Diagnosis of carcinoma cervix

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carcinoma cervix evaluation

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Diagnosis of carcinoma cervix

  1. 1. • 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
  2. 2. • 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
  3. 3. • 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%
  4. 4. How PAP test to be done??? • • • • • 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
  5. 5. NORMAL
  6. 6. 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
  7. 7. 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
  8. 8. LSIL
  9. 9. 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
  10. 10. HSIL
  11. 11. LIQUID BASED CTYOLOGY
  12. 12. • HPV DNA: hybridization (HYBRID CAPTURE II) or PCR, 88% sensitive • ENDOCERVICAL CURETTAGE: scraping of mucus membrane by endocervical brush or curretage
  13. 13. • 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
  14. 14. HINSELMANN
  15. 15. • 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
  16. 16. Normal cervix Acetowhite areas
  17. 17. Abnormal areas • Punctation: Dilated capillaries terminating on the surface appear from the ends as a collection of dots
  18. 18. • Mosaic: terminal capillaries surrounding roughly circular or polygonal shaped blocks of AW epithelium crowded together
  19. 19. • Leukoplakia:
  20. 20. • Atypical vascular pattern: looped vessels,branching vessels,reticular vessels
  21. 21. • 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
  22. 22. CIN 1 • Evaluate every 6 months • With pap test, HPV DNA If lesion progress or persist for 2 years Ablative treatment
  23. 23. CIN 2 and 3 • Require treatment • Loop electrosurgical excision procedure
  24. 24. 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
  25. 25. CRYOTHERAPY • Destroy surface epithelium by crystallization of intracellular fluid • Freeze thaw freeze technique over 9 minutes • CO2(-65oc), nitrous oxide(-89oc)
  26. 26. Applicable only • CIN 1 and 2 • Small lesion • Ectocervical location • Negative endocervical sample • No endocervical gland involvement
  27. 27. Advantages: • Least painful,cheap,best tolerated and safe Disadvantages: • Discharge,infection,bleeding,stenosis
  28. 28. • LASER ABLATION: expensive,special training required
  29. 29. 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
  30. 30. • Disadvantages: hemorrhage,stenosis,preterm labour
  31. 31. 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
  32. 32. Hysterectomy(not indicated) • Older and parous women • Poor compliance with follow up • A/w fibroid, DUB, prolapse • If micro invasion exist • Recurrance
  33. 33. FIGO staging of carcinoma cervix based on: • • • • • • • • • Biopsy Colposcopy Endocervical curettage Conization Hysteroscopy Cystoscopy Proctoscopy Intravenous urography Xray chest and skeleton
  34. 34. Thank you
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