Authors: Amanda Herbert

The cervical chapters comprise the following material:

1. Introduction
2. Anatomy, histology and function of the cervix
3. Cervical cancer epidemiology and aetiology
   • Cervical cancer worldwide and in Europe
   • HPV as a causative agent and other risk factors
4. Pathogenesis of cervical cancer and its precursors
   • CIN and squamous cell carcinoma
   • AIS and adenocarcinoma
   • Presentation, stage and treatment of invasive cancer
5. Effect of screening on incidence and mortality
   • Fall in incidence and mortality due to screening (US, Nordic countries, England)
   • Factors affecting incidence and mortality rates
6. Principles of screening and measurement of accuracy
   • Requirements of screening programmes
   • Measurement of accuracy
7. HPV tests in cervical cancer screening
   • HPV triage and test of cure
   • Primary HPV testing; HPV-cytology co-testing
   • Vaccination and its consequences for screening
8. Collecting cellular samples from the cervix
   • Guidelines for taking cellular samples
   • Comparison of conventional and liquid-based cytology
   • Criteria for adequacy
9. Cervical cytopathology
   • Terminology
   • Normal cytology; benign/reactive changes
   • Squamous intraepithelial lesion (SIL)
   • Low-grade SIL; High-grade SIL
   • Aytpical/borderline cytology
   • ASC-US: bordering on LSIL
   • ASC-H: suspicious for HSIL or cancer
   • Squamous cell carcinoma
   • Adenocarcinoma in situ/adenocarcinoma/CGIN
   • Atypical glandular cells
10. Pitfalls in cytology
    • Potential false positives and false negatives
    • Limiting borderline and atypical reports
11. Quality control
    • Rapid re-screening; rapid pre-screening; automation
    • Comparison of reporting rates (LSIL; HSIL; ASC; AGC)
    • Proficiency testing
    • Invasive cervical cancer audit
    • Laboratory accreditation
12. Cytology in a multidisciplinary setting
    • Role of the multidisciplinary team
    • Accuracy of cytology and HPV tests
    • Accuracy of colposcopy and punch biopsy