Cytology Update M Laing QEUH

Transcription

1 Cytology Update M Laing QEUH

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5 Age change to 25 to 65

6 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

7 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%

8 Abnormal Smears Direct referral by GG&C. Patients with BNA and LGD are sent a letter inviting them to make a Colp appointment suitably to them. (Patient focused booking) Patients with High grade smears are given an appointment directly

9 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%

10 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.

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13 CERVICAL SCREENING

14 THE CERVIX

15 JUNCTION AND TRANSFORMATION ZONE

16 Normal squamous cells

17 High Grade dyskaryosis

18 Colposcopy appointments are now by direct referral in GG&C.

19 Colposcopy appointments are now by direct referral in GG&C

20 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.

21 CIN

22 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

23 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 1 st visit. (pregnant women are excluded)

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27 HPV Vaccination programme still at forefront of protection against HPV 16 and 18

28 But. There are other oncogenic Human Papilloma Viruses out there HPV 16 and 18 cause 70% of Cervical cancers

29 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 Follow up for HGCGIN is still 6 smears over 5 years. No TOC done.

30 HPV Testing as a primary screening tool Coming January 2020 Smear will be taken as at present but cytology will only be done as a triage if the HPV testing is High Risk Positive

31 Cervical Cancer Squamous cell carcinoma % of cervical Ca Transformation zone HPV Prevention Adenocarcinoma Glandular epithelium Aggressive Fatal Unpredictable

32 Squamous carcinoma

33 Stage and Grade

34 Epidemiology Cervical Cancer (C53): European Age-Standardised Incidence Rates per 100,000 Population, Females, Great Britain Source: cruk.org/cancerstats

35 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

36 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

37 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.

38 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.

39 So what should be done? Visual inspection of the cervix Chlamydia testing Swabs Referral if symptoms persist

40 This now includes girls under 25 who are not part of the screening programme. Investigate symptoms but not with a smear

41 Just taking a smear out of routine recall while ignoring symptoms is not an option.

42 Endometrial Abnormalities can be picked up on smear. Post menopausal bleeding should always be referred to Gynaecology for Endometrial biopsy.

43 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

44 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

45 Thank you! Questions?