Welcoming remarks by Dr Osborne E Nyandiva on Symposium: Cervical cancer and its prevention
Co-Presenter Dr Giama. We are happy to present to you this very crucial discussion on Cancer.
Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).
Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
Current knowledge and state of the art about management of abnormal cervical Cancer screening tests and cancer precursors for health providers in low-income settings is presented.
Welcoming remarks by Dr Osborne E Nyandiva on Symposium: Cervical cancer and its prevention
Co-Presenter Dr Giama. We are happy to present to you this very crucial discussion on Cancer.
Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).
Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
Current knowledge and state of the art about management of abnormal cervical Cancer screening tests and cancer precursors for health providers in low-income settings is presented.
Basics To Ca Cx Screening (Eastern Biotech)Pankaj Sohaney
Detecting HPV means better understanding of the risk of cervical cancer was the major focus of Dr. Dinesh Gupta. He spoke on “Opportunistic Screening for Cervical Precancer Lesions” and informed why the combination screening is vital for prevention and detection of cervical cancer. According to Dr. Gupta, combined screening with liquid based cytology and hybrid capture2 HPV DNA test would identify who’s at risk for high-grade disease and cancer and reduce missed disease caused by false-negative Pap Smear. HPV DNA test is the only FDA approved test to detect 13 high risk HPVs associated with virtually all cervical cancer, he added.
The presentation describes various facts about breast and cervical cancer including burden of disease, survival outcomes, need for early diagnosis and screening recommendations.
Basics To Ca Cx Screening (Eastern Biotech)Pankaj Sohaney
Detecting HPV means better understanding of the risk of cervical cancer was the major focus of Dr. Dinesh Gupta. He spoke on “Opportunistic Screening for Cervical Precancer Lesions” and informed why the combination screening is vital for prevention and detection of cervical cancer. According to Dr. Gupta, combined screening with liquid based cytology and hybrid capture2 HPV DNA test would identify who’s at risk for high-grade disease and cancer and reduce missed disease caused by false-negative Pap Smear. HPV DNA test is the only FDA approved test to detect 13 high risk HPVs associated with virtually all cervical cancer, he added.
The presentation describes various facts about breast and cervical cancer including burden of disease, survival outcomes, need for early diagnosis and screening recommendations.
Atlas on bethesda system for reporting cervical cytologyAshish Jawarkar
This is an atlas with more nearly 100 images, authentic taken from NCI web atlas. Useful to understand and report pap smears. The subject has been presented in a way which will help students reproduce in exams.
Nulife module 6 screening for malignancies editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
Cervical cancer by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Cervical cancer develops in a woman's cervix (the entrance to the uterus from the vagina).
Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.
Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.
Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570 000 women were diagnosed with cervical cancer worldwide and about 311 000 women died from the disease.
Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.
When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.
With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
2. Cervical Cancer Screening
Techniques of Screening
Physical Exam
Visual Inspection with Acetic Acid
Pap Smear
HPV Testing
Cervical Biopsies
Module III
3. Techniques of Screening
Physical Exam
1. Visually examine the vulva and perianal region
2. Insert the speculum into the vagina
3. Visually examine the cervix and the walls of the
vagina
4. Palpate the cervix and the walls of the vagina.
5. Palpate the parametria and uterosacral ligaments by
rectovaginal exam
Module III
4. Techniques of Screening
Visual Inspection with Acetic Acid
With the speculum in the vagina and the
cervix visualized, apply 3% acetic acid using
a sponge (ALERT: confirm that the acetic
acid has been diluted. 100% acetic acid
will cause third degree burns)
Wait 60 seconds and then visually examine .
Dysplastic lesions are nuclear dense. The
dehydration of the mucous membrane will
temporarily cause dysplastic lesions to look
white
Module III
5. Visual Inspection
Author, year of
publication, country of
study
No. of participants
Sensitivity, % (95%
CI)
Specificity, % (95%
CI)
University of
Zimbabwe/JHPIEGO [5],
1999, Zimbabwe
2148
77 (70–82)
64 (61–66)
Denny et al. 2000, South
Africa
2885
67 (56–77)
84 (82–85)
Belinson et al. [24],
2001, China
1997
71 (60–80)
74 (71–76)
Denny et al. [8], 2002,
a,c
South Africa
2754
70 (59–79)
79 (77–81)
Cronjé et al. [9], 2003,
South Africa
1093
79 (69–87)
49 (45–52)
54,981
79 (77–81)
86 (85–86)
Sankaranarayanan et al.
