Makindo Medical Notes

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🧪 Cervical Cancer Screening helps detect precancerous changes early, allowing treatment before progression to invasive cancer. It involves sampling cells from the cervix and analysing them for abnormalities. Early detection → better outcomes ✅

📌 About

• Cells collected from the ectocervix using a spatula or brush.
• Sample placed on a glass slide or in liquid-based cytology medium → stained & examined in the lab.
• Goal: Detect precancerous lesions early → prevent progression to cervical cancer.

📅 Screening Guidelines (UK)

• 👩 Women aged 25–49 years: Invited every 3 years.
• 👩‍🦳 Women aged 50–64 years: Invited every 5 years.
• Women >65: Only screened if not tested since 50 or if recent abnormal results.
• Screening may be modified if high risk (e.g., HIV, immunosuppression).

🧾 Pap Smear Results

• Mild Dyskaryosis: Often due to transient HPV infection; usually low risk.
• Moderate Dyskaryosis: More significant abnormalities; likely CIN 2/3.
• Severe Dyskaryosis: High-grade abnormality → high risk of progression to cancer.

🔬 Cervical Intraepithelial Neoplasia (CIN)

• CIN 1: Abnormal cells in lower third of epithelium → low-grade; many regress spontaneously.
• CIN 2: Abnormal cells in two-thirds of epithelium → high-grade; usually needs treatment.
• CIN 3: Abnormal cells throughout full epithelial thickness → high risk; requires treatment.

⚡ Actions Based on Results

• Mild dyskaryosis / CIN 1: Repeat smear in 6–12 months or colposcopy referral.
• Moderate dyskaryosis / CIN 2: Refer for colposcopy + likely treatment.
• Severe dyskaryosis / CIN 3: Urgent colposcopy + excisional treatment (e.g. LLETZ).

🩺 Management of Precancerous Changes

• Colposcopy: Magnified cervix examination ± biopsy; treatment includes laser ablation, cold coagulation, or cryotherapy.
• LLETZ / Cone biopsy: Removes transformation zone containing abnormal cells. 🔑 Cone biopsy reserved for glandular disease or unclear margins.
• Follow-up: Repeat smear/HPV test at 6 months → ensure clearance.

ℹ️ General Management Notes

• Benign findings (e.g., metaplasia, atrophic smear) → no action.
• Inflammatory changes → test for infections (e.g., chlamydia, candida, bacterial vaginosis).
• Actinomyces on smear with IUCD → consider IUCD removal + gynae review.
• Glandular neoplasia: Always urgent referral (risk of adenocarcinoma).

📚 References

• NICE Cervical Cancer Screening Guidelines (2013)
• RCOG Green-top Guideline No. 31 (2016)
• BSCCP Colposcopy & Treatment Guidelines (2019)
• Smith JS et al. HPV and Cervical Cancer. Lancet 2007.
• Castle PE et al. Evidence Review of Screening. Int J Cancer 2013.