This document discusses carcinoma of the cervix, including survival rates by stage, diagnostic tests, and details of Pap smear tests. The survival rate ranges from over 90% for stage I to under 15% for stage IV. Diagnostic tests mentioned include Pap smear using conventional or liquid-based cytology methods, HPV DNA detection, visual inspection with acetic acid or Lugol's iodine, and colposcopy. Interpretation of tests and techniques for Pap smears are described.

1. CARCINOMA CERVIX
Ava collin juggi
18

2. CONTENTS
➤ SURVIVAL RATE IN EACH STAGE
➤ DIAGNOSTIC TESTS

3. SURVIVAL RATE
1. Stage 1 - >90
%
2. Stage II A. -
>80%
3. Stage II B. -
>65%
4. Stage III A. -
45%
5. Stage III B -
35%
6. Stage IV -
<15%

4. PRE OPERATIVE DIAGNOSTIC TESTS
➤ PAP SMEAR
Conventional
Liquid based cytology
➤ HPV DNA DETECTION
Hybrid Capture II test
PCR
HPV E6/E7 mRNA testing
➤ Visual inspection with acetic acid
➤ Visual inspection with lugols iodine

5. ➤ Other screening tests
➤ Speculoscopy
➤ Spectroscopy
➤ Magnoscope
➤ Colposcopy
➤ Cervicography
➤ Cone biopsy

6. PAP SMEAR - CONVENTIONAL
➤ Normal cell - diploid / polypoid
- Aneuploidy
➤ Sensitivity - 70to 80 %
➤ Specificity - 95 to 98%
➤ Reduce incidence of invasive cancer by 80%
➤ Mortality by 60%

8. Cells are collected from transformation
zone by AYRE ‘S spatula.

11. ➤ Insert the endocervical brush ensuring that the
lower row of bristles are seen .
➤ The endocervical brush is rotated 5 times
clockwise
➤ Sample is smeared onto a slide
➤ Short arm of Ayres spatula is fixed at ext os .

12. ➤ The long arm sweeps over the external
surface of cervix 5 times
➤ The material collected is smeared onto a
slide
➤ Both slides are fixed in absolute alcohol
➤ Transported to lab in koplicks jar

13. ➤ Endo cervical scrape - pipelle
➤ Ectocervical smear - cotton swab

14. ➤ Causes
Improper technique
Dry vagina
Poor shedding of cervical cells

15. Recession of sqamocoloumnar junction in
endocervical canal - post menopausal
women

16. Liquid based cytology
➤ Sample collected by cervical broom
and plastic spatula

17. ➤ Sample placed in bottle containing liquid
fixative ( buffered methanol solution).
➤ Remove blood , mucus and inflammatory
cells

18. ➤ Cells
Sucked into filter membrane
Filter pressed onto a glass slide
Form thin monolayer
Staining

19. ➤ Uses of LBV
➤ Test HPV infection
➤ Genetic studies
➤ Better sample

20. ➤ Artifacts removed
➤ Better diagnosis
➤ Fluid can be used for HPV detection

22. VISUAL INSPECTION WITH ACETIC ACID
➤ Apply 3-5% acetic acid
➤ Normal squamous epithelium appears pink
➤ Coloumnar epithelium appears red

23. Acetic acid coagulates mucus
Dehydration of cells
Coagulation of cellular proteins
Reduce transparency of epithelium
Better recognition of dysplastic cells

24. VISUAL INSPECTION WITH LUGOL’S IODINE
➤ A/k/a schiller’s test
➤ Use lugols iodine instead of acetic acid

25. ➤ PATHOPHYSIOLOGICAL BASIS
➤ Stratified squamous epithelium with
glycogen laden superficial cells
➤ Apply iodine
➤ Stains mahogany brown

26. ➤ Coloumnar cells doesn’t contain glycogen
➤ Doesn’t take up iodine
➤ Unstained

27. Interpretation of VIA and VILI
➤ On application of acetic acid
➤ No aceto white area
➤ Application of acetic acid
➤ Well defined dense aceto white areas

29. VILI
➤ When lugols solution applied
➤ Squamous epithelium turns mahogany
brown
➤ No colour change in coloumnar cells

31. ➤ Application of iodine
➤ Entire cervix turns bright yellow
➤ Dense thick bright mustard yellow or saffron yellow
➤ With or without raised margin in transformation
zone

33. ➤ SUSPICION OF CANCER
➤ Clinically visible frank , nodular, irregular,
ulceroproliferative growth in the cervix
➤ Bleeds on touch

36. Caption

37. SPECULOSCOPY
➤ Disposible
➤ Low intensity
➤ Blue white magnifying device
➤ more false negative cases

38. Spectroscopy
➤ Specific and sensitive
➤ Instant results
➤ Non invasive
➤ Probe tissue morphology and
➤ Biochemical composition

39. Magnoscope
➤ Magnifying lens
➤ Magnifies cells 5 times
➤ Visualisation of punctuation and mosaics
➤ Portable

40. Microspectrophotometry
➤ Distinguishe between benign and malignant
cells

41. Colposcopy
➤ Introduced by HEINSELMAN in 1936
➤ Study cervix when Pap smear detects
abnormal cells
➤ To locate abnormal areas and take biopsy

42. ➤ To study extent of abnormal lesion
➤ Conservative surgery under colposcopic
guidance
➤ Follow up

47. ➤ It is difficult in post menopausal women
➤ Narrow vagina
➤ Senile vaginitis
➤ Squamocoloumnar junction indrawn and
not visible
➤ Atropic cervix flush with vagina

48. CERVICOGRAPHY
➤ Photograph of entire ext Os
➤ Using 35mm camera
➤ Apply 5% acetic acid
➤ Biopsy in selected areas

49. CONE BIOPSY
➤ Diagnostic and therapeutic
➤ Done using cold knife technique under general
anaesthesia
➤ When area of abnormality is large
➤ It’s inner margin is receded into cervical canal
➤ Squamocoloumnar junction is not completely visible
on colposcopy

50. ➤ Discrepancy between cytology and
colposcopy
➤ Bleeding
➤ Infection
➤ Cervical stenosis
➤ Incompetent os

52. LARGE LOOP EXCISION OF TRANSFORMATION ZONE
➤ Less bleeding
➤ Low chance of infection
➤ Fast healing
➤ No scar formation

54. AgNOR
➤ Molecular tumour marker
➤ DNA in dysplastic cell which appear as
black dots
➤ Increase in number,decrease in size

56. ➤ NAME THE TEST AND IT’S
INTERPRETATION

57. ➤ Test. : VILI
➤ interpretation: negative

58. ➤ Identify
C
A
B

59. :
➤ A : transformation zone
➤ B: new SC junction
➤ C: old squamocoloumnar junction

60. ➤ Identify the instrument and it’s use

61. ➤ Ayre’s spatula
➤ Usedto collect cells from transformation
zone

62. ➤ In a 25 year old female, when should we do
Pap smear screening??

63. every 3 years

64. ➤ Reason for false negative Pap smear in
post menopausal women ? How can we
prevent it ??

65. Recession of sqamocoloumnar junction in
endocervical canal - post menopausal
women

66. ➤ Shaw’s textbook of gynaecology
➤ Bhasker Rao and Roy chowdhury clinical gynaecology