The document discusses preventative strategies for cervical cancer, including social and behavioral changes, vaccination, and screening. It covers HPV vaccines, recommended doses and schedules. Screening methods like downstaging, Pap smear, LBC, HPV DNA, colposcopy, VIA, VILI are explained. Interpretation of results, management guidelines for abnormal findings, diagnostic techniques like colposcopy and different treatment modalities including cryotherapy, LEEP, and conization are summarized.
Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.
Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Introduction
Pregnancy is a normal physiological process and any intervention that is offered to the pregnant or expectant mother should have known benefits and should be acceptable to the woman
Screening in pregnancy is the process of surveying a population of women with markers and defined screening cut-off levels, to identify those at higher risk for a particular disorder
All pregnant women, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
A.B.C. of Paps Smear Update (2016) ,DR. SUDHIR JAIN Consultant Pathologist Lifecare Centre
HISTORY
Papanicolaou first reported in 1923 that cervical cancer or precancer could be detected by pap smear.
But it was only in 1943 that Pap test became accepted and widely used.
Many terminologies were used. Mostly numbers and term dysplasia. There were multiple poorly defined gradations which were poorly reproducible.
In 1988 the first Bethesda System workshop was convened to address the issue and to standardize the reporting of pap smear.
In 2001 a consensus was achieved and a terminology was recommended The 2001 Bethesda System (TBS)
Revision agreed upon in 2014
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Introduction
Pregnancy is a normal physiological process and any intervention that is offered to the pregnant or expectant mother should have known benefits and should be acceptable to the woman
Screening in pregnancy is the process of surveying a population of women with markers and defined screening cut-off levels, to identify those at higher risk for a particular disorder
All pregnant women, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Endometrial hyperplasia - irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
Endometrial Ca - most common gynaecological maglinancy in the western country, endometrial hyperplasia as the precursor
Incidence of endometrial hyperplasia 3 folds higher than endometrial Ca
Fourth most common cancer in women in Peninsular Malaysia
A.B.C. of Paps Smear Update (2016) ,DR. SUDHIR JAIN Consultant Pathologist Lifecare Centre
HISTORY
Papanicolaou first reported in 1923 that cervical cancer or precancer could be detected by pap smear.
But it was only in 1943 that Pap test became accepted and widely used.
Many terminologies were used. Mostly numbers and term dysplasia. There were multiple poorly defined gradations which were poorly reproducible.
In 1988 the first Bethesda System workshop was convened to address the issue and to standardize the reporting of pap smear.
In 2001 a consensus was achieved and a terminology was recommended The 2001 Bethesda System (TBS)
Revision agreed upon in 2014
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.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
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In this webinar:
Dr. Paula Gordon will share information on when individuals should start screening for breast cancer, and how often to screen - in order for cancer to be found as early as possible, and to allow the least aggressive options for treatment. Dr. Gordon will also discuss how to screen for recurrence in women who’ve had cancer, explain why these methods are not always offered, and suggest what you can do to improve access to optimal screening.
View the video: https://youtu.be/7uFksz6_4Zk
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The Cervical Cancer is the second most common cancers and it can be easily prevented by timely screening & proper education, awareness program for women.
Pprom by dr alka mukherjee dr apurva mukherjee nagpur indiaalka mukherjee
Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.
In most cases of PPROM, the cause is not known.
These things may increase risk:
• Having a preterm birth in a previous pregnancy
• Having an infection in your reproductive system
• Vaginal bleeding during pregnancy
• Smoking during pregnancy
Symptoms can occur a bit differently in each pregnancy. They can include:
• A sudden gush of fluid from your vagina
• Leaking of fluid from your vagina
• A feeling of wetness in your vagina or underwear
Call your healthcare provider right away if you have these symptoms.
The symptoms of this health problem may be similar to symptoms of other conditions. See your healthcare provider for a diagnosis.
Diagnosis
• pH (acid-base) balance testing. The pH balance of amniotic fluid is different from vaginal fluid and urine. Your healthcare provider will put the fluid on a test strip to check the balance.
• Looking at a sample under a microscope. When amniotic fluid is dry, it has a fern-like pattern.
• ultrasound exam. This is done to check the amount of amniotic fluid around baby.
