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Cellular Science > Cervical Cytology > Flashcards

Cervical Cytology Flashcards

1
Q

What are the criteria for the introduction of screening programmes

A
  • the condition should be an important health problem - the natural history should be known
  • the test should be simple safe and acceptable with known cutoff point for test values
  • the treatment should be effective, leading to better outcomes with evidence based policies on who should receive treatment
  • the screening programme should be known to be effective in reducing mortality or morbidity
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2
Q

What is the aetiology of cervical cancer?

A
  • Rare outcome of STI
  • Linked to Human Papilloma Virus (low risk types 6&11, high risk types 16&18)
  • HPV DNA can be found in all invasive cervical cancer specimens
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3
Q

What are some risk factors of cervical cancer

A
  • persistent infection with HPV or STI
  • sexual activity from young age
  • women with kate pregnancies or >5 full term pregnancies
  • condoms only offer limited protection
    Smoking decreases number of lanerghans cells in the cervix reducing ability to process virus
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4
Q

What stages happen in between normal and the cancer stage in the cervix

A

Low grade squamous intraepithelial lesion —> high grade squamous intraepithelial lesion

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5
Q

Describe the human papilloma virus

A

Non-enveloped
DsDNA
Circular genome (approx 8kb pairs)
Most encode 8 major proteins

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6
Q

How long is the average incubation period

A

3 weeks to a year

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7
Q

Can HPV infection be latent or assymptimatic

A

Yes, possibly years before appearance of genital warts or abnormalities
Some will be transient and may never be detected

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8
Q

What proteins from HPV play a massive role in immortality and malignant transformation of infected cells

A

E6&E7

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9
Q

Characteristics of low risk HPV 6 & 11

A

Lead to benign cervical changes and genital warts

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10
Q

Characteristics of high risk HPV types 16 & 18

A

Precancerous cervical changes
Cervical cancer
Anal and other cancers

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11
Q

True or false: most women are infected at some time

A

True

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12
Q

True or false: the immune system usually clears a HVP infection

A

True, usually, not always

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13
Q

What is the pathology of persistent HPV infection

A

Leads to loss of maturation of cervical epithelium (disrupts normal cell cycle)
Keratinocyte differentiation retarded

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14
Q

What are the first stages of the triage pathway

A

See if the pt. displays borderline/low grade dyskaryosis then do a HR-HPV test

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15
Q

What is the next move if the HR-HPV test is negative

A

Pt. returned to routine recall because it’s likely the cause of problem is non-high-risk HPV infection or not a clinically significant amount of HPV

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16
Q

What are some benefits of a triage

A

Reduces need for multiple repeat tests, women see colposcopy sooner

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17
Q

What’s the next move if the HR-HPV test is positive

A

Women referred to colposcopy

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18
Q

What is a test of cure

A

Used to assess the risk of women who test negative at follow up are at very low risk of Cervical Intraepithelial Neoplasia having residual of recurrent disease

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19
Q

What is standard protocol after CIN 3 detected in colposcopy

A

Annual follow up cytology for 10 years —> returned to routine recall

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20
Q

Where are cervical cytology samples taken from?

A

The transformation zone

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21
Q

What is the transformation zone

A

The zone between the new and old squamo-columnar junction

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22
Q

A method acquiring a cervical sample

A

Using a brush then transfer the sample to alcohol

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23
Q

True or false: mild dyskaryosis is heavily linked to HPV positive

A

True: the initial pilot study for HOV triage showed 83% showing dyskaryosis were HOV positive

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24
Q

Name a benefit of test if cure for cervical screening

A

Allows majority of women to be r freed back to routine recall directly

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25
Q

How does HPV attack

A

Micro trauma to squamous epithelial of transformation zone allows HPV to attach tit he nasal cells. The genome is then release into the cell remaining as an extra-chromosomal element until cEll reaches surface

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26
Q

What happens after a cell is infected with the HPV genome

A

The extra-chromosomal elements are packaged into virions that are lost from the surface during desquamation

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27
Q

What happens in the non latent case of HOV infection

A

Genome is incorporated, increased expression of viral protein E6 and E7 that interacted with cellular proteins to induce proliferation, eventually immortalisation and neoplastic transformation of HPV infected cells

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28
Q

Describe the epithelial of the cervix

A

Lined in 1 cell thick columnar glandular epithelial layer then the vagina lines in squamous cells, where they meet is the squamo-columnar junction

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29
Q

What area of the cervix is the most susceptible to abnormalities

A

Transformation zone

30
Q

Why is the transformation zone particularly vulnerable

A

Because the changes in hormones make the cervix swell and expose the T zone to the vaginal are making it open to infection

31
Q

What are the two methods of cervical sample preparation

A

Thinprep and surepath (BD)

32
Q

Describe the characteristics if the thin prep sample method

A

Methanol based
Filtration method
Ubstained sample

33
Q

Describe characteristics of Surepath cervical sampling method

A

Ethanol based preservative
Density gradient and sedimentation
Stained slide produced by automation

