Lecture 6 Cytology_part 2_Power Point Presentation.ppt

Exfoliative cytology … Areas of exfoliative cytology • Cancer detection in suspected cases Cervix – cervical smears Bladder – urine deposits Bronchus – sputum or brushing or washing Serous effusions – aspirate Breast – aspiration Skin scrapings – for basal cell carcinoma • Screening of population...

Exfoliative cytology … Areas of exfoliative cytology • Cancer detection in suspected cases Cervix – cervical smears Bladder – urine deposits Bronchus – sputum or brushing or washing Serous effusions – aspirate Breast – aspiration Skin scrapings – for basal cell carcinoma • Screening of population at suspected risk Cervical smears from normal women Stool samples from over 60s people for colon cancer • Follow-up after treatment Post-irradiation: cervix, bladder Cervical Cytology … Slide preparation – Liquid based cytology (LBC) Brush sampling (CervexTM ) Drop into dilution Vortex mix Aim to suspend cells Could make a cytospin slide Assembling slide and sample holder Papanicolaou stain Mature (squamous cells) pink Georgios Papanicolaou inventor of the "Pap smear" 1883– 1962 PAP stain There were around 3,200 new cases of cervical cancer in the UK in 2014, that’s around 9 cases diagnosed every day. Incidence rates for cervical cancer are projected to rise by 43% in the UK between 2014 and 2035, to 17 cases per 100,000 females by 2035. National Screening Programme … How it used to be until March 2020 National Screening Programme • The aim of the NHS Cervical Screening Programme is to reduce the number of women who develop cervical cancer and the number of women who die from the condition. • Introduced in the 1980s, the number of cervical cancer cases has decreased by about 7% each year. • All women who are registered with a GP: • aged 25 to 49 – every three years • aged 50 to 64 – every five years • over 65 – only women who haven't been screened since age 50 or those who have recently had abnormal tests Risk factors for Cervical cancer • Infection with ‘High Risk (HR) Human Papilloma Virus (HPV) – most notably 16,18. (Other types –eg 6,11 which cause genital warts do not place a woman at increased risk of developing cervical cancer) Majority of sexually active women will come into contact with HR-HPV at some time. It is a transient infection in most women Risk factors for Cervical cancer • Other risk factors such as multiple sexual partners • Immunosuppression – allows infection to persist • Smoking – was found to be an independent risk factor • Early first pregnancy • Long term use of oral contraception Cervical screening • Despite the risk factors, cervical screening can prevent around 75% of cancer cases in women who attend regularly. • Screening is one of the best defences against cervical cancer. Many of those who develop it have never been screened. The biggest risk factor is non-attendance for screening! Organisation of the programme • The national office in Sheffield is responsible for monitoring performance • Develops systems and guidelines to ensure consistent quality • Regional quality assurance teams communicate and oversee standards at local levels Hospital Based Programme Coordinator • Responsible for communications between all the stakeholders in the programme • Primary care • Cytology • Histology • Colposcopy • Recall agency Who does what? Cytology MLA staff: Receive and process samples Admin staff: data entry and other clerical duties Cytoscreeners: Primary screen and report negative and inadequate Biomedical Scientists: Checking, supervision, management. Pathologists : Reporting abnormal cases, leading the service Failsafe • This is the term given to the process each lab has to undertake to ensure that Patients are not lost to follow up following an abnormal smear Cancer audit • Every case of invasive cervical cancer is investigated in order to assess if any aspects can be improved and therefore minimise the number of cases of invasive