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Cervical Issues

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Cervical Issues
Annual update 2010
Tamsin Groom
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Overview of screening and management
Do’s and Don’ts
The “suspicious cervix”
Quiz
Screening
• Why?
Screening
• To identify precancerous lesions
• Allow early detection and prevention of
progression to cancer
• SCSP started 1988
• Incidence of cervical cancer has fallen by
47.7% (1986 to 2005)
• 20-60 only (3 yrly)
Current Screening management
Negative, after borderline
Further repeat at 6 months Return
to routine recall after 2nd negative.
Negative, after mild
Further repeat at 6, & 18 months
Return to routine recall after 3rd
negative
Unsatisfactory
3 month recall. Refer after third in
succession
Borderline Squamous Changes +/- 6 month recall. Refer after third.
HPV
Borderline ?High grade – Flag as
such and Refer to Colposcopy on
1st.
Borderline Glandular Changes
6 month recall. Refer after second.
Current Screening management
Mild dyskaryosis
Repeat in 6 months. Refer after
second.
OR Refer to Colposcopy on 1st
3 abnormal results within the last 10 years,
refer to colposcopy
2008-09
• 116,000 smears
• 9.9% abnormal
(excluding unsatis)
Unsatis rate approx 2.5%
1309 smear in <20s
Why?
1 revealed severe
dyskaryosis
Negative
90.1
Borderline
6.2
Mild
2.3
Mod/Severe
1.2
Incidence of Cervical Cancer GG&C
Age range
2007
2008
20-29
7
9
30-39
29
21
40-49
20
14
50-59
3
11
60-69
5
5
70-79
2
2
80+
1
3
67
65
2004-8 36 women aged 20-24 diagnosed in whole of
Scotland, 1 aged 15-19 (1471 in total)
Cervical Cancer Incidence (European Age Standardised Rates)
Females of All Ages, Scotland 1975 - 2007
20
17.3
18
16
EASR per 100,000
14
12
10
Baseline 1986
8
6
8.9
4
2
0
1975
1977
1979
1981
1983
1985
1987
1989
1991
Year
1993
1995
1997
1999
2001
2003
2005
2007
Comparison with HPV 6/11
C h art 4: N e w d iag n o se s o f g e n ital warts in 16-45 ye ar o ld s b y ag e an d g e n d e r,
600
1998
Ma le s
550
Fe m a le s
500
N um be r of dia gnos e s
450
400
350
300
250
200
150
100
50
0
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
Age
Comparison with HPV 6/11
Chart 4: New cases of genital warts in 16-45 year olds by age and gender 2008
Males
Females
600
550
500
Number of diagnoses
450
400
350
300
250
200
150
100
50
0
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
Age
Ectopy
Cervical Cancer
And again
Do’s and Don’ts
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PCB in young women
Heavy bleeding during smear taking
DO take a Sexual history
DO take a chlamydia/GC swab
DO treat chlamydia & review before
referral.
• Do consider changing contraceptive
method if on COCP/condoms
Do’s and Don’ts
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ECTOPY
Do refer if symptomatic
Do refer if concerned re appearance
Not if asymptomatic
Other cervical appearances
Other cervical appearances
•
• Prolapsed fibroid polyp
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•
• Nabothian follicles/cysts
• Normal finding
• No action required
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Cervical polyps
Removal?..symtomatic/other
Easy to remove…in surgery?
Yes if small, polyp forceps and silver
nitrate sticks
• Not in pregnancy!
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• Chlamydial cervicitis
• Screen, treat and review
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• Herpetic cervicitis
• Not seen often as may have external
lesions
• Unwell, highly symtomatic…not consistent
with cancer
• Can cause frank necrosis
• Treat and review
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Cervical wart
Treat external warts
Stop smoking
Review after resolution of others…refer if
still present
• No others, young review in 3/12
• No others over 30 refer
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• Endometriotic nodule
• Do nothing unless symptomatic
Questions?
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