Glossary and Definitions

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PHRASE	MEANING
A
Abnormal	A change in the appearance of epithelial cells (dysplasia) or the appearance of the nucleus (dyskaryosis) has been noticed. Follow up will depend on how the changes have been graded: mild or moderate. Severe would be positive..
Acute hospitals	Where most colposcopy clinics are based.
Adeno carcinoma	Cancer of glandular type affecting columnar cells. Unfortunately this type of cancer cannot be prevented through cervical screening. This represents about 25% of cervical cancers.
Audit	An exercise to check that standards are being met in a particular area.
B
Benefit and limitations	Any screening programme will have benefits and limitations. In the cervical cancer screening programme some of the benefits are: a proven ability to decrease the incidence and mortality from cervical cancer. Fewer cervical cancer deaths and fewer women having to undergo radical surgery. However, some of the limitations include: • Worry or anxiety about being invited for a smear test. • Not getting a negative/normal result. • Having to go for more tests or colposcopy treatment. • Worrying about what the doctors may find. • The inconvenience of going for the aditional appointments.
Benign	A tumour that is not cancer. It does not spread to other parts of the body but sometimes it is removed anyway if it grows too big. Not malignant.
Biomedical scientist	A scientist who has a qualification in a health related subject; usually works in a laboratory.
Biopsy	Procedure carried out to extract a sample of tissue so it can be examined.
Borderline	Minor changes noted in the appearance of the cells. These changes are of doubtful / uncertain significance / usually insignificant as they may have been caused by infection or the cells repairing themselves.
Brush	Sometimes used as well as a spatula to take smear tests.
C
Call/Recall system	Computer-based system inviting women to attend for a smear test every 5 years and will recall the same women in another 5 years depending on age.
Cervical cancer	A cancerous growth of epithelial cells that is growing in or on a woman’s cervix. It will be either squamous or adeno carcinoma. Cancer is graded depending on the severity.
Cervix	A round pink tissue/ organ that protects the entrance to the womb. Sits at the top of the vagina.
Chemotherapy	Treatment for cancer where large amounts of strong chemicals are administered.
CIN	Cervical Intra-epithelia Neoplasia. A pre-cancer condition NOT cancer. There are changes to the nucleus (dyskaryosis). Graded 1-3 depending if mild, moderate and severe. CIN does not have symptoms, and is only detectable by smear or biopsy.
Clinician	Nurse or doctor who has had specialised training.
Colposcopist	Doctor of gynaecological medicine specialising in the use of a colposcope and treatment.
Colposcopy	The study of the cervix using a colposcope.
Columnar	Cells found inside the os, where normal vaginal secretions come from. These cells are not sampled during a smear test because they are too far inside the cervix.
Cone biopsy	When a cone shaped sample of tissue is removed to aid diagnosis.
Cover slip	Placing a thin glass cover slip on the fixed smear slide to protect the cells and ease examination.
Coverage	The percentage of eligible women who had a smear test in the last 5 years.
CPA	Clinical Pathology Accreditation
Cypher codes	Code number used by Central Services Agency to identify GPs by board.
Cytologist	A registered BMS who has been extensively trained to read smear test slides
Cytology	The study of individual cells. In cervical cytology it is the study of the cells of the cervix.
Cytology Lab	A laboratory which processes cancer screening tests, were smear test are transferred onto glass slides or into vials of transport fluid, and sent to a laboratory where they are processed and looked at under a microscope.
Cytopathologist	A doctor who has been extensively trained to read smear test slides
Cytoscreener	Person who has been extensively trained to read smear test slides
D
Diagnostic assessment	When a patient is examined, the symptoms are described and, usually, a diagnosis is made.
Dyskaryosis	Changes to the nucleus in a cell. The changes are graded as Mild, Moderate or Severe depending on the severity of the lesion.
Dysplasia	Changes in the appearance or pattern of cells within tissue and are are graded as Mild, Moderate or Severe depending on how bad it looks.
