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Flashcards in Cervical CA screening Deck (38):
1

________ is the fourth most common cause
of cancer death in women worldwide, especially in
developing countries.

Cervical cancer

2

It is the most common cancer
in women in Eastern and Middle Africa, and the _______
most common in Australian women

12 th

3

Australia has
the second lowest incidence of cervical cancer in
the world as a result of the success of the _______

National
Cervical Screening Program introduced in 1991

4

The most common cervical cancer is ________ accounting for 80% of cases

squamous
cell carcinoma (SCC),

5

________ is less common and more difficult
to diagnose because it starts higher in the cervix.

Adenocarcinoma

6

Cervical cancer almost exclusively occurs in women
who have been sexually active, due to exposure to
_________

human papillomavirus (HPV).

7

Of the genital HPV types, 15 are
classified as ‘high risk’, as they are associated
with _________

anogenital cancer (including squamous and
adenocarcinoma of the cervix).

8

HPV _________ are responsible for around 70% of invasive cervical cancers and 50% of high-grade lesions

16 and 18

9

Most cervical HPV infections are cleared or suppressed by __________

cell-mediated
immunity within 1–2 years of exposure.

10

The focus of attention is the__________ where columnar cells lining the endocervical
canal undergo metaplasia to squamous cells in
the region of the squamocolumnar junction.

transformation zone

11

It is important clinically to realise that this transformation
zone can extend with progressive metaplasia of
columnar epithelium and so the squamocolumnar
junction may recede into the ________

endocervical canal

12

________ represent an acute HPV infection of the transformation zone.

Low-grade squamous intraepithelial lesions (LSILs)

13

T or F

HSILs may return to normal, persist or eventually
progress to invasive cervical cancer

T

14

The average duration between HSILs and cancer is between _________

10 and 15 years.

15

Current cervical screening uses ________

cytology from the
Papanicolaou smear, or Pap test, as the screening
tool

16

Cervical CA screening

• Commence cervical screening at _________after first sexual intercourse, whichever is later

• Perform every 2 years and cease at ______ in
those who have had two normal Pap tests within
the last 5 years

18–20 years or 2 years



70 years

17

Screen women over 70 years if _______

they request it or
if they have never had a Pap test

18

Women with postcoital or persistent
intermenstrual bleeding require a ______

diagnostic Pap
test and referral for colposcopy irrespective of
the resul

19

Screening in particular groups

Hysterectomy . Cervical screening is still required if
__________

the cervix was not completely removed.

20

vaginal vault Pap tests are indicated if there is a
1
2
3

1. history of gynaecological dysplasia or malignancy, or
2. exposure to diethylstilboestrol in utero, as well as in
3. immunosuppressed women.

21

Screening in particular groups

Pregnancy. If due, cervical screening is still
recommended and can be safely performed until
________

24 weeks gestation

22

T or F

Pap tests have been associated
with an increased rate of miscarriage in the first and
second trimesters

False

have not

23

Postmenopausal women. If not taking hormone
replacement therapy, postmenopausal women may benefit from a _______

short course of topical vaginal oestrogen
before their Pap test

24

Special attention should be focused on screening the
following women:

• _________
(mortality of cervical cancer five times that of
other women in Australia)
• Women from _______
• Women in______
• Lesbian and bisexual women
• Women with disabilities

Aboriginal and Torres Strait Islander women


non-English-speaking backgrounds


rural and remote areas

25

What are the smear taking instruments

— Ayer’s spatula, wooden or plastic
— Cervex sampler broom
— Cervex-Brush Combi
— endocervical brush

26

pregnancy—avoid use of the ____ and ____

endocervical brush and the Cervex-Brush Combi

27

The __________provides better exposure
of the vulva but requires more manipulation of
the patient.

Sims exaggerated left lateral
position

28

cervix is situated in the _______

upper sixth of the anterior vaginal
wall (not in the apex of the vagina).

29

A__________ is normal in most premenopausal women and was formerly incorrectly called an erosion.

cervical ectropion

30

A woman treated for HSIL should have a ______

colposcopy
and cervical cytology at 4–6 months after treatment

31

three-dose schedule of the quadrivalent HPV vaccine
that protects against:

HPV types 16 and 18 (high risk for cervical cancer) and types 6 and 11 (which cause genital warts).

32

Currently, the HPV vaccine (Gardasil®)
is administered through the National Immunisation
Program to __________

males and females aged 12–13 years

33

Women who have been immunised still require
cervical screening because ________

the vaccine does not
prevent all HPV types that cause cervical cancer

34

Negative smear—no endocervical cells_______
Negative smear—inflammatory cells ______
Unsatisfactory smear________

Repeat in 2 years.
Repeat test in 2 years.
Repeat smear in 6–12 weeks (allows regeneration of cells).

35

Low-grade epithelial lesion

Possible LSIL and definite LSIL

Repeat Pap test at 12 months. If the woman is 30+ years,
and has no negative cytology in previous 2–3 years, refer for colposcopy or repeat the test in 6 months

36

High-grade epithelial lesion

Possible HSIL and definite HSIL______

Glandular abnormalities including adenocarcinoma in situ ____________
Invasive squamous cell carcinoma or adenocarcinoma ___________
Inconclusive—raising possibility of high-grade disease ____________

Refer for colposcopy.

Refer to a gynaecologist.


Refer to appropriate specialist gynaecologist or unit.


Refer for colposcopy and possible biopsy

37

Pending policy approval, in 2017 it is anticipated
that the cervical cancer screening test will transition
from the 2-yearly Pap test to ________

5-yearly HPV DNA
testing

38

prior to HPV vaccination,
the role of HPV DNA testing was limited as a
screening tool because ________

as many of 25% of women aged <30 were likely to test positive for oncogenic viruses.