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Report of the Ministerial Inquiry into the Under-reporting of Cervical Smear Abnormalities in the Gisborne RegionGlossary of Legal and Medical DefinitionsFor the assistance of lay people ABNORMAL BLEEDING
ABNORMAL SMEAR All smears showing epithelial cell abnormalities, including atypical squamous cells of undetermined significance (ASCUS), and atypical glandular cells of undetermined significance (AGUS), but not including benign cellular changes (i.e. infection and reactive epithelial cell changes) ADENOCARCINOMA Malignant lesion of glandular (endocervical) cells of the cervix ADEQUATE SMEAR A smear that contains both squamous and endocervical or squamous metaplastic cells AETIOLOGY (etiology) The cause of disease AGE-ADJUSTED (OR AGE-STANDARDISED) RATES Mortality or morbidity rates in which there has been an adjustment for differences in the age distribution of populations being compared AGUS Atypical glandular cells of undetermined significance. These are glandular cells which demonstrate changes which exceed those normally expected in benign reactive processes but which are insufficient for a diagnosis of AIS or adenocarcinoma AIS Adenocarcinoma in situ ASCUS Atypical squamous cells of undetermined significance. These are minor epithelial cell changes whose nature is uncertain but which may result from inflammation and repair processes, human papilloma virus (HPV) effect or minor squamous or glandular intraepithelial neoplasia ASYMPTOMATIC Without symptoms ATYPIA Deviation from the normal or typical state BENIGN TUMOUR A tumour that is not malignant, which usually remains a uniform shape enclosed in a fibrous sac. It does not spread to other parts of the body, and usually does not recur after being removed. A benign tumour does not indicate cancer BETHESDA SYSTEM A systematic method of reporting cervical smear results BIOPSY Removal of a sample of tissue from the body, for examination under a microscope, to assist with the diagnosis of a disease CANCER (Ca.) A general term for a large number of diseases which all display uncontrolled growth and a spread of abnormal cells. Also called a malignant tumour CANCER PRECURSOR Pre-cancerous CARCINOMA A malignant new growth or tumour made up of epithelial cells that may infiltrate surrounding tissues and give rise to metastases CARCINOMA IN SITU (CIS) A high grade abnormality confined to the squamous cell epithelial layer of the cervix. Without treatment it may develop into invasive cancer. This is synonymous with CIN-3 CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) Abnormal, potentially pre-cancerous cell changes of the cervix. The abnormality can be graded as mild (CIN-1), moderate (CIN-2) and severe/CIS (CIN-3) CERVICAL SMEAR TEST A screening test for the detection of squamous intraepithelial lesions, in which a sample of the surface cells of the cervix or vagina/vault is taken, preserved immediately and sent to the laboratory for examination CERVIX (Cx.) The neck of the uterus CIN Cervical intraepithelial neoplasia CIN-1 Mildly abnormal cervical squamous cell changes CIN-2 AND CIN-3 Moderately and severely abnormal cervical squamous cell changes CLINICAL Matters relating to the health and care of patients COITUS Sexual intercourse COLPOSCOPE An instrument which allows the cervix and vagina to be examined in more detail. It is a lighted magnifying instrument resembling a small mounted pair of binoculars. A colposcope may have a camera attached that enables a woman to view her cervix on a television monitor COLPOSCOPY An examination of the lower genital tract using a colposcope to examine for abnormal tissue. Colposcopy has a central role in diagnosis and management or premalignant disease of the cervix. It is a diagnostic technique involving the examination of a woman’s cervix using a low powered microscope and to facilitate biopsy for histological examination as appropriate. Treatment may also be carried out under colposcopic examination CONE BIOPSY, CONE EXCISION Surgical removal of a cone-shaped section of the cervix to remove abnormal cells. The procedure is diagnostic and may be curative COVERAGE The number, percentage, or proportion of eligible women reached by the NCSP CYTOLOGY The study of cells. Cervical cytology aims to detect squamous cell carcinoma or the precursors of cervical carcinoma. The cells are examined under a microscope for signs of abnormality:
