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Week 11 > Screening Programmes > Flashcards

Screening Programmes Flashcards

1
Q

what is screening

A

a test offered to an asymptomatic person to detect those who have a high probability of having a disease

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2
Q

what are the principles of early disease detection

A

Wilson + Junger
1- the condition should be an important problem for the individual and the community (IMPORTANT)
2- the disease should be an accepted treatment for patient with the disease (TREATMENT)
3- facilities for diagnosis and treatment should be available (FACILITIES)
4- there should be a recognisable latent or early stage (LATENT)
5- there should be suitable test or examination (TEST)
6- the test should be acceptable to the population (ACCEPTABLE)
7- the natural history of the condition, including development from latent to declared disease, should be adequately understood (UNDERSTANDING)
8- there should be an agreed policy on whom to treat as patients (PATIENTS)
9- the cost of the case finding programme should be economically balanced in relation expenditure on medical care as a whole (COST)
10- case finding should be a continuing process (CONTINUING)
I take flowers (lilies) to another undertaker past crematory casket

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2
Q

How is cervical cancer an important problem for the individual and community

A

incidence has fallen since the early 1980s
death has also fallen (5 year survival was 50% in the early 70%)
- now 60%
causes 105 deaths in Scotland and 852 in the UK/ year

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3
Q

what is the accepted treatment for cervical cancer (rule 1)

A

all cancers are staged using clinical exams, pathology and radiology
gynaecology/ oncology multidisciplinary team meeting
- 1 a week
management is based on the stage/ fitness

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4
Q

what are the differences in treatment for different stages of cervical cancer (rule 2)

A

small cancers = outpatient
larger tumours = radical hysterectomy
inoperable tumours = chemotherapy and radiotherapy

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5
Q

what are the facilities for diagnosis for cervical cancer (rule 3)

A

if abnormality is detected, a formal diagnosis is then required
- a biopsy for cervical cancer
in CSP (cervical screening programmes), referred to colposcopy for both diagnosis and treatment

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6
Q

what is the suitable test for cervical cancer (rule 5)

A

Cervical Smear Test
- carried out at a GP/ sexual health centres
- a brush is used to remove cells from the cervix
- these are transferred to a pot of preservative
- then tested for HPV (human papilloma virus) +/- cytology
speculum used to hold open the cervix/ lubricant

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7
Q

how is the cervical cancer test acceptable to the population (rule 6)

A

depends on perceived risk and how inconvenient/ unpleasant the test is
promotion -> posters to show
- speed
- normality
- effectiveness

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8
Q

how is case finding a continuing process for cervical cancer

A

Scottish Cervical Call Recall System (SCCRS)
- generates invitations for women to attend for a smear test
- 25-65 invited every 5 years
- women who have abnormal tests are called more frequently
- computer system interacts with other software to refer patients to colposcopy when required
- colposcopy visits are documented and follow up in the community (GP) can be organised by SCCRS once the patient is discharged

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9
Q

what are the components of cervical cancer screening

A

Call Recall office and SCCRS
smear takers
laboratories
colposcopy service

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10
Q

what are the risk factors associated with cervical cancer

A

smoking
poor immune function (e.g. immunosuppression)
multiple sex partners

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11
Q

what is HrHPV

A

a high risk subtype of HPV
- majority of cervical cancers

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12
Q

what type of virus is HPV

A

DNA
- high risk and low risk
- over 200 types (40 are STIs)

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13
Q

what circumstances create risk of someone developing pre-cancerous changes with cervical cancer

A

patients who have persisting infection with a high risk oncogenic subtype of HPV

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14
Q

what does the endocervix look like

A

rough area
inner

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15
Q

what does the ectocervix look like

A

smooth + shiny
ouer

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16
Q

what is the epithelium of the endocervix

A

simple cuboidal epithelium
- musin

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17
Q

what is the epithelium of the ectocervix

A

squamous epithelium

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18
Q

describe the progression of an HPV infection

A

1- micro abrasions expose the BM
2- allows for infection of HPV
3- HPV replicates in maturing squamous cells
4- produces koilocytes

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19
Q

describe the end result of low risk HPV infection

A

free rival DNA within the cell
responsible for viral warts (e.g. 6, 11, 42, 44)

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20
Q

describe the end result of high risk HPV

A

incorporate their DNA into that of the host cell
viral E6 and E7 proteins are responsible for reactivating the cell cycle in cells which are not normally proliferating
persistent infection/ disruption of cell cycle -> proliferation of epithelial cells -> precursor lesions for cervical cancer (CIN and CGIN)

21
Q

list examples of high risk subtypes of HPV

A

16, 18, 31 and 45

22
Q

what is CIN

A

cervical intraepithelial neoplasia
- CIN1, CIN2, CIN3

23
Q

how does CIN1 resolve in most patients

A

without treatment
patients are monitored

24
Q

what is CIN3

A

CIN3 precursor lesions for squamous cell carcinoma -> usually takes >2 years to develop into invasive carcinoma