[25], 2004 India and
b,c
Africa
Sensitivity – 67-79% Specificity – 49-86%
Technique :Place Speculum
Apply 3-5% Acetic Acid
Wait at least 1 Minute; record Observations
Module III
6. Techniques of Screening
Pap Smear
With a spatula, rotate the spatula 360
degrees around the exocervix
With a cytobrush, place the brush within
the endocervix and rotate 360 degrees
Apply both the spatula and cytobrush to a
slide and then apply fixative
Or place spatula and cytobrush into liquid
based solution and break off the tips
Module III
7. SCREENING
conventional cytologic sampling
Thin layer (or liquid-based) cytology
ThinPrep (1996)
AutocytPrep (1999)
SurePath (2000)
MonoPrep (2006)
liquid-based : other diagnostic assessments (only Thin
Prep is FDA approved )
testing for gonorrhea
chlamydia
HPV
Module III
8. Sources of potential error in the Pap smear
The clinician may not sample the area of cervical
abnormality.
The abnormal cells may not be plated on the slide or
transferred to the liquid medium.
The cells may not be adequately preserved with fixative.
The cytologist may inaccurately report the findings
The cytopathologist may not identify the abnormal cells.
Module III
9. Techniques of Screening
HPV Testing
HPV testing should be confined to testing
for high risk (oncogenic) subtypes
HPV testing for low risk (nonocogenic)
subtypes has NO role in the evaluation of
abnormal pap smears
Module III
10. HPV TESTING
p16 cytology
P16 cytology can be used as a triage test in HPV-positive
women.
P16 is a marker of HPV oncogene activity that is
independent of carcinogenic HPV tyoe
Carozzi . Lancet Oncol 2012
Of 1170 HPV positive women,493 (42%) overexpressed p16
at baseline
At baseline, 55 of these 493 women had CIN3 (9.7%)
Compared to p16 negative over expression, positive p16 had
a longitudinal sensitivity of 82.4%
Module III
12. Cervical Cancer Screening
Screening Guidelines
Screening Guidelines can be separated
into two sections
General guidelines for when to pap
smears and on whom
What follow up and intervention is
recommended based on pap sear results
Module III
13. Cervical Cancer Screening
Screening Guidelines
Guidelines are only for women at average risk for cervical cancer.
These guideline do not apply to women with:
history of cervical cancer
In Utero exposure to DES
who are immuno-compromised
organ transplantation,
chronic steroid use,
chemotherapy
HIV positive
Module III
14. Screening Guidelines
When to perform pap smear
Do not screen before age 21 years
Screening should start at age 21
Screening guidelines are age dependent
Annual pap smears in women without a history of
premalignant or malignant lower genital disease are no
longer recommended
Recommended Screening practices should not change
on the basis of HPV vaccination status
Module III
15. PREVALENCE OF CIN 3 OR GREATER BY AGE
MOORE 2008
CIN3 OR
GREATER
LESS THAN CIN 3
TOTAL
<50 YEARS
189 (71%)
77 (29%)
266
>50 YEARS
51 (59%)
35 (41%)
86
TOTAL
240
112
352
Patients older
than 50 had
Signif higher
Prevalence CIN3
Module III
16. Vaccination Against HPV
Recommend routine HPV vaccination for females aged
11 to 12 years
Recommend routine vaccination for females aged 13 to
18 years to “catch-up” those who missed earlier
screening
Insufficient data to recommend for or against universal
vaccination of females aged 19 to 26 years
Module III
17. Screening Guidelines
When to perform pap smear
Ages 21- 29 years: PAP SMEAR screening every three
years
No screening HPV testing
HPV testing only for evaluation of atypical squamous
cells of uncertain significance
Module III
18. Screening Guidelines
When to perform pap smear
Ages 30 – 65 years:
screening with both PAP SMEAR and HPV testing
every five years (preferred)
Or PAP SMEAR testing every three years (accepted)
Module III
19. Screening Guidelines
When to perform PAP SMEAR
Ages greater than 65: No Further Pap Smear Testing
who have had > 3 consecutive normal pap tests
or > 2 consecutive negative HPV tests and pap tests in
last 10 years with the most recent pap occurring within
the last 5 years
or women who have had hysterectomies for benign
disease
Module III
20. Cervical Cancer Screening
Screening Guidelines
In 2012 the American Society for
Colposcopy and Cervical Pathology
(ASCCP) published new guidelines for
management of pap smear results
Guidelines should never replace clinical
judgment
Module III
21. ASCCP Guidelines
Guidelines for management of abnormal pap smears
are different by the following age categories:
Ages 21- 24
Ages over 30
Guidelines for management of abnormal pap smears
are different for the pregnant woman (see screening:
special situations)
Module III
22. ASCCP Guidelines
Unsatisfactory Cytology
Repeat pap smear after 2 to 4 months
Refer to colposcopy for persistently unsatisfactory pap
smears
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.1
3.pdf (Page 4)
24. ASCCP Guidelines
Age > 30: Cytology Negative & HPV positive
For HPV 16 and 18: colposcopy
Repeat co-testing in one year is acceptable
http://www.asccp.org/Portals/9/docs/Algorithms%207.30
.13.pdf (Page 6)
25. Risk of HSIL with + HPV HR
2% (52 of 2562 over 10 years) Khan 2005
3% (88 of 2941 over 10 years) Castle 2002
1.2% (30 or 2562 over 10 years) Miller 2002
Module III
26. ASCCP Guidelines
ASC - US
Repeat pap smear in one year, if ASC-US again: refer
to colposcopy
OR
Upfront HPV testing, if HPV positive: refer to
colposcopy
http://www.asccp.org/Portals/9/docs/Algorithms%207.30
.13.pdf (Page 7)
27. ASCCP Guidelines
Ages 21-24 – ASC-US or LSIL
HPV testing:
If HPV negative: return to routine testing
If HPV positive: repeat pap smear in one year
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.