CYTOPATHOLOGY The science of the study of diseased cells DIAGNOSIS Identification of disease DIAGNOSTIC SMEAR A smear taken outside the normal screening interval as part of the diagnostic assessment of a woman who has signs or symptoms which might indicate cervical cancer DIFFERENTIATION The process by which abnormal or immature cells are distinguished by individual characteristics which are attributes of normal cell types DOH Department of Health DYSPLASIA Abnormal cell growth DYSPAREUNIA Difficult or painful coitus (sexual intercourse) in women ECTOCERVIX External aspect of the cervix ENDOCERVIX Internal aspect of the cervix ENROLMENT The process of entering a woman’s cervical smear information and results on the NCSR EPIDEMIOLOGY The study of the distribution and causes of diseases and events in populations and the application of this study to the control of health problems EPITHELIUM Cells which make up the lining of the external surface and some internal linings of the body, i.e. the skins, the lining of the lungs, the genital tract, the bladder EJUSDEM GENERIS The rule that where particular words are followed by general words, the general words are limited to the same kind as the particular words GLANDULAR Epithelial cells that produce a secretion HFA Health Funding Authority and any successor to the HFA HIGH GRADE LESION A cytological diagnosis encompassing CIN-2 and CIN-3 (moderate dysplasia, severe dysplasia and carcinoma in situ), high grade squamous intraepithelial lesion (HSIL), and adenocarcinoma in situ (AIS) HISTOLOGY The microscopic study of the minute structure and composition of tissues by tissue sections. Within the context of the NCSP this includes:
HISTOPATHOLOGY The science of the study of diseased tissues HSIL High grade squamous intraepithelial lesion. A cytological diagnosis encompassing CIN-2, CIN-3 and CIS (moderate dysplasia, severe dysplasia and carcinoma in situ) HUI Generic term for Maori gathering, meeting or conference (typically held on a Marae) and organised according to Maori protocol HUMAN PAPILLOMAVIRUS (HPV) A group of wart viruses, a high proportion of which are sexually transmitted HYSTERECTOMY Surgical removal of the uterus. The operation may be recommended for persistent or recurrent CIN. Radical hysterectomy is performed in certain cases of early invasive cervical cancer. In a total hysterectomy the uterus and cervix are both removed and in a subtotal hysterectomy the cervix remains - so that regular smears are still necessary INCIDENCE The number of new cases of a specified disease which are diagnosed or reported during a defined period of time in a specified population INTRAEPITHELIAL NEOPLASIA Abnormal cells in the epithelium of the lower genital tract. See CIN, VAIN, VIN INVASIVE CANCER OF THE CERVIX (INVASIVE SQUAMOUS CELL CARCINOMA) Condition where cancerous cells spread beyond the surface epithelium into the underlying tissues. It may be diagnosed by clinical examination with biopsy in women who present with abnormal bleeding and discharge. The cervical smear is not a reliable method of diagnosing cervical cancer. Classified in four stages, from Stage I where the cancer has not spread beyond the cervix, to Stage IV where it has extended beyond the pelvis. Cold knife cone biopsy or an extended hysterectomy (involving the upper vagina and lymph nodes) may be used to treat early stage disease. Late stage disease is usually treated by radiation therapy KAIMAHI Maori cervical screening co-ordinators, educators and smear takers KAITIAKI Caregivers or guardians. The National Kaitiaki Group refers to the group set up to oversee the disclosure, use, and publication of Maori women’s summary data held on the NCSR under the Health (Cervical Screening (Kaitiaki)) Regulations 1995 LAY SMEAR TAKERS Smear takers who have successfully completed an accredited educational course in smear-taking and have no formal medical, nursing, or midwifery qualifications LESION An area of tissue damaged by disease or injury LLETZ Large Loop Excision of the Transformation Zone LOW GRADE LESION A cytological diagnosis encompassing the changes previously described as HPV infection and or CIN-1 (mild dysplasia) and atypical glandular cells - favouring dysplasia LSIL Low-grade squamous intraepithelial lesion MALIGNANT TUMOUR A cancer. A tumour that grows and invades surrounding tissue and infiltrates the blood and lymphatic vessels. It eventually destroys the surrounding tissue and may spread to other parts of the body (metastasise) (See cancer) MALIGNANCY A condition which if unchecked usually develops into serious illness and may cause premature death. When applied to tumours, may be described as an uncontrolled growth of cells. MANAGEMENT The complete care of a patient including advice, information, treatment and follow-up treatment or monitoring of a condition METASTASES Malignant cells which have spread via lymph or blood vessels from the original site to another site in the body MOH Ministry of Health MORTALITY The number of deaths from a specified disease during a defined period of time in a specified population NCSP National Cervical Screening Programme NCSR National Cervical Screening Register NEOPLASTIC Cancerous (See cancer/malignant tumour) NON-MEDICAL SMEAR TAKERS People trained and approved to take cervical smears. A non-medical smear taker is