Cervical cancer screening (Complete) Flashcards
(33 cards)
What is the main aim of cervical screening?
To detect pre-malignant changes rather than to detect cancer
Who is eligible for cervical screening?
Woman and people with a cervix between the age of 25-64 years.
How frequent is cervical screening?
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
Which type of woman are exempt from cervical screening?
Pregnant woman: Delayed until 3 months-post partum and only done if previous abnormal findings/missed screenings
Woman who have never been sexually active (Can opt out due to very low risk of cervical cancer)
When is the optimal time to take a cervical smear?
Mid-cycle
N.B. NHS reccomends this but limited evidence to prove this
What is tested for after cervical sample is taken?
High-risk HPV viruses
N.B. (The NHS has now moved to an HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.)
If a person is found to be HPV negative, what is the next step of action?
Return to normal recall
If a person is found to be HPV positive what further tests are conducted?
Cytological examination
(Asseses for signs of dyskaryosis/ dysplasia)
What is the normal histology of the cervix?
Outer cervix: Squamous epithelial cells
The squamocolumnar junction (SCJ)/ Transformation zone: Where columnar epithelial undergoe squamous metaplasia
Inner cervix: Columnar glandular epithelial cells
Which region of the cervix is most susceptible to development of cancer?
Transformation zone (TZ)
Due to high rates of cell turnover
What is dyskariosis?
Change in appearance of cervical cells
Change in cervical appearance of cells is known as?
Dyskaryosis
(AKA Dysplasia)
Cervical Dyplasia/dyskaryosis is also known as?
Cervical intraepithelial neoplasia (CIN)
What are the types of abnormal cytological findings that can be detected from cervical screening? (6)
Borderline
Mild dyskaryosis
Moderate dyskaryosis
Severe dyskaryosis
Invasive squamous cell carcinoma
Glandular neoplasia
If abnormal cytological findings are found, what are the next steps for the patient?
Colposcopy
If no abnormal findings found on cytological testing, what are next steps for patient?
Because they are HPV positive, they would have to get a repeat screen after 12 months.
If still positive, repeat again in a years time (at 24 months)
If still positive at 24 months refer for colposcopy
If a patient had positive findings for HPV during 24 month follow-up screening, what is the next action to be taken?
Refer for colposcopy
What should be done for patients who have inadequate samples during a cervical screen?
Repeat test in 3 months
If this happens again then refer for colposcopy
How is CIN staged?
CIN1: 1/3rd thickeness of surface layer of cervix is affected
CIN2 — 2/3rds of the thickness of the surface layer of the cervix is affected.
CIN3: Full thickness of the surface layer is affected.
CIN 1 is also known as?
Low-grade squamous intraepithelial lesions
60-90% revert to normal after 10-23 months
How is low-grade (CIN 1) cases managed?
Conservative management with repeat cytology in 6 months
50-60% spontaneously regress within 2 years
CIN 3 is also known as? (2)
High-grade or severe dysplasia
Stage 0 cervical carcinoma in situ
30% progress to cervical carcinoma if left untreated within the next 10 years
What is the management plan for patients with high-grade CIN?
Invasive/Surgical:
Large loop excision of transformation zone (LLETZ)
Follow-up:
Test of cure (TOC) repeat cervical sample in the community after 6 months
What should be done if patient with TOC following LLETZ is HPV positive with no abnormal cytological findings?
Colposcopy
