Obs and Gynae Yr 4 A - Cervical Screening - 2020 CHanges to Screening Flashcards
What is a smear test?
A smear test is a test which analyses the cells from the cervix (neck of the womb) - it is not a test for cancer but a test looking for abnormal cells
Who is a smear test offered to?
Smear tests are offered to woman aged 25 to 64
- Women aged 25 to 49 should be offered a test every 3 years
- Women aged 50 to 64 should be offered a test every 5 years
- Women aged 65 and over should only be offered a test if one of their last 3 smears was abnormal
Does the smear test analyse cytology or histology?
What is looked for in the smear test?
Smear tests look for high risk HPV then may be sent away for cytology analysis - the analysis of the cells rather than histology which requires a biopsy to analyse tissue
Smears can be graded normal, borderline, mild, moderate and severe - depending on the level of dyskaryotic cells
As of 2020 Smears will change
HPV primary screening is a way of testing the sample of cells taken during cervical screening. A lab tests your sample for a virus called high-risk HPV
Woman will still be offered smears from the age of 25
- What will happen to the smear tests from here?
The smears will be sent for HPV testing as the primary screening test
- If the smears are negative for high risk HPV (Hr-HPV), then they will be invited for their next routine cervical screening appointment in 3 or 5 years’ time
- If the smears are positive for Hr-HPV, Cytology-based tests will be used in a woman’s sample.
What happens if
- High risk HPV test negative on smear?
- High risk HPV test positive and cytology negative?
- High risk HPV test positive and cytology positive for dyskaryotic cells?
- High risk HPV test negative- invited for next cervical screening appointment in 3 or 5 years (age dependent)
- High risk HPV test positive and cytology negative - attend annual screening appointments
- High risk HPV test positive and cytology positive for dyskaryotic cells- referred to colposcopy if any degree of abnormality on cytology
High risk HPV test positive and cytology negative - attend annual screening appointments
What happens if the patient keeps testing positive for high risk HPV hower cytology shows no abnormal cells?
HPV found (HPV positive) but no abnormal cells
- You’ll be invited for screening in 1 year and again in 2 years if you still have HPV.
- If you still have HPV after 3 years, you may need to have a colposcopy.
What is a dyskaryotic cell?
Dyskaryosis refers to the abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin and an increase in the nuclear to cytoplasm ratio
Dyskaryosis - the is an abnormality of nuclei seen in exfoliated cells, often from the uterine cervix, in which the cytoplasm remains unchanged but the nuclei exhibit hyperchromatism, irregularity or an increase in number
Dyskaryosis is on cytology - smears are sent for cytology where the cells are examined
Koilocyte is on histology -microscopic features of tissues
Colpsocpy analyses the histology of the cervical tissue (the architecture)
What is carried out in colposcopy?
The cervix is examined macroscopically using a speculum to widen the vagina nad visualise the cervix
Stains are then applied to the cervix and depending on the colour of the stain, a biopsy may be taken - usually a punch biopsy if not aiming for treatment
Which stains are applied in colposcopy and why?
Acetic acid is the initial stain - this dehydrates the cell and appears white if abnormal cells are present (aceto-white)
To confirm the result, Lugol’s iodine is applied to the cervix - normal cells uptake iodine and stain brown, abnormal cells will not uptake - confirming the aceto-white result
If the abnormal stainig is found a punch biopsy of the cervix will be taken to histologically analyses the cells
What do the different gradings of the colposcopy biopsy mean?
- CIN 1
- CIN 2
- CIN 3
- Invasion through the basement membrane?
- CIN I - 1/3rd of the epithelium has dsykaryotic cells
- CIN II - 2/3rds
- CIN III - full thickness dykarysosis
- Invasion through basement membrane - cervical malignancy
Can see the enlarged nuclei easily
The two treatment options for the colposcopy results are usually
- LLETZ (Large loop excision of the transformation zone) or
- Cold coagulation aka thermocoagulation aka thermoablation
Which is used when and why?
CIN I - 80% will resolve with expected management so not treated
CIN II and III are treated
- LLETZ - weakens the cervix due to a loop of the musuclar tissue being excised and therefore usually used in woman after menopause
- Cold coagulation - used mostly in woman of child bearing age in Tayside
Follow up is required
- To identify treatment failures
- To identify patients with recurrence early
- While not causing significant anxiety to those who are not at risk
What is the test of cure aka follow up after treatment in woman who have been treated for CIN?
6 months after treatment - Cytology (smear) and HPV tests are carried out on the cervix
- Double negative result - resume 3 or 5 yearly smears
- Positive for either or both - refer for colposcopy
It is important not to worry patients with a dyskaryotic smear
What are some points that should be considered?
(ie discussing if smear is cancer or not, what is going to be done next)
What is the majority cause of cervical cancers? (state which types and what percentage they cause)
What impairs the clearance of this virus?
HPV 16 and 18 cause 70% of cervical cancers with approx 12 other types cause almost the entire remaining 30% of cervical cancers
Smoking impairs the clearance of the human papilloma virus
What other cancers is the HPV virus linked to - specifically the high risk (oncogenic) types?
High risk (oncogenic) types - 16,18 and about 12 others
Linked to 50% of cases of vulval, throat and penile cancers
