Cervical Cancer Screening Module 4 - from Massachusetts Medical Society. Copyright © 2013. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411

1. Cervical Cancer Screening
Module IV
Techniques for Evaluation of Abnormal
Pap Smear
Treatment of Preinvasive Disease

2. Techniques for Evaluation of
Abnormal Pap Smear
Colposcopy
Biopsies
LEEP and Cone Biopsy
Dilation and Curettage, hysteroscopy
Hysterectomy
Module IV

3. Techniques for Evaluation of
Abnormal Pap Smear
Colposcopy
Evaluation of the cervix, vagina, and
vulva with a colposcopy after the
application of acetic acid 3-5%
Crucial to have appropriate dilation of
acetic acid. Less dilute solutions (strength
greater than 5%) can cause third degree
burns
Module IV

4. Techniques for Evaluation of
Abnormal Pap Smear
Colposcopy
Adequate colposcopy means that the
entire squamo-columnar boundary is
seen or that the full extent of the lesion is
seen.
Module IV

5. Techniques for Evaluation of
Abnormal Pap Smear
Biopsies
Endocervical sampling involves a
curettage of the endocervical canal
Module IV

6. Cervical Cancer Screening
Treatment of Preinvasive Disease
Low Grade Preinvasive Disease
Most LSIL will not have treatment
High Grade Preinvasive Disease
Module IV

7. Treatment of Preinvasive Disease
High Grade Preinvasive Disease
Observation
LEEP
Cone Biopsy
Cryotherapy
Carbon Dioxide Laser Ablation
Hysterectomy
Module IV

8. Treatment of High Grade Preinvasive Disease
Hysterectomy
Laparoscopic
Vaginal
Abdominal
Module IV

9. Simple Hysterectomy
Prevesical space
Vesicouterine ligament
Paravesical space
Vesicouterine space
Cardinal ligament
Rectovaginal space
Pararectal space
Uterosacral ligament
Retrorectal space

10. CERVICAL CANCER
SCREENING
MODULE IV
CONCLUSIONS
-This module summarizes the steps to the pelvic exam and
the evaluation of an abnormal pap smear.
-Treatment of preinvasive disease includes fertility-sparing
local ablative techniques and simple hysterectomy for
women who have completed child bearing.