a 42 year old para 3 Māori woman whose recent smear has shown HSIL (CIN2/3). Her husband had a vasectomy seven years ago. Her children are aged 14, 12 and 7. All of her previous smears have been normal. Of the following, which is the MOST IMPORTANT predisposing factor to Awhina developing HSIL?
She had chlamydia aged 25
She has used the oral contraceptive pill
She has HPV-16
She smokes 10-20 cigarettes per day
She first had sex when aged 21
She has had two sexual partners
She has HPV-16
You are a trainee intern in general practice with Jess, a 43 year old para 3 Pākehā woman whose recent smear showed LSIL (CIN 1). Because of her age, high-risk HPV testing was also done. This was positive, so Jess was referred for a colposcopy. Jess’ husband had a vasectomy seven years ago. Her three daughters are aged 14, 12 and 7. All her previous cervical screening tests have been normal and her last smear was five years ago. She has had warts on her hands during her last pregnancy but these went away by themselves. Jess asks whether there is anything she has done that has contributed to her developing a cervical abnormality. Of the following options, which would be the MOST IMPORTANT risk factor for Jess?
Jess has used the oral contraceptive pill
Jess smokes cigarettes
Her husband has penile warts
Jess has had previous termination of pregnancy
Jess has had chlamydia which was treated
Jess smokes cigarettes
Penile warts - 6 and 11 - very low risk for HPV
You are a trainee intern in general practice with Jess, a 43 year old para 3 Pākehā woman whose recent smear showed LSIL (CIN 1). Because of her age, high-risk HPV testing was also done. This was positive, so Jess was referred for a colposcopy. Jess’ husband had a vasectomy seven years ago. Her three daughters are aged 14, 12 and 7. All her previous cervical screening tests have been normal and her last smear was five years ago. She has had warts on her hands during her last pregnancy but these went away by themselves. Jess asks whether there is anything she has done that has contributed to her developing a cervical abnormality. Of the following options, which would be the MOST IMPORTANT risk factor for Jess?
Jess has used the oral contraceptive pill
Jess smokes cigarettes
Her husband has penile warts
Jess has had previous termination of pregnancy
Jess has had chlamydia which was treated
Jess smokes cigarettes
Penile warts - 6 and 11 - very low risk for HPV
You are a trainee intern in general practice with Hannah, a 25 year old nulliparous Pākehā woman who presents to discuss contraception. She is currently using condoms. Hannah has not previously had a cervical screening test, so you advise her to have one and to join the National Cervical Screening Programme (NCSP) register. You provide some additional information. Of the following options, which statement about cervical screening in the NCSP is TRUE?
To register with the NCSP, Hannah needs to complete in writing an enrolment form
There is only a small initial cost to join the register
Only doctors who are specially trained can take the cervical screening samples
If Hannah enrols, the NCSP will inform Hannah when her next cervical screen is overdue
The NCSP informs enrolled women only if their result is abnormal
If Hannah enrols, the NCSP will inform Hannah when her next cervical screen is overdue
You are a trainee intern in a gynaecology clinic with Fergie, a 34 year old para 3 NZ European woman who has been referred for colposcopy because her smear showed HSIL (probable CIN 2/3). Fergie was asymptomatic and had not previously had an abnormal smear. Of the following options, where are you MOST LIKELY to see the cervical abnormality in a woman with HSIL?
On the anterior lip of the cervix
On the posterior lip of the cervix
In the vaginal fornices
In the transformation zone of the cervix
In the endocervical canal
In the transformation zone of the cervix
You are a trainee intern in general practice with Dawn, a 34 year old para 3 Samoan woman who has presented with an episode of postcoital bleeding. Dawn has never had an abnormal smear. Her last smear was two years ago. Dawn is on the oral contraceptive pill. General and abdominal examination is unremarkable. From the following options, what is MOST IMPORTANT aspect of the speculum examination?
Take swabs for an STI
Take a swab for bacterial vaginosis
Carefully examine the cervix and vaginal sidewalls
Show the speculum to the woman before insertion
Take an HPV test
Carefully examine the cervix and vaginal sidewalls
You are a trainee intern in general practice reviewing the result of a routine cervical screening test you recently took on Rena, a 34-year-old British woman. Rena had previously had a normal cervical screening history. The test is reported as showing “Atypical squamous cells of uncertain significance (ASC-US). Routine high-risk HPV (HrHPV) testing will be reported separately.” From the following options, what is the most important impact the result of the HrHPV test will have on Rena’s management?
