Cervical Screening and Colposcopy

Question 1

how common is cervical cancer

Answer 1

12th most common in scottish women
most common cancer in women under 35
276 new cases and 80 deaths in 2018

Question 2

what ages does cervical cancer affect most

Answer 2

30-45

Question 3

is cervical cancer more common in most or least deprived

Answer 3

most deprived

Question 4

what are the points needed in order to make a screening programme feasible

Answer 4

Important health problem?
Treatment available?
Recognizable latent or early symptomatic phase?
Suitable screening test available?
Natural history of condition understood?
Cost effective?

Question 5

what are the advantages of screening programmes

Answer 5

Reduced disease incidence
Reduced disease mortality
Earlier, less radical treatment
Cost-effective
Overall population benefit

Question 6

what does cervical screening look for

Answer 6

cell changes which may develop to be pre-cancerous in women who otherwise have no symptoms
If left untreated, may develop into cervical cancer

Question 7

what are the symptoms of cervical cancer

Answer 7

unusual vaginal bleeding/ discharge
increased bleeding after sex/ between periods
dyspareunia

Question 8

should women with symptoms get a screening test

Answer 8

no should get a diagnostic test

Question 9

what is the screening programme for cervical cancer

Answer 9

women aged 25-49 every 3 years

women aged 50-64 every 5 years

Question 10

what is the cervical cancer screening test

Answer 10

speculum exam
visualise the cervix
brush sample of the cells from the transformation zone of the cervix
liquid based cytology (and HPV testing starting 2020)

Question 11

who is most likely to uptake screening tests

Answer 11

ages 50-64, least deprived

Question 12

what is the formula for coverage of a screening test

Answer 12

(screened population/ eligible population) x 100%

Question 13

what is the formula for uptake of a screening test

Answer 13

(screened population/ invited population) x 100%

Question 14

who is at risk of not getting screening

Answer 14

Minority ethnic groups
Immigrants
Travellers
Prisoners
Students

Question 15

what are the challenges in optimising uptake

Answer 15

Change of address
Communication
Health literacy
Deprivation
Accessibility
Vulnerable groups

Question 16

how is screening coverage and uptake increased

Answer 16

Promotion of screening programme
Material in variety of languages
GP incentives
Local and national initiatives

Question 17

which types of HPV cause cervical cancer

Answer 17

16 and 18

Question 18

who gets the HPV vaccine

Answer 18

Girls S1 to S3 and MSM 45 (through SRH)

Boys in S1

Question 19

is HPV 6/11 vacinnated against

Answer 19

yes to protect against genital warts

Question 20

do people who have had HPV vaccinations still need screening

Answer 20

yes vaccine doesnt prevent 30% of cervical cancers

Question 21

what reproductive cancers are increased by obesity

Answer 21

breast
womb
ovary

Question 22

what is the impact of obesity in O&G

Answer 22

Increased subfecundity
Increased infertility
Decreased effectiveness of IVF
Increased risk of miscarriage
Increased risk of pregnancy complications

Question 23

what does smoking cessation do in O&G problems

Answer 23

Decreased risk of complications in pregnancy and birth
Reduced risk of stillbirth, premature birth, sudden infant death syndrome
reduced risk of developing cervical cancer
Improved prognosis following diagnosis of cervical cancer

Question 24

what is the recommended dose of folic acid

Answer 24

400 micrograms folic acid tablet every day before pre-conception, until 12 weeks pregnant.

Question 25

who gets cervical smears in scotland

Answer 25

25-65 year olds
3 yearly smears till age 50
5 yearly from 50 -65

Question 26

what do the different results of a cervical smear need management wise

Answer 26

normal- routine recall
unsatisfactory repeat in 3 months
borderline or mild dyskaryosis = repear in 6 months
mod/ severe dyskaryosis or glandular abnormalities= refer to colposcopy
?invasive- urgent (2 weeks) colposcopy

Question 27

what is a colposcopy

Answer 27

Magnified inspection of cervix
and use of stains to identify abnormality
can perform: 
-Biopsy and follow up
-Biopsy and treat with cold coagulation
-LLETZ (large loop excision of TZ)

Question 28

what stains are used in colposcopy

Answer 28

Acetic acid
-Acetowhite
-White with abnormality
shows:
-Extent of lesion
-Density 
-Mosaic
-Punctation
-Abnormal vessels

Iodine
Positive is brown = normal
Negative is absence of stain = abnormal

Question 29

What is the test of cure for cervical dysplasia

Answer 29

Combined smear and HPV test after 6 months
Double negative – 3 yearly repeat smear
If positive need further colposcopic assessment

Question 30

what might patients experience after a colposcopy

Answer 30

period like bleed ad cramping

if foul smelling/ heavy bleeding with clots then not normal

Question 31

how long to colposcopy results take

Answer 31

4 weeks, arrive by letter

Question 32

what are the treatment options for CIN

Answer 32

Cold Coagulation (Destructive)
Hot probe which causes cells to burst
LLETZ (Excisional)
Electosurgical wire can cut through tissue (loop)
(both performed in clinic under LA)

Question 33

when can you have sex after colposcopy

Answer 33

when feel comfortable to

small risk of infection

Question 34

does colposcopy/Tx affect fertility

Answer 34

no

Question 35

does colposcopy affect contraception

Answer 35

only IUD- may need removal and reinsertion

Question 36

what might LLETZ increase the risk of

Answer 36

late miscarriage, prematurity

Question 37

should you albate suspected malignancy

Answer 37

no always excise

Question 38

what is the chance of high grade dyskaryosis turning into cancer

Answer 38

50%

Question 39

what causes cervical cancer

Answer 39

HPV (70% due to types 16 qnd 18)

Question 40

what can impair immune clearance of HPV

Answer 40

HIV
immunocompromised
transplant
diabetics