Cytopathology

Question 1

Describe the cervical screening programme

Answer 1

• Women screened from ages 25 to 65
• From age 25: every 3 years
• From age 50: every 5 years

Sample sent and checked for dyskaryosis

Question 2

Describe CIN

Answer 2

Cervical intraepithelial neoplasia can be graded as 1, 2 or 3, with 3 being the most severe, and a step below cancer.

Question 3

What is CGIN

Answer 3

Cervical glandular intraepithelial neoplasia, the neoplasia that is a precursor of adenocarcinoma of the cervix

Question 4

How are results of the cervical screening triaged?

Answer 4

Low or borderline: test for high risk HPV

• HR-HPV +ve: colposcopy
• HR-HPV -ve: routine smear

Moderate or severe

• Refer for colposcopy
• May need to be within 2 weeks

Question 5

What are the low risk HPV types?

Answer 5

6 and 11, can cause genital ulcers

Question 6

What are the high risk HPV types?

Answer 6

16 and 18, responsible for over 70 percent of cervical cancers

Question 7

What is the HPV vaccine?

Answer 7

Protects against 6, 11, 16 and 18. Given to 12-13 year old girls from 2008, will now be rolled out to boys.

Question 8

Describe exfoliated methods of cytology

Answer 8

Taken from cells

• Bronchial brushing
• Pleural fluid
• Pleuritic fluid
• Urine

Question 9

Describe FNA

Answer 9

Fine needle aspiration

• Needle moved around cyst to sample whole area
• Commonly used in breast, thyroid, H&N, pancreas, lung
• Can be done by hand, by radiological guidance (US/CT) or endoscopically

Question 10

What are the applications of FNA?

Answer 10

• Primary diagnosis
• Staging
• Post adjuvant therapy
• Recurrence
• Morphological diagnosis
• Mutation analysis

Question 11

What are the side effects of FNA

Answer 11

• Mostly none
• Bruising
• Fainting
• Can get pneumothorax if done by lung
• Ischaemia of damage to vessel

Question 12

What are the advantages of FNA?

Answer 12

• Safe
• Quick
• Accurate
• Acceptable
• Can set up fast access clinics

Question 13

Name some common mutations associated with lung, breast, melanoma and colon cancer

Answer 13

Lung: EGFR, ALK 1
Breast: BRCA1/2, CERB-B2
Melanoma: BRAF
Colon: APC, K-RAS

Question 14

How long does an HPV infection take to clear? what can impact this?

Answer 14

Usually can be cleared within 2 years. Smoking can delay this or impact immune system to mean HPV cannot be cleared