13.pdf (Page 8)
28. ASCCP Guidelines
ASC-US ages 21-24
Initial Management
Cytology alone in 12 months is preferred
Reflex HPV testing acceptable
If HPV positive, repeat cytology one year
If HPV negative, return to routine screening with
cytology alone in three years
Module III
29. ASCCP Guidelines
LSIL
If LSIl and HPV negative, repeat pap smear in one year
If LSIL and HPV positive: refer to colposcopy
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 9)
31. ASCCP Guidelines
Ages 21-24 -ASC-H
If colposcopy is negative, repeat pap smear and
colposcopy every six months for two years
If HSIL is found, acceptable to monitor for one year. If
lesion is persistent for one year, treat with excision
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 12)
33. ASCCP Guidelines
AGC
All women with AGC need colposcopy
Women > AGC also need an endometrial biopsy
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 14)
34. ASCCP
Subsequent management of AGC after
colposcopy
For CIN 2 but no glandular lesion, manage per
ASCCP guideline
For negative biopsies, repeat pap and HPV testing
yearly for two years
For preinvasive glandular lesion, treat by excisional
biopsy
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 15)
35. Histologic Outcome after Atypical Glandular Cells
Obstet Gynecol 2010; 115:243-248
Age < 50 years
Age < 50 years
Age > 50 years
Age > 50 years
HPV neg
(n=656)
HPV pos
(n=269)
HPV neg
(n=420)
HPV pos
(n=497)
CIN 2
10
34
4
9
CIN 3
3
42
1
5
Cervical
4
adenoca in situ
29
1
4
Cervical SCC
2
10
1
6
Cervical
adenoca
0
7
1
2
Endometrial
atypical
10
0
10
0
Endo CA
10
3
44
0
Other cancers
0
0
6
0
36. ASCCP Guidelines
Biopsy: CIN I
No treatment
Repeat pap smear and HPV testing in one year
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 16)
37. ASCCP Guidelines
Biopsy: CIN I after Pap ASC-H or HSIL
Treatment not recommended
Repeat pap smear and HPV testing yearly for two years
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 17)
38. ASCCP Guidelines
Ages 21-24 – Biopsy CIN I
Treatment not recommended
After ASC-US or LSIL pap: Repeat pap smear
After ASC-H or HSIL pap: repeat pap smear and
colposcopy every six months for one year
If colposcopy is inadequate: excisional procedure
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 18)
40. ASCCP Guidelines
Young women, Biopsy: CIN 2-3
Excisional procedure
OR
Pap smear and colposcopy every six months for one
year
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 20)
42. Cervical Cancer Screening
Special Screening Situations
Immunosuppression
Pregnancy
After Hysterectomy
After Treatment for Cervical Cancer
After Pelvic Radiation
Challenging Anatomy
History of Sexual Assault
In Utero DES (diethylstilbestrol) exposure
Module III
44. Immunosuppression
Human Immunodeficiency Virus
Women with HIV infection are at high risk
for preinvasive lower genital tract disease
and cervical cancer
They are high risk for persistent HPV
infections
They should be screened by PAP SMEAR
twice in the first year and then yearly
thereafter
Module III
45. Immunosuppression
Organ Transplant
Women who are on high dose
immunosuppressants are at high risk for
lower genital tract neoplasia
They should be screened by PAP SMEAR
twice in the first year and then yearly
thereafter
Module III
46. Immunosuppression
Chronic Steroid Use
Chronic steroid use can lead to a
reduction in the clearance of HPV
infection
They should be screened by PAP SMEAR
twice in the first year and then yearly
thereafter
Module III
47. Special Screening Situations
Pregnancy
Pap smear is performed at first prenatal
visit and at the six week post partum visit
Abnormal Pap smears are evaluated in a
similar manner to non-pregnant women
Module III
48. Special Screening Situations
Pregnancy: ASC-US pap
Identical to non-pregnant women
It is acceptable to defer colposcopy until 6
weeks postpartum
Endocervical curettage is unacceptable
For pregnant women with no cytologic,
colposcopic , or histologic findings of CIN,
postpartum follow-up is recommended
Module III
49. ASCCP Guidelines
Pregnant with LSIL
Colposcopy in pregnancy
Treatment of all preinvasive lesions delayed until after
delivery
http://www.asccp.org/Portals/9/docs/Algorithms%207.30.13.p
df (Page 10)
50. Special Screening Situations
After Hysterectomy
Cervical cancer screening is not indicated if
removal of cervix or entire uterus in women
with no history of cervical cancer or
preinvasive disease.
