Cytology Update

M Laing QEUH

Age change to 25 to 65

• Age 25 to 50 Three yearly smear invitation

• Age 50 to 65 Five yearly smear invitation

• Women on non routine screening will be

invited up to age 70

OUTCOME OF SCREENING

• 1. normal—90.3%

• 2. inadequate sample—2.3%

• 3. abnormal 9.7%

High Grade dyskaryosis— 1.3%

– Suspected invasive cancer—0.1%

• 18.5% of eligible women did not take up

the offer of a smear

• Lowest uptake was Glasgow North West

at 60.3%

• Highest uptake was in East Renfrewshire

at 79.4%

No requirement for smear

• If it not due

• Out of age recommendation

• If post treatment smear and TOC are Negative Routine repeat in 3 years

• Post Chemo /radiotherapy

• Post total hysterectomy unless there is CIN in the hysterectomy specimen.

• Postnatal smears should be at least 12 weeks post partum.

Publicity

CERVICAL SCREENING

THE CERVIX

JUNCTION AND

TRANSFORMATION ZONE

Normal squamous cells

High Grade dyskaryosis

• Colposcopy appointments are now by

direct referral in GG&C.

Colposcopy appointments are now

by direct referral in GG&C

• Cervix visualised

• Washed with acetic acid

• Application of Iodine

• Green light filter

• Abnormal area can be biopsied or treatment performed at the time or at a further appointment.

CIN

Micro-invasive lesions of the

cervix

• Colposcopic Features

• Densely staining acetowhite lesion

• Atypical vessels, suspicious of invasion

• Beware 'Pollarded' vessel, thick calibre with no visible branching on surface

• Often large volume lesions

• Poor iodine uptake

• May bleed easily

Management of abnormalities

• Women with a mild dyskaryotic result should not be managed on a see and treat basis. To prevent possible overtreatment.

• Women with higher grade abnormalities and correlation at colposcopy should be treated at first visit and they should have evidence of CIN2/3 or cGIN on histology in > or = 90% of cases.

• Women should be treated within 8weeks from 1st visit. (pregnant women are excluded)

LLETZ

HPV

Vaccination programme still at forefront of

protection against HPV 16 and 18

But……………….

• There are other oncogenic Human

Papilloma Viruses out there

• HPV 16 and 18 cause 70% of Cervical

cancers

HPV Testing -Test of Cure

• Offered only with the first post treatment

smear (following Rx for CIN 1,2 or 3)

• Patient returned to routine screening if

cytology negative and HPV high risk

negative

What happened to HPV Testing as

a primary screening tool?

Cervical Cancer

• Squamous cell carcinoma - 80-90% of cervical Ca

•Transformation zone

•HPV

•Prevention

• Adenocarcinoma

•Glandular epithelium

•Aggressive

•Fatal

•Unpredictable

Squamous carcinoma

Stage and Grade

Epidemiology Cervical Cancer (C53): 1979-2013 European Age-Standardised Incidence Rates per 100,000 Population, Females, Great Britain

Source: cruk.org/cancerstats

Invasive Cancer

• The incidence in Scotland is 11.2 per

100,000

• Cancers are subject to national audit

• 10 years of previous smears and

Colposcopy are reviewed

In 2014

• Of the 83 invasive cancers in GGC

• 57 (13.6%) had no smear

• 194 (46.5%) had an incomplete smear

history

• 157 (37.6%) had a complete smear history

Patient with symptoms

Because a smear is a screening test and not

diagnostic it may not be appropriate to do

a smear if the patient is complaining of

symptoms but is not due a cervical smear.

For example

• 30 yr old not due a cervical smear but

complaining of symptoms of post coital

bleeding and discharge should be

investigated for the cause of these

symptoms.

So what should be done?

• Visual inspection of the cervix

• Chlamydia testing

• Swabs

• Referral if symptoms persist

• This now includes girls under 25 who are

not part of the screening programme.

• Investigate symptoms but not with a smear

• Just taking a smear out of routine recall

while ignoring symptoms is not an option.

• Endometrial Abnormalities can be picked

up on smear.

• Post menopausal bleeding should always

be referred to Gynaecology for

Endometrial biopsy.

You can help interpretation

• Helpful if the LMP is recorded

• Endometrial cells over the age of 40 are no longer being reported by the lab

• Endometrial cells will be reported if the patient is postmenopausal.

Indicate if the patient is on HRT or taking other relevant medication. eg Tamoxifen

Suspicious Cervix

• The ‘suspicious cervix’ box on SCCRS

should only be ticked if there is a genuine

concern about an invasive malignancy.

• Tick the immunosuppression box only if

the patient is HIV Positive

Thank you!

Questions?