25
Q

what is the CSPs main purpose

A

to detect and treat CIN2 and CIN3

26
Q

what is CGIN

A

cervical glandular intraepithelial neoplasia
much less common and is the precursor lesion for adenocarcinoma

27
Q

describe the appearance of a sample of cervical tissue stained with H + E when affected by CIN1

A

higher nucleus to cytoplasmic ratio –> hyperchromatic (darker) appearance
cells have less cytoplasm
towards the top, nuclei are a little large -> koilocytes

28
Q

describe the appearance of a sample of cervical tissue stained with H + E when affected by CIN3

A

can develop from CIN1
affects all layers of squamous epithelium
all cells have larger nucleus

29
Q

describe the path a cervical sample takes in the lab

A

HPV testing (all)
Cytology testing (15%)
- samples with a +ve HPV test
- samples from patients on follow up pathways (for previous cytological or histological abnormalities)

30
Q

who is called back after HPV testing is complete (14 high risk subtypes)

A

positive -> recall in 5 years (machine interface with SCCRS)
negative -> sample tested for cytology
fail
specific subtype is not reported

31
Q

what is dyskaryosis

A

transformation zone cells are spread out
abnormal cells have enlarged, irregularly shaped nuclei

32
Q

how is dyskaryosis graded

A

mild, moderate or severe depending on the size of the nucleus

33
Q

what do the dyskaryosis grades roughly equate to

A

CIN1, CIN2, CIN3 on histology specimens
- biopsy is needed to confirm the degree of abnormality

34
Q

what is the treatment for someone who tests positive for HPV

A

patients who test positive but have no cell changes are called back in 1 year for a repeat HPV test
patients who have cell changes are referred to colposcopy investigation

35
Q

what is a colposcopy

A

examination of the cervix using a specialist microscope
acetic acid is applied to highlight any abnormalities
patients can have biopsies taken and treatments for abnormalities detected

36
Q

what is the risk of developing breast cancer in Scotland

A

1/8 women -> increases with age

37
Q

how often do women need to get a mammogram

A

women ages 50-70 are invited to attend every 3 years

38
Q

what were the results of breast cancer screening in 2018

A

1573 cancers and 198 non-invasive cancers were detected

39
Q

what is the process of breast cancer screening

A

appointment takes 30 mins and 2 x-rays are taken of each breast
images are interpreted and the results sent to the GP and patient

40
Q

what is the treatment for patients with abnormal or unsatisfactory x-ray results

A

4-5% of patients
sent to hospital for triple assessment
- examination
- radiology -> repeat mammogram or ultrasound (if necessary)
- biopsy

41
Q

describe the appearance of normal breast tissue

A

central duct
lobules
fibrous tissue (pale pink)
adipose cells (white)

42
Q

what is the structure of the ducts in the breasts

A

2 layers
inner tall cuboidal (high nucleus to cytoplasm ratio)
no cytological atypia
no mitotic activity
- surrounded by basal layer (less visible)

43
Q

describe the appearance of breast tissue with cancer

A

cells infiltrating within the fat cells
no ducts or lobules
variation between nuclei is subtle in certain subtypes of cancer
pleomorphism

44
Q

what was the bowel cancer screening programme trialled and subsequently rolled out

A

2006 and 2009

45
Q

which portion of the population is most susceptible to bowel cancer

A

over 50s

46
Q

what is the aim of bowel cancer screening programmes

A

to detect precancerous changes (often polyps) and early cancers which are treatable and have a better prognosis

47
Q

what is the screening test for bowel cancer

A

a faecal immunochemical test (FIT) is sent in the post for completing at home
- patients 50-74 = every 2 years
one sample of stool is collected and returned in a pre-paid package

48
Q

what is the stool sample tested for in bowel cancer screening

A

detecting blood
small, unnoticeable -> haemoglobin more accurate
if above 80ugHb/ faeces -> colonoscopy
1 in 5 referred
1 in 10 already have cancer

49
Q

describe the appearance of normal bowel tissue

A

large cytoplasm -> musin for lubricating movement of contents
mucosal elements should remain superficial to muscle

50
Q

describe the appearance of a polyp with H + E

A

fibrovascular stalk - attaches to wall
disordered architecture
- cystically dilated glands; bigger lumina
bluer than should be
- less musin, more nucleus

51
Q

describe the appearance of cancerous bowel tissue with H + E

A

dysplasia
- more blue
- glands are more closely packed (haphazardly arranged, not tubular shaped)
cribriform
invasive adenocarcinomas
- invading underlying tissues

Week 11 (3 decks)

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