E
Eligible women	Those who are Aged 20-65, who have a cervix i.e. where the cervix has not been surgically removed.
Epithelial cells	Cells that form the surface of any organ or body part like a form of skin. In the cervix they are squamous or columnar.
External QA Schemes	Where staff from another screening programme outside NI carry out an assessment of the standard of service provided.
F
Fail Safe System	Built into the computer system to ensure any woman with a not normal result is followed up.
Family Planning Clinic	This provides advice and medical services on contraception and other gynaecological matters
Follow up	When a woman’s smear test is not negative, follow up will ensure she proceeds to the next stage of the programme for further examination or treatment.
Follow up smear	Usually recommended after a borderline result where the cells are not quite normal but not quite abnormal. Usually taken 6 or 12 months later.
G
Grading carcinoma	Pre-invasive: Abnormal cells are just showing traits of cancer but are not yet forming a tumour or causing damage to normal tissue. Micro-invasive: Cancer where a few cells have broken off from the rest and are growing the wrong way. Invasive: When the cancer cells grow into normal tissue causing damage. Frankly invasive: When a significant number of cancer cells are growing the wrong way into normal tissue causing damage.
Grading changes	mild: moderate: severe:
Guidelines	Drawn up by the NHSCSP to ensure all regions are providing the same standard of screening.
GUM clinic	Genito-Urinary Medicine.
Gynaecology	Study of female reproductive organs
H
Health and Social Services Boards	In NI there are 4 boards, responsible for commissioning certain health services, e.g. Breast and Cervical screening.
HPV	Human Papilloma Virus. There are over 70 different types of this virus and they cause different epithelial conditions e.g. HPV 1,2, + 4 cause hand and feet warts; HPV 6 + 11 cause genital warts and HPV 16 +18 cause CIN, indicated as major risk factor for developing cervical cancer.
Hysterectomy	Partial or Subtotal: usually only the top of the womb is removed and the cervix is left intact. Any woman who has had a partial hysterectomy will still need to have cervical smears as the cervix is left behind. Full, Complete or Total: usually removal of the womb, cervix and sometimes the top of the vagina. No need for any more smear tests.
I
IBMS CPD	Institute of BioMedical Sciences Continuing Professional Development.
Inadequate Unsatisfactory Unsuitable	The cells on the slide were not good enough for the cytoscreeners to determine a normal or abnormal result. These smear tests will need to be retaken. An inadequate test can also be attributed to the presence of blood, signs of infection, too few cells, poor spreading of the cells, poor fixing, poor staining or incorrect cells sampled.
Incidence	The number of women per 100,000 of the population of NI who were diagnosed with cervical cancer.
Informed Consent	The principle that women are given more information so they can make an informed choice about their invitation for a smear test or any follow-up treatment.
J
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L
LBC- liquid based cytology	New technology for taking and preparing slides to be read. A different brush/spatula is used to scrape the cells and instead of smearing the cervical cell sample over the slide, it is placed in a preservative liquid.
Lead Clinician	The medical person with overall responsibility for a dept e.g. a lab or colposcopy clinic.
Lead Colposcopist	A medical person with overall responsibility of a colposcopy clinic.
M
Malignant	Harmful tumour that without successful treatment becomes worse and may cause death. Not benign.
Metastasis	Malignant cells moving to another part of the body and growing another tumor.
Microscope	Instrument used in labs to magnify a small object to examine it in more detail.
Mortality	The number of people in a population who die from a condition. Usually written as a number per 100,000.
N
Negative (Normal)	A smear result where all cells viewed were normal – no changes in structure of cells or nucleus were observed.
NHSCSP C of C in CS	National Health Service Cancer Screening Programme Certificate of Competency in Cervical Screening.
NI Cancer Registry	Based in Queen’s University Belfast, they record the number of people who are diagnosed with cancer, including type of cancer, mortality and survival rates.