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
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3. Preventative strategy
• Preventable Ca
• Known etiology
• Long natural course of disease
• Preventative strategy
– Social and behavioral changes
– Life style / hygiene
– Vaccination
– Screening
4/6/2022 3
Dr Anuj Sharma
4. Social and behavioral changes
• Avoid child marriage / early coitarche
• Avoid polygamy
• Barrier contraception
• Personal hygiene
• Proper nutrition/ social uplifting
• Avoid substance abuse
• Immune surveillance management
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Dr Anuj Sharma
5. HPV Vaccines
Types
• HPV 16 & 18 (Cervarix,GSK)
• HPV 16,18,6,11 (Gardasil, Merk,FDA June
2006, Males in 2009)
• HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58
(Nonavalent, Merk, Dec 2014) …….still not
available in India !
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Dr Anuj Sharma
6. Recommended number of
doses
Recommended dosing
schedule
Population
2 0, 6–12 months Persons initiating
vaccination at ages 9
through 14 years, except
immunocompromised
persons
3 0, 1–2, 6 months
(0-2-6 m)
Persons initiating
vaccination at ages 15
through 26 years, and
immunocompromised
persons initiating
vaccination at ages 9
through 26 years
HPV Vaccines
4/6/2022 6
Dr Anuj Sharma
7. Screening – Ca Cervix
• Down Staging
• Pap Smear & Liquid Based Cytology (LBC)
• HPV DNA
• Colposcopy
– VIA & VILI
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Dr Anuj Sharma
8. Down Staging
• Detection of the disease in an earlier , curable
stage in asymptomatic women ,using simple
speculum examination.
• ASHA/ Aanganwari worker/ ANM
• Trained to diagnosed unhealthy cervix and
refer them to higher health center..
4/6/2022 Dr Anuj Sharma 8
11. Screening of Ca Cervix
• Who should undergo ?
• When should it begin ?
• Why not early screening ?
• Co testing ?
• Exceptions
• Does early intercourse or Vaccination alter the
approach for screening ?
4/6/2022 11
Dr Anuj Sharma
12. Who Should Undergo
• All Females at the age of 25 yrs onwards
• Discontinue at 65 yrs Provided 3 samples are
negative in last 10 yrs
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Dr Anuj Sharma
14. Why Not Early Screening
• Increase anxiety, morbidity, and expense
• The emotional effect of labeling an
adolescent with a sexually transmitted
infection and potential pre-cancer must be
considered because adolescence is a time of
heightened concern for self-image and
emerging sexuality.
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Dr Anuj Sharma
15. Co Testing
• Preferred
• Performed every 5 yrs
- HPV + Cytology
• cytology alone every 3 y is a acceptable
option
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Dr Anuj Sharma
16. Exceptions
• Women who are infected with HIV (annualy)
• Women who are immunocompromised (such as
those who have received solid organ transplants)
• Women who were exposed to diethylstilbestrol
in utero
• Women previously treated for CIN 2, CIN 3, or
cancer
4/6/2022 16
Dr Anuj Sharma
20. Which One Is Better
• Both are same
• Advantage of LBC – Reflex HPV testing can be
done
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Dr Anuj Sharma
21. Interpretation Of Results
• Bethesda System (1 to 7)
• Dysplasia/CIN System (CIN 1,2,3, CIS, SCC)
• Papanicolaou System ( I to V )
4/6/2022 21
Dr Anuj Sharma
22. • Develops following HPV
infection.
• Clear zone around
nucleus (peri-nuclear
halo)
• Enlarged nucleus
• Increased staining of
nucleus
• Irregularity of nuclear
membrane
• High HPV DNA & Caspid
Antigen
Koilocytosis
4/6/2022 22
Dr Anuj Sharma
23. Normal Ectocervical Epithelium
Nonkeratinizing, stratified
squamous epithelium.
Mitoses are normally
confined to the lower layers,
namely, the basal and
parabasal epithelial layers.
4/6/2022 Dr Anuj Sharma 23
24. Low-grade Squamous Intraepithelial Lesion(LSIL)
Disordered proliferation of
squamous cells and increased
mitotic activity confined to the
basal one third of the epithelium.
Koilocytotic atypia, which is
indicative of proliferative HPV
infection, involves the more
superficial epithelium.
Koilocytosis Is nuclear enlargement,
coarse chromatin, nuclear
“wrinkling,” and perinuclear halos
4/6/2022 Dr Anuj Sharma 24
25. Disordered, highly
atypical squamous cells
and increased mitotic
activity involving the
full thickness of the
epithelium.
Note the mitotic figure
located close to
epithelial surface
(yellow arrow).
