EARLY DETECTION OF CERVICAL CANCER final.pptx

Cervical cancer

1. ROLE OF PAP SMEAR, COLPOSCOPY AND CERVICAL BIOPS Y IN SCREENING OF CERVICAL CANCER Investigator:- DR. AAKANSHA DAYAL PG RESIDENT DEPARTMENT OF OBSTETRICS AND GYNECOLOGY Guide:- DR. KIRAN DABHOLKAR PROFESSOR DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

2. INDEX INTRODUCTION REVIEW OF LITERATURE AIMS AND OBJECTIVE MATERIAL AND METHODS REFERENCES

3. INTRODUCTION Cervical cancer is second most common cancer among women worldwide. It is a preventable cancer due to its prolonged pre-invasive phase, often spanning 15–20 years from the onset of abnormal epithelial changes to invasive carcinoma. Human papilloma virus infection is primary cause of cervical cancer.Of more than 200 known HPV types, oncogenic strains like HPV-16 and HPV-18 are most commonly associated with cervical cancer.Other risk factor can be early onset of sexual activity, multiple sexual partner, immunosupression .

4. Sign and symptoms;- -Often asymptomatic in early stage. -May present as abnormal uterine bleeding, foul smelling vaginal discharge, inter- menstural bleeding, post-coital bleeding Screening methods -Pap smear is commonly used screening method. - Colposcopy -Cervical Biopsy

5. Vaccines are available for HPV CERVARIX – Bilvalent HPV16,18 GARDASIL- Quadrivalent HPV 6,11,16,18 GARDASIL9- HPV 6,11,16,18,31,33,45,52,58

6. REVIEW OF LITERATURE Acog guidelines Under 21: No screening is needed.21-29 years: A Pap test alone every 3 years is recommended. HPV testing alone can be considered for women aged 25-29, though Pap tests are generally preferred.30-65 years: Screening options include co-testing (Pap and HPV tests) every 5 years (preferred), a Pap test alone every 3 years, or HPV testing alone every 5 year. WHO estimates that over 600,000 new cases and 340,000 deaths occur annually, with over 85% in low- and middle-income countries. Screening methods:Pap smear: Introduced in the 1940s; uses Bethesda system for reporting. Sensitivity for high-grade lesions ranges from 47–62%, specificity from 60–95%. Colposcopy : Developed in 1925; provides real-time visual assessment; sensitivity for CIN2+ often above 80% but specificity varies. Biopsy: Histopathological examination of targeted or random biopsies is the diagnostic gold standard

7. Rampuria et al., 2023 assessed 100 women with clinically unhealthy cervices. Pap smear showed limited sensitivity (50%) but good specificity (86.6%). Colposcopy , on the other hand, had high sensitivity (96.4%) but lower specificity (39.5%). The study highlighted that combining cytology, colposcopy , and biopsy yields better diagnostic accuracy Shanmugham et al. (2014) studied 200 women with persistent inflammatory Pap smears. Even after antibiotic therapy, a significant proportion had underlying pathology, with 20.7% showing CIN and 1.3% invasive carcinoma. The authors stressed that persistent inflammatory smears should always be followed up with colposcopy and biopsy

8. Pretorius et al. (2011) demonstrated that colposcopy -directed multiple biopsies substantially improve detection of CIN 2+ lesions, reinforcing histopathology as the gold standard

9. AIMS AND OBJECTIVE AIMS To evaluate and compare the clinical utility of Pap smear, colposcopy, and cervical biopsy in the early detection of cervical neoplasia and to describe the clinical outcomes OBJECTIVE To screen women at risk for cervical cancer using Pap smear, colposcopy , and cervical biopsy. To compare the diagnostic accuracy of Pap smear and colposcopy with histopathology (biopsy) as the gold standard.