usually a registered or enrolled nurse with a current practising certificate but may be lay. If the trainee smear taker is a lay person additional teaching is given to enable them to practice safely NORMAL SMEAR A smear result which is reported to be within normal limits PAPANICOLAOU TEST (SMEAR) A simple painless test used to detect pre-cancerous or cancerous changes in the genital tract. Often called Pap smear or test. This term is not generally used in NZ. The preferred term is cervical smear test PATHOLOGY The study of the essential nature of disease, particularly changes in body tissues and organs which are caused by disease PLAINTIFF One who brings an action at law PRE-CANCEROUS Disease which has not invaded tissue outside the original site. In the context of this Inquiry, it refers to changes confined to the epithelium or lining tissue, and is denoted by the classifications CIN-1 to CIN-3 and AIS PRECLINICAL Before disease becomes recognisable by symptoms or appearance PREVALENCE RATE The number of cases of a specified disease in a given population at a designated time PROGNOSIS Forecast of the probable course and outcome of a disease including prospects of recovery PUNCH BIOPSY Very small specimen of tissue taken with special biopsy forceps which allows microscopic examination by a pathologist RADIUM A highly radioactive material used in the treatment of malignant diseases RECURRENCE The return of symptoms after a period during which they have disappeared or reduced in intensity, or the reappearance of overt disease RHA Regional Health Authority SCREENING The routine search for unsuspected disease (or medical investigation which does not arise from the patient’s request for advice for a specific complaint) SCREENING TESTS Tests which sort apparently well women who probably have a disease from those who probably do not. Screening is an initial examination only; those with a positive test require a more definitive diagnostic examination SENSITIVITY OF A TEST The proportion of truly diseased persons in the screened population who are identified as diseased by the screening test. Sensitivity is a measure of the probability of correctly diagnosing a case, or the probability that any given case will be identified by the smear test SMEAR TEST See Papanicolaou test SNOMED CODES Systematised Nomenclature of Medicine. A coding system for recording histological diagnosis SPECIFICIFY OF A TEST The proportion of truly non-diseased persons who are so identified by the screening test. It is a measure of the probability of correctly identifying a non-diseased person with a screening test SQUAMOUS CELL CARCINOMA Cancer arising in the squamous epithelium identifiable microscopically by its scaly or plate-like appearance. The most common form of cervical cancer arising from squamous cells in the epithelium (tissue which lines the vagina and outer layers of the cervix) SQUAMOUS CELLS A type specialised cell, which lines the vagina and outer layers of the cervix STANDARD A standard is a minimum requirement upon which practice can be measured TRANSFORMATION ZONE The region of the cervix where columnar cells have changed or are changing to squamous cells. The metaplastic process (change from one cell type to another) may become abnormal due to various factors such as viruses. It is the transformation zone that needs to be completely sampled when a smear is TREATMENTS/THERAPY Management or care of a patient in combating a disease or disorder TUMOUR An abnormal growth of tissue. A benign tumour remains localised. It does not spread to other parts of the body. A malignant tumour (cancer) invades surrounding tissue and may infiltrate the blood and lymphatic vessels. A malignant tumour may spread to other parts of the body. ULTRA VIRES An act in excess of the authority conferred by law, and therefore invalid. UNSATISFACTORY SMEAR A smear that cannot be evaluated by the laboratory UTERUS (WOMB) The hollow muscular organ in which the fertilised egg normally becomes embedded and in which the developing embryo-foetus is nourished. The uterus is a pear-shaped organ consisting of the body of the uterus (or corpus) which narrows to form the cervix or neck of the womb. The Fallopian tubes enter the uterus at its upper outer aspect, and at its lower end the cervix opens into the vagina or front passage VAGINAL VAULT The upper part of the vaginal cavity into which the cervix projects VAIN Vaginal intraepithelial neoplasia (See intraepithelial neoplasia) VAULT SMEAR A smear taken from the top of the vagina after a hysterectomy or radiation treatment for cancer of the cervix VIN Vulval intraepithelial neoplasia (See intraepithelial neoplasia) WEDGE BIOPSY a surgically-excised, wedge-shaped piece of tissue (large than the punch biopsy) taken for examination by a pathologist WHO World Health Organisation
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