4/6/2022 Dr Anuj Sharma 25
High-grade Squamous Intraepithelial Lesion (HSIL)
27. Bethesda System CIN / Dysplasia Papanicolaou System
Within Normal Limits Normal I Absence of atypical cells
Infection with organism Inflammatory atypia II Atypical cytology
Atypical squamous cells of
undetermined significance
ASCUS-US
Squamous atypia, HPV
atypia, Exclude LSIL
Atypical squamous cells to
exclude high grade lesions
ASCUS-H
HPV atypia
Exclude HSIL
Low-grade squamous
intraepithelial lesion LSIL
Mild dysplasia CIN I
High-grade squamous
intraepithelial lesion HSIL
Moderate dysplasia CIN II III Cytology suggestive of
malignancy but not
conclusive of malignancy
Severe dysplasia CIN III
Carcinoma in-situ
IV Cytology strongly
suggestive of malignancy
Squamous cell carcinoma Squamous cell carcinoma V Cytology conclusive of
malignancy
4/6/2022 27
Dr Anuj Sharma
32. Colposcopy
• Examination under magnified illumination of the
cervix, vagina and lower ano-genital tract
• Triage of abnormal cytologic, virologic or clinical
findings
• Diagnosing neoplasia in ano-genital tract
• Abnormal or Adjunct to Pap smear / HPV testing
• There should be 80% accuracy rate in colposcopy
& histologic correlation
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Dr Anuj Sharma
33. • No contraindications but may be differed in case of
periods, use of intravaginal products 24 hrs prior to
procedure
• After application of estrogen cream in postmenopausal
women
• Explanation & consent before the procedure
• Transformation Zone
Type 1 - SCJ completely visible
Type 2 – SCJ partly visible
Type 3 - SCJ completely not visible
Colposcopy
4/6/2022 33
Dr Anuj Sharma
39. • ¼ Lugol’s Iodine (Schiller’s Test)
- Rule out allergy history
- Normal ectocervix/vaginal squamous epithelium
(contains glycogen) stains mahogany brown
- Normal columnar/immature or neoplastic
epithelium (no glycogen) stains mustard yellow
Colposcopy Interpretation
4/6/2022 39
Dr Anuj Sharma
40. Zero Point One Point Two Point
Margin Distinct
Feathery
Angular jagged shape
Regular smooth
Straight edges
Rolled or Peeling
edges
Color Shinny or semi-
transparent whitening
Shinny grey white Dull reflectance
Oyster white
Vessels Fine calibre
Poorly formed pattern
No surface
vessels
Definite coarse
punctation or
mosaic pattern
Iodine Mahogony brown Mottled pattern
or partial iodine
staining
Mustard yellow
staining
Reid’s Colposcopic Index
4/6/2022 40
Dr Anuj Sharma
41. RCI (overall score) Histology
0 - 2 Likely to be CIN 1
3 - 4 Overlapping lesion: likely to be CIN 1 or
CIN 2
5 - 8 Likely to be CIN 2-3
Reid’s Colposcopic Index
4/6/2022 41
Dr Anuj Sharma
48. LEEP
• Cartier, 1990 : Outpatient & Tissue specimen
• Loop Electrodes 1-2 cm width & 0.7-1.5 mm
rectangular thin wire loops & 35-55 W
• 2-3 mm lateral & depth of 5-7 mm of entire TZ
• Ideal specimen dome shaped 5-6mm base to 7-
10 mm center
• Good for lateral lesions & Cure rates 95%
• Complications: bleeding/stenosis/incompetence
4/6/2022 48
Dr Anuj Sharma
51. Sequelae
• Vaginal discharge upto 3 weeks
• Minor spotting & secondary bleeding
• Douching, tampon use, SI to be avoided for
next 3-4 weeks
• Repeat Pap & Colposcope at 6 & 12 months
4/6/2022 51
Dr Anuj Sharma
52. Indications Of Conization
• Unsatisfactory colposcopy
• Entire lesion is not visible
• Discrepancy between cytology & HPE
• ECC is (+) in HSIL
• Microinvasion is suspected
• HPE suspected the adenocarcinoma
4/6/2022 52
Dr Anuj Sharma
54. • Cure rates for high grade CIN is 95%
• Haemorrhage within 24 Hrs or after 10-21
days
• Rates of stenosis (3%) & incompetence is high
• Persistence is related to lesion
size/grade/extension
Excisional Cervical Conization
4/6/2022 54
Dr Anuj Sharma
55. सा विद्या या विमुक्तये
4/6/2022 55
Dr Anuj Sharma