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Cervical Issues Annual update 2010 Tamsin Groom Slide 2 Overview of screening and management Dos and Donts The suspicious cervix Quiz Slide 3 Screening Why? Slide 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) Slide 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. Slide 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 Slide 7 2008-09 116,000 smears 9.9% abnormal (excluding unsatis) Unsatis rate approx 2.5% 1309 smear inSlide 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) Slide 9 Slide 10 Comparison with HPV 6/11 Slide 11 Slide 12 Ectopy Slide 13 Cervical Cancer Slide 14 And again Slide 15 Dos and Donts 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 Slide 16 Dos and Donts ECTOPY Do refer if symptomatic Do refer if concerned re appearance Not if asymptomatic Slide 17 Other cervical appearances Slide 18 Slide 19 Prolapsed fibroid polyp Slide 20 Slide 21 Slide 22 Nabothian follicles/cysts Normal finding No action required Slide 23 Slide 24 Slide 25 Cervical polyps Removal?..symtomatic/other Easy to removein surgery? Yes if small, polyp forceps and silver nitrate sticks Not in pregnancy! Slide 26 Slide 27 Chlamydial cervicitis Screen, treat and review Slide 28 Slide 29 Slide 30 Herpetic cervicitis Not seen often as may have external lesions Unwell, highly symtomaticnot consistent with cancer Can cause frank necrosis Treat and review Slide 31 Slide 32 Cervical wart Treat external warts Stop smoking Review after resolution of othersrefer if still present No others, young review in 3/12 No others over 30 refer Slide 33 Slide 34 Slide 35 Endometriotic nodule Do nothing unless symptomatic Slide 36 Questions?