NICE	National Institute for Clinical Excellence. It examines new health related technologies and advises on government policy.
Nurse practitioners or nurse colposcopist	Nurses who have advanced training to specialize in an area of treatment.
O
P
Pap test	Method currently used to take cell samples. Named after Papanicolaou who developed the method in the 1940s.
Pathologists	Doctors who study samples of diseased tissue.
Pilot study	Used to test new technology on a small number of samples before the technology is introduced on a larger scale.
Positive	Very generally, refers to severe dysplasia, severe dyskaryosis or CIN3.
Primary Care	First port of call for most people, e.g. GP, A+E dept.
Proficiency testing	Used to check the standard of staff expertise.
Proforma	A form.
Q
Quality Assurance Reference Centre	A department in every cervical or breast screening programme in the UK. Examines methods and results to ensure best practice is followed.
Quality initiatives	Schemes or ideas introduced to try and either measure the level of service against standards or to improve the standards being met.
R
Radiotherapy	A treatment method for cancer involving treating specific areas with radiation.
Regional Screening Office	Office located in Belfast which maintains information held on the call/recall system e.g. updating details of the women screened, results and follow-up if any.
Repeat smear	Usually taken 3-6 months after a positive or abnormal result to check if cells have fixed themselves or are still not normal
Result letter	Sent by the Regional Screening Office to GPs. Only sent to the women if the smear test is abnormal and she is being referred to colposcopy. Sent to GPs even if they weren't the smear taker.
Risk factor	A reason why someone has a slightly higher risk of developing a condition at some stage in his or her lifetime e.g. smoking
S
Screening	Exercise to identify those most at risk of developing a condition, or those who show signs of it to enable early diagnosis and timely treatment.
Secondary tumour /metastasis	When cancer spreads and starts to grow somewhere else in the body
Slide exchange	Quality scheme where NI and Scotland examine each other’s slides to compare results.
Smear test	Examination of woman’s cervix by primary care teams who then take a sample of cells from the surface of the cervix at the transformation zone and smear them onto a slide for a lab to examine.
Spatula	Tool used to scrape across the surface of the cervix and collect the cells to be examined/checked. Either plastic or wooden.
Speculum	Plastic or metal instrument inserted in the vagina during a smear test to allow the smear taker to examine the cervix properly and sample the correct cells. Comes in different sizes.
Squamous	Epithelial cells. There are several layers of them making up the surface of the cervix. They tend to flatten in appearance as they get nearer to the surface. These are the cells sampled during a smear test.
Squamous carcinoma	Cancer of the squamous cells on the cervix. This is what screening is trying to pick up/prevent.
Staining	When slides reach the lab they are stained with several dyes so that different types of cells become different colours which makes the slides easier to read.
State-registered	All biomedical scientists in the cervical screening programme are state-registered. They have had to undertake extra exams and are regulated by a national body.
SurePath	One of two brand names for LBC. The Welsh Screening Programme uses this one.
T
ThinPrep	One of two brand names for LBC. The Scottish Screening Programme uses this one.
Transformation zone	Ideal area for cervical sampling. It surrounds the os, a small opening in the middle of the cervix.
Treatment at Colposcopy	Cold Coagulation: Areas of abnormal cells are treated using low levels of heat. The treated cells will pass out of the body with normal discharge over the following weeks. Laser Excision: A laser is used to heat-treat abnormal cells. The treated cells will pass out of the body with normal discharge over the following weeks. Loop Diathermy LLETZ: Abnormal cells are cut out with a thin wire that has been heated to a high temperature.
U
V
Vagina	The only non-surgical way to get access to the cervix.
Vault Smear Test	Smear test carried out after a hysterectomy on the area where the cervix would have been.
W
Warning signs	Symptoms that indicate many different gynaecological conditions, including cervical cancer, and therefore should NEVER be ignored. Includes bleeding between periods or bleeding after sex or pain in the lower abdomen. Go to see your GP just in case.
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