The document summarizes guidelines from various health organizations for cervical cancer screening and diagnostic procedures. It recommends that cervical cancer screening should begin between ages 21-30 and can stop at age 70 if prior results were normal. It describes the Pap test procedure and provides information on abnormal results and procedures like colposcopy, LEEP, and conization used to diagnose and treat cervical dysplasia or cancer.

3. • AMERICAN CANCER SOCIETY
recommendation
Screening should begin at the age of 21
Or within 3 years of onset of sexual activity
Stop at age of 70,if no abnormal result in past
10 years

4. • AMERICAN COLLEGE OF OBSTETRICIANS AND
GYNECOLOGISTS recommendations states
Women younger than the age of 30 should
undergo screening yearly
Those older than the age of 30 can extend
screening their screening interval to 2 to 3
years

5. • US FOOD AND DRUG ADMINISTRATION
approved
HPV DNA testing combined with cervical
cytology as a screening technique for
women older than age 30
When results of both tests are
negative,does not have to be retested for
3 years
The negative predictive value of a double
negative test exceeds 99%

6. How PAP test to be
done???
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Patient in dorsal position
Labia minora parted
Speculum introduced
Cervix exposed
Squamocolumnar junction scraped with
spatula by rotating all around
• Spread on slide and immediate fixation
• Stained with papanicolaou
• Presence of
: satisfactory

10. NORMAL

11. Atypical Squamous Cells
• 10% to 20% incidence of CIN 1
• 3% to 5% risk for CIN 2 or 3
• Repeat pap test every 4 to 6 months with
referral for colposcopy
• Immediate colposcopy
• HPV testing

12. Low Grade Squamous
Intraepithelial Lesions
• 75% of the patients have CIN,of these 20%
being CIN 2 or 3
• Colposcopy done to evaluate a single LSIL
result

13. LSIL

14. High Grade Squamous
Intraepithelial Lesions
• Should undergo colposcopy and directed
biopsy
15-30% false negativity
Sensitivity 50-60% and specificity 95-98%
• Post menopausal women: indrawing of
SCJ,dry vagina,poor exfoliation
• Estrogen cream 10 days

15. HSIL

16. LIQUID BASED CTYOLOGY

17. • HPV DNA: hybridization (HYBRID CAPTURE
II) or PCR, 88% sensitive
• ENDOCERVICAL CURETTAGE: scraping
of mucus membrane by endocervical brush
or curretage

19. • Binocular stereoscope giving 10-20 times
magnification
To study cervix when pap smear detect
abnormal cells
To locate the abnormal areas and take biopsy
Conservative surgery under colposcopic
guidence
Follow up

20. HINSELMANN

21. • Visual inspection of acetowhite areas;
• Applying 5% acetic acid
• Acid coagulates protein of nucleus and
cytoplasm and makes the protein opaque
and white
• Dull white plaque with faint border: LSIL
• Thick plaque with sharp border: HSIL

24. Normal cervix
Acetowhite areas

25. Abnormal areas
• Punctation:
Dilated
capillaries
terminating
on the surface
appear from
the ends as a
collection of
dots

27. • Mosaic: terminal
capillaries
surrounding
roughly circular
or polygonal
shaped blocks of
AW epithelium
crowded
together

28. • Leukoplakia:

29. • Atypical vascular pattern: looped
vessels,branching vessels,reticular vessels

30. • Diagnostic and therapeutic
• Large abnormalities,inner wall receded into
cervical canal,SCJ not visible
 Cold knife technique under GA
 Large loop excision of transformation zone
 Laser excision

33. CIN 1
• Evaluate every 6 months
• With pap test, HPV DNA
If lesion progress or persist for 2 years
Ablative treatment

34. CIN 2 and 3
• Require treatment
• Loop electrosurgical
excision procedure

35. Ablative therapy is appropriate
when
• No evidence of microinvasion or invasive
cancer
• Lesion located on ectocervix
• No involvement of the endocervix with high
grade dysplasia

36. CRYOTHERAPY
• Destroy surface
epithelium by
crystallization of
intracellular fluid
• Freeze thaw freeze
technique over 9
minutes
• CO2(-65oc), nitrous oxide(-89oc)

37. Applicable only
• CIN 1 and 2
• Small lesion
• Ectocervical location
• Negative endocervical sample
• No endocervical gland involvement

38. Advantages:
• Least painful,cheap,best tolerated and safe
Disadvantages:
• Discharge,infection,bleeding,stenosis

39. • LASER ABLATION: expensive,special training
required

40. LEEP
• Low voltage diathermy
o Loop advanced lateral to lesion
o When required depth reached
o Loop taken across to opposite side
o Cone of tissue removed
• Cutting d/t steam envelope developing at the
interface b/w wire loop and tissue

41. • Disadvantages: hemorrhage,stenosis,preterm
labour

42. Conization
• Entire outer margin and endocervical lining
short of internal os
 Bleeding, Sepsis, Stenosis, Abortion,
Preterm labour
Indications
• Limits of lesion not visible
• SCJ not seen
• ECC finding positive for CIN 2 and 3
• Lack of correlation
• Microinvasion is suspected

43. Hysterectomy(not indicated)
• Older and parous women
• Poor compliance with follow up
• A/w fibroid, DUB, prolapse
• If micro invasion exist
• Recurrance

44. FIGO staging of carcinoma
cervix based on:
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Biopsy
Colposcopy
Endocervical curettage
Conization
Hysteroscopy
Cystoscopy
Proctoscopy
Intravenous urography
Xray chest and skeleton

45. Thank you