If the HPV test is positive, Rena should be referred to colposcopy
If the HPV test is positive, Rena will need STI testing
If the HPV test is positive, Rena will need a cone biopsy
If the HPV test is negative, the interval to the next smear test is the routine three years
If the HPV test is positive, Rena must have genital warts
If the HPV test is positive, Rena should be referred to colposcopy
You are a trainee intern in general practice reviewing Bernie, a 33 year old nulliparous Pākehā woman who recently had a routine cervical smear. The report reads: “Low grade squamous intraepithelial lesion (LSIL). High-risk HPV detected.” Bernie’s previous history was of regular and normal smears. She uses a 30 ug ethinyl oestradiol combined oral contraceptive pill. She has genital warts. From the following options, what is the MOST APPROPRIATE management?
Refer Bernie for colposcopy now based on the LSIL, HrHPV positive result
Advise Bernie to stop the oral contraceptive, and repeat the cytology test in 12 months.
Refer Bernie for cryotherapy treatment of genital warts and repeat the cytology in 6 months
Recommend HPV immunisation with the nonavalent vaccine, “Gardasil-9”
Repeat the cytology test in 6 months, and refer to colposcopy if the result is still LSIL.
Refer Bernie for colposcopy now based on the LSIL, HrHPV positive result
You are a trainee intern at a colposcopy clinic reviewing Joy, a 38-year-old para 3 New Zealander of Chinese ethnicity. Joy had a colposcopy a week ago colposcopy following a LSIL, HrHPV positive screening test. The colposcopy identified an area of acetowhite change and a biopsy of this area was taken. The histology of this cervical biopsy has been reported as showing high-grade change involving the full thickness of the cervical epithelium, but not breaching the basement membrane. Which of the following is the most likely DIAGNOSIS on the histopathology report?
HPV
CIN 3 / HGSIL
Cervicitis
Microinvasion
CIN 1 / LGSIL
CIN 3 / HGSIL
You are a trainee intern in a colposcopy clinic seeing Nora, a 35 year old asymptomatic para 3 Māori woman for treatment of biopsy proven CIN3. Nora has completed her family. When the colposcopy was done the area of the lesion was small and the lesion was able to be completely visualised. There was no evidence of a glandular lesion in the cervical canal. Of the following options, what is the MOST APPROPRIATE treatment?
LLETZ (Large loop excision of the transformation zone)
Cone biopsy
Further biopsy
Cryotherapy
Hysterectomy
LLETZ
Cone biopsy is more extreme
You are a trainee intern in general practice reviewing the notes of Larni, a 36 year old para 3 Pasifika woman who had a routine cervical screening test with you last week The smear results has returned as HSIL (probable CIN 2/3). Of the following factors in her history, which would MOST LIKELY have predisposed her to having this abnormality?
Diethylstilboestrol exposure in utero
First pregnancy at age 16
Past history of two premature births
Smoking
A cervical infection with HPV-16
A cervical infection with HPV-16
You are a trainee intern attending a gynae oncology multidisciplinary team meeting (MDT). Naomi, a 51 year old Niuean woman, is being discussed. She had been seen urgently last week in the colposcopy clinic after her GP noted a 2 cm fungating mass on the posterior cervical lip, which bled profusely when a smear was taken. The cervical screening test had been reported as abnormal with a high grade cervical squamous intraepithelial lesion (HSIL). A biopsy taken last week has confirmed squamous cell carcinoma. Radiological investigations have shown that the lesion is restricted to the cervix and there is no evidence of metastasis. From the following options, what is the MOST LIKELY treatment for Naomi?
Total hysterectomy and bilateral salpingo-oophorectomy
Radiation therapy (brachytherapy)
Chemotherapy
LLETZ biopsy under general anaesthesia
Radical hysterectomy and pelvic lymph node dissection
Cone biopsy under general anaesthesia
Radical hysterectomy and pelvic lymph node dissection
You are a trainee intern in a gynaecology clinic seeing Jane, a 30 year old asymptomatic nulliparous Fijian Indian woman who required a cone biopsy for AIS – adenocarcinoma in situ. Histology confirmed the excised lesion as AIS, and this was completely excised. Jane is now planning a pregnancy. From the following options, what is the most important pregnancy complication of Jane’s cervical abnormality and treatment?
Premature delivery or preterm prelabour rupture of membranes
Cervical tear causing primary postpartum haemorrhage after vaginal delivery
Recurrence of the AIS lesion during her pregnancy
An antepartum haemorrhage related to residual or recurrent AIS
Failure of the cervix to dilate in labour, requiring delivery by caesarean section (cervical stenosis)
Premature delivery or preterm prelabour rupture of membranes