10. Inclusion criteria: Persistent vaginal discharge Post coital bleeding Abnormal vaginal bleeding or irregular menstrual cycle Unhealthy cervix on per speculum examination Postmenopusal bleeding

11. Exclusion criteria: Women who have already undergone total hysterectomy Women with active vaginal bleeding at the time of examination. Patients not willing to give consent Age>60 yr

12. METHOD AND MATERIAL Study design : Prospective observational study Study setting:- Department of Obstetrics and Gynaecology, Varun Arjun Medical College and Rohilkhand Hospital. Study duration : The study will be done for a period of 12 months, after obtaining approval from the IEC Sample size: A total of 110 patients will be enrolled. Indian Journal of Surgical Oncology (September 2020) 11(3):453–458https://doi.org/10.1007/s13193-020-01118-2

13. Data collection Written consent History taking Pap smear- .PAP SMEAR: Performed in lithotomy position using Ayre’s spatula and endobrush after exposing the cervix with a sterile Cusco’s speculum.Samples will be spread on glass slides, fixed with 95% ethanol, and sent to the pathology department for cytological evaluation using the Bethesda system.

14. 2.COLPOSCOPY: Conducted in women with abnormal Pap smear findings or suspicious cervical lesions. A colposcope will be used to examine the cervix after application of 5% acetic acid or Lugol’siodine.Abnormal vascular patterns, acetowhite changes, and iodine-negative areas will be documented. 3.CERVICAL BIOPSY: Performed under aseptic precautions in cases with high-grade lesions or suspicious colposcopic findings.Biopsy specimens will be fixed in 10% formalin and sent for histopathological examination to confirm diagnosis

15. STATSTICAL ANALYSIS Entering data into Excel worksheet. Then it was analyzed by means of frequency, propotion , mean, standard deviation and tests of significance wherever required. A p-value of <0.05 will be considered to be statistically significant Data will be analysed using statistical software (e.g., EpiInfo 7.2.6.0)

16. Implications of the study: The present study aims to assess the effectiveness of Pap smear, colposcopy , and cervical biopsy in early detection of cervical cancer. Early detection can significantly improve treatment outcomes and survival rates. By identifying lesions at a pre-cancerous stage, this approach may help reduce morbidity, mortality, and healthcare costs associated with advanced disease. Findings may also support strengthening cervical cancer screening programs and guide policy for community-level awareness and screening initiatives.

17. STUDY PROFORMA General Information: Patient ID: Name: Age : __________ years Sex: Female Marital Status: Single / Married / Divorced / Widowed MENSTRUAL HISTORY 1. Age at menarche: ______ years 2. Cycle length (days): __________ 3. Duration of bleeding (days): __________ 4. Flow pattern:☐Light ☐ Heavy (>3 pads/day) ☐Normal 5.Passage of clots: ☐ Yes ☐ No 6. Regularity: ☐ Regular ☐ Irregular (specify: ____________________________) 7. Intermenstrual bleeding: ☐ Yes ☐ No 8. Dysmenorrhoea: ☐ None ☐ Mild ☐ Moderate ☐ Severe  

18. SYMPTOMS 1. Persistent vaginal discharge: ☐ Yes ☐ No 2. Postcoital bleeding: ☐ Yes ☐ No 3. Intermenstrual bleeding: ☐ Yes ☐ No 4. Lower abdominal/pelvic pain: ☐ Yes ☐ No 5. Abnormal vaginal bleeding (e.g. postmenopausal): ☐ Yes ☐ No OBSTETRIC & SEXUAL HISTORY Gravida : ___ Para: ___ Abortions: ___ Living: ___ History of miscarriage: ☐ Yes (No. ___) ☐ No Use of contraception: ☐ OCP ☐ IUCD ☐ None History of sexually transmitted infection: ☐ Yes ☐ No History of multiple partners ☐ Yes ☐ No Clinical Examination Per speculum findings: __________________________ Per vaginal examination: ________________________ Cervix: ☐ Healthy ☐ Erosion ☐ Hypertrophied ☐ Growth present Investigations Pap smear result (Bethesda system): ____________________ Colposcopy findings (Reid’s Index): ____________________ Cervical biopsy histopathology: ____________________  Outcome Final diagnosis: ____________________ Consent Taken: ☐ Yes ☐ No 

19. REFERENCES World Health Organization. Cervical cancer. WHO Fact Sheet; 2018. Available