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.
Cervical Cancer Screening Guidelines and Diagnostic Techniques Summary
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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
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
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
17. • HPV DNA: hybridization (HYBRID CAPTURE
II) or PCR, 88% sensitive
• ENDOCERVICAL CURETTAGE: scraping
of mucus membrane by endocervical brush
or curretage
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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
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
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
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33. CIN 1
• Evaluate every 6 months
• With pap test, HPV DNA
If lesion progress or persist for 2 years
Ablative treatment
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
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
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