1. Cervical Issues Annual update 2010 Tamsin Groom

2. Overview of screening and management Do’s and Don’ts The “suspicious cervix” Quiz

3. Screening Why?

4. 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)

5. 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 +/- HPV 6 month recall. Refer after third. Borderline ?High grade – Flag as such and Refer to Colposcopy on 1st. Borderline Glandular Changes6 month recall. Refer after second.

6. Current Screening management Mild dyskaryosisRepeat in 6 months. Refer after second. OR Refer to Colposcopy on 1st 3 abnormal results within the last 10 years, refer to colposcopy

7. 2008-09 116,000 smears 9.9% abnormal (excluding unsatis) Unsatis rate approx 2.5% 1309 smear in <20s Why? 1 revealed severe dyskaryosis Negative90.1 Borderline6.2 Mild2.3 Mod/Severe1.2

8. Incidence of Cervical Cancer GG&C Age range20072008 20-2979 30-392921 40-492014 50-59311 60-6955 70-7922 80+13 6765 2004-8 36 women aged 20-24 diagnosed in whole of Scotland, 1 aged 15-19 (1471 in total)

10. Comparison with HPV 6/11

12. Ectopy

13. Cervical Cancer

14. And again

15. Do’s and Don’ts 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

16. Do’s and Don’ts ECTOPY Do refer if symptomatic Do refer if concerned re appearance Not if asymptomatic

17. Other cervical appearances

19. Prolapsed fibroid polyp

22. Nabothian follicles/cysts Normal finding No action required

25. Cervical polyps Removal?..symtomatic/other Easy to remove…in surgery? Yes if small, polyp forceps and silver nitrate sticks Not in pregnancy!

27. Chlamydial cervicitis Screen, treat and review

30. Herpetic cervicitis Not seen often as may have external lesions Unwell, highly symtomatic…not consistent with cancer Can cause frank necrosis Treat and review

32. 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

35. Endometriotic nodule Do nothing unless symptomatic

36. Questions?