34
Q

True or false: cervical screenings aim to look for cancer

A

False: they aim to prevent it

35
Q

What cells does squamous epithelium consist of

A

From surface to base: superficial cells, intermediate cEll’s, parabasal cells, basal cells

36
Q

Explain what screening sample adequacy is

A

Does the sample have an adequate number of visible squamous cells for screwing - >4500

37
Q

How long do you need to leave it in between samples from a patient

A

3 months

38
Q

Can the appearance of cells be affected by hormones

A

Yes

39
Q

What are some features of dyskaryosis

A

High nuclear to cytoplasm ratio
Hyperchromasia (darker nuclei)
Chromatic irregularity
Irregularity in form and outline of nuclear membrane

40
Q

Where in the endometrium does CIN 1 affect

A

Infected cells occupy lower third of basal cells

41
Q

Where in the endometrium does CIN 2 affect

A

Lower TWO thirds of basal cells

42
Q

Where in the endometrium does CIN 3 affect

A

Majority of basaloid cells —> carcinoma

43
Q

What are the typical nuclear to cytoplasmic ratio reference values for low-grade dyskaryosis

A

Ratio<50%

44
Q

What are the typical nuclear to cytoplasmic ratio reference values for high-grade (moderate) dyskaryosis

A

50

45
Q

What are the typical nuclear to cytoplasmic ratio reference values for high-grade (sever) dyskaryosis

A

Ratio>75%

46
Q

What are some changes to cells due to HPV

A
  • Minor nuclear abnormality
  • dyskeratosis (abnormal keratinisation)
  • parakeratosis (normal keratinisation in abnormal places)
  • koilocytosis - red cells with abnormal nuclei and hard edged clear spaces surrounding the nuclei pathognamonic If HPV infection
47
Q

Why do you have to look at nuclei features to confirm its dyskaryosis

A

Because it has lookalikes such as atrophy

48
Q

Describe the appearance (cytology) of invasive squamous carcinoma cells

A

High grade dyskaryosis

Loose cluster of pale (cytoplasm) cells with enlarged nuclei (dark), coarse chromatin and a thickened nuclear membrane

49
Q

What is colposcopy

A

The microscopic examination is the cervix with the use of stains to see cells in the TZ

50
Q

What are the procedures of a colposcopy

A

Examine cervix, wipe off mucus, apply 5% acetic acid for 2 mins, aptly green filter and aqueous iodine.
Biopsy if necessary

51
Q

What are the chances of regression for CIN 1

A

Most likely will regress

52
Q

What are the chances of regression for CIN 2

A

50%

53
Q

What are the chances of regression for CIN 3

A

0%, needs treatment

54
Q

Name a couple treatments for premalignancy of cervical cells

A

Loop excision - extract bad cells with a loop tool

Cryotherapy - gun like tool that freezes (kills) malignant cells

55
Q

What are the symptoms of cervical malignancy

A

Vaginal bleeding at any time other than period
vaginal discharge with unpleasant smell
Discomfort or pain during sex

56
Q

Where is cervical cancer at stage 1/4

A

Just in neck of the womb

57
Q

Where is cervical cancer at stage 2/4

A

Begun to spread outside neck of womb into surrounding tissues

58
Q

Where is cervical cancer at stage 3/4

A

Spread away from cervix and into surrounding structures in pelvic area

59
Q

Where is cervical cancer at stage 4/4

A

Advanced cancer. Spread to other body organs outside cervix and womb

60
Q

How do you treat stage 1 cervical cancer

A

Cone biopsy

61
Q

How do you treat stage 2+ cervical cancer

A

Hysterectomy

62
Q

What are some limitations of screening

A

Not 100% effective, false negative rate up to 40%, sampling and screening errors.
However HPV triage and test of cure have improved detection significantly

63
Q

Who must the HPV screening program be offered to

A

All girls up to 18 years old

64
Q

What product is now used as the vaccination against cervical cancer (HPV infection)

A

Gardasil A’s protects against HPV 6 and 11 and genital warts aswell

65
Q

True or false: Boys have to have HPV vaccinations too

A

True: as of September 2019 all boys aged 12-13 because it’s connected to anal Carcinoma too

66
Q

How effective is Gardasil

A

Clinical trials show 100% effective at PREVENTING infection of 6,11,16&18 ONLY

67
Q

How is the HPV vaccination administered

A

2 injections within 6-24 months of each other

68
Q

What is a benefit of HR-HPV over Cytology

A

More sensitive

69
Q

What is a benefit of Cytology over HR-HPV

A

Gives less false positives

70
Q

What is an argument for the extending of screening intervals

A

HrHPV and Cytology decreases CIN 3 or worse and cervical cancer by 40 and 30% as opposed to cytology. Low incidence OF CIN3 or worse 3 years after screening supports the extension of interval time

71
Q

How many sentinel sites are there for HOV screening

A

6

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