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Cervical Issues

Cervical Issues. Annual update 2010 Tamsin Groom. 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

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Cervical Issues

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  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

  6. Current Screening management 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

  8. Incidence of Cervical Cancer GG&C 2004-8 36 women aged 20-24 diagnosed in whole of Scotland, 1 aged 15-19 (1471 in total)

  9. Comparison with HPV 6/11

  10. Comparison with HPV 6/11

  11. Ectopy

  12. Cervical Cancer

  13. And again

  14. 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

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

  16. Other cervical appearances

  17. Other cervical appearances

  18. Prolapsed fibroid polyp

  19. Nabothian follicles/cysts • Normal finding • No action required

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

  21. Chlamydial cervicitis • Screen, treat and review

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

  23. 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

  24. Endometriotic nodule • Do nothing unless symptomatic

  25. Questions?

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