Cervical cancer screening

Every woman, 21-65 yrs : Pap smear for cytology every 3yrs

For those above 30, alternative is Pap smear for cytology + HPV testing every 5yrs


If cytology yields abnormal results do further tests

Atypical squamous cells of unknown significance, ASC-US:
The "significance" is not clear so check for the HPV virus
If HPV +, then do colposcopy
If HPV -, then patient goes home and returns for repeat pap smear in 12 months (instead of the usual 3 yrs)


Atypical squamous cells, cannot exclude HSIL, ASC-H:
Still not clear and even more suspicious, HSIL is a possibility so go straight and do colposcopy


Low grade squamous intraepithelial lesion, LSIL:
For premenopausal women including pregnant women, do colposcopy

For postmenopausal women, 3 options:

• Do colposcopy
• Do HPV and then colposcopy if +
• Wait and repeat in 6months and 12months

High grade squamous intraepithelial lesion, HSIL:
Do colposcopy


20% of CA cervix may arise from glandular cells but the majority, 80%, are from squamous cells

Colposcopy is done for visual inspection + targeted biopsy + endocervical curretage (EC is contraindicated in pregnancy).

Findings:

If colposcopy done following abnormal cytology does not show any CIN, repeat cytology in 12 months (or 6 months if HPV+)

CIN 1: usually regresses spontaneously
CIN 2 & 3: Cautery, LEEP, Cone biopsy