2. Cervical Cancer Screening
• Concept of cervical cancer screening& down staging
• Why Colposcopy ?
• Uses / Indications
• Method of Colposcopy
• Normal Colposcopy
• Abnormal; Colposcopy
4. Cancer Cervix –
a Global Paradox
• Cancer cervix –100% Preventable Disease
WHO
• Cancer cervix –Death by Incompetence
Lancet
• Cancer cervix – The Unmet Challenge
5. System Failures Leading to
Cervical Cancer Diagnosis
Women do not
come in for
screening
Health care providers
do not screen women
at visits
Colposcopy for
abnormal screen
not done
Patient does not get
appropriate therapy
Patient gets cervical
cancer
Courtesy of Connie Trimble, MD, Johns Hopkins University School of Medicine, Baltimore, MD
8. Natural History of CIN lesions
Ostor 93
Regression % Persistence
%
Progression
to CIS %
Progression
to invasion
%
CIN 1 60 30 11 1
CIN 2 40 30 22 5
CIN 3 30 <60 - Over 12
9.
10. Accessibility of CERVIX……..
• seen instantly after putting speculum inside the vagina
and becomes apparent.
• The success of colposcopy lies in visualising the
cervical epithelia in the region of transformation zone
in its entirely.
11. Indications for COLPOSCOPY….
• Abnormal PAP Smear
• Evaluation & treatment of CIN
• Bleeding- post coital
- Postmenopausal
- Menorrhagia
• Persistent vaginal discharge
• Long standing foul smelling vaginal discharge
• Unhealthy Cervix
• HPV positive / external vulval warts
• Evaluation of sexual assault Victims
12. Benefits of Colposcopy…….
• Non invasive, no anaethesia for pain
• Helps in precise examination of cervix and TZ
• Guide to locate the biopsy, improve accuracy of
early diagnosis
• Reduce over-treatment
• Easy for follow up
• This is an outpatient procedure
• It takes only a few minutes
20. STEPS FOR PERFORMING VIDEO
COLPOSCOPY….
• Normal Inspection after cleaning with normal saline
• Inspection through Green filter
• Inspection after application of Acetic Acid 3%
White Vinegar
• Inspection after application of Lugols Iodine
Stains mature sqa epi- dark Brown
• Examination of Vagina
• Directed Biopsy.
21. COLPOSCOPY DIRECTED
• Biopsy forceps: Punch biopsy forcep is preferred
• Tissue specimen is sent to Lab for testing further.
22. Endo- Cervical Sampling by Curettage
• ECC is needed if Colposcopy is unsatisfactory
• Initial glandular cell abnormalities
• Ablative treatment if plan
26. Diagrammatic Representation of
Colposcopy Finding is Must
• Normal
• Ectopy
• Zone of transformation
• Nebothian Cyst
• Picture
• Leukoplakia
• Punatation
• Mosaic
• Atypical
transformation Zone
• Erosion vera
• Atypical Vessels
ODELLS DIAGRAM Hammomds
29. TZ lies between the
original squamo-columner
junction and the new (or the
present ) squamo-columner
junction. This is a
highly active zone of
metaplastic tissues
in which the single layered
columnar epithelium is
transformed by metaplastic
cellular divisions into
multilayered squamous
epithelium.
35. VIEW WITH GREEN FILTER
• For vascular pattern of cervix.
• This absorbs the red color and makes the
appearance of blood vessels black
• Black blood vessels can be viewed clearly.
40. Vascular Pattern In Abnormal Epithelium…
Mosaic
Fine
Coarse
A typical
Vessels
CorkScrew
Irregular Caliber
Irregular branching
Punctuations
Fine
Coarse