- Incidence: 10.00 cases per 100,000 person-years
- Peak incidence: 30-40 years
- human immunodeficiency virus
- early first intercourse, many sexual partners
- high parity
- lower socioeconomic status
- combined oral contraceptive pill*
*the strength of this association is sometimes debated but a large study published in the Lancet (2007 Nov 10;370(9599):1609-21) confirmed the link
- HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
- E6 inhibits the p53 tumour suppressor gene
- E7 inhibits RB suppressor gene
- persistent biliary colic symptoms
- associated with anorexia, jaundice and weight loss
- a palpable mass in the right upper quadrant (Courvoisier sign),
- periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen
Screening and prevention
The NHS has now moved to an HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
Management of results
- return to normal recall, unless
- the test of cure (TOC) pathway: individuals who have been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community
- the untreated CIN1 pathway
- follow-up for incompletely excised cervical glandular intraepithelial neoplasia (CGIN) / stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer
- follow-up for borderline changes in endocervical cells
- samples are examined cytologically
- if the cytology is abnormal → colposcopy
- this includes the following results:
- borderline changes in squamous or endocervical cells.
- low-grade dyskaryosis.
- high-grade dyskaryosis (moderate).
- high-grade dyskaryosis (severe).
- invasive squamous cell carcinoma.
- glandular neoplasia
- if the cytology is normal (i.e. hrHPV +ve but cytologically normal) the test is repeated at 12 months
- if the repeat test is now hrHPV -ve → return to normal recall
- if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
- If hrHPV -ve at 24 months → return to normal recall
- if hrHPV +ve at 24 months → colposcopy
If the sample is 'inadequate'
- repeat the sample within 3 months
- if two consecutive inadequate samples then → colposcopy
The follow-up of patients who've previously had CIN is complicated but as a first step, individuals who've been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community.