Women who have undergone a subtotal
hysterectomy with preservation of the cervix
should follow screening recommendations
of average risk women
Module III
51. Special Screening Situations
After Treatment for Cervical Cancer
No age cut off for stopping screening
Women should undergo pap smears every 3 to 4
months for the first two years after treatment for
cervical cancer.
Pap smear screening is performed every 6
months from years 2 to 5 after treatment
Annual pap smear screening five years after
treatment
Module III
52. Special Screening Situations
After Pelvic Radiation
There is a higher risk of radiation induced
malignancies after pelvic radiation.
Annual pap smear screening should be
performed in women who receive pelvic
radiation for all cancer types (lymphoma,
cervical cancer, endometrial cancer, rectal
and anal cancer)
Module III
54. Challenging Anatomy
Vaginismus
Vaginismus is the painful and
involuntary contraction of vaginal
muscles
Causes: sexual assault, vulvar vestibulitis,
inflammatory conditions of the pelvic
floor such as diverticulitis
Adequate pelvic examination and pap
smear may require an examination under
anesthesia
Module III
56. Challenging Anatomy
Pelvic Floor Prolapse
Uterine prolapse can place the cervix at
the introitus leading to trauma and
cornification of the cervix
Module III
57. Challenging Anatomy
Vaginal Agglutination
Vaginal agglutination can occur after
radiation, trauma, surgery, and infection
Evaluation by examination under
anesthesia should be considered
Use of vaginal dilators and estrogen
vaginal cream should be considered
Module III
58. Challenging Anatomy
Cervical Stenosis
Cervical stenosis is defined as the inability
to place a cutip or cytobrush within the
endocervix
There is increased risk of a false negative
pap smear
Recommendation:
Dilation of cervix
In a postmenopausal woman, consideration
of a transvaginal ultrasound to evaluate the
endometrial cavity for fluid
Module III
59. Challenging Anatomy
Obesity
Obesity can in some women lead to
difficulty examining the cervix due to
discomfort, vaginal wall redundancy, or
increased vaginal length.
Sensitive use of larger speculums and
retraction of the labia by an assistant can be
helpful in optimally postioning the
speculum to visualize the cervix
Module III
60. Special Screening Situations
History of Sexual Assault
Women who have survived the trauma of sexual
assault should be screened for sexually
transmitted disease including HIV testing.
For women who are older than age 30, high risk
HPV testing should be offered.
Consideration should be given for a pap smear
regardless of the timing of their previous pap
smear test within six months of sexual assault for
women older than age 21 years.
Module III
61. Special Screening Situations
In Utero DES (diethylstilbestrol) exposure
The cohort of women exposed to
Utero DES were born before 1980.
In-
They have a twofold increased risk of
cervical dysplasia
Based on clinician judgment, they should be
screened at least every three years if they
have had three consecutive normal pap
smears
Module III
62. CERVICAL CANCER
SCREENING
MODULE III
CONCLUSIONS
-This module summarizes the screening recommendations
for the average risk patient.
-The full algorithms can be reviewed on the asccp website:
http://www.asccp.org/Guidelines
-Providers must be cognizant of special screening situations
and tailor evaluation to each patient, their particular
anatomy, and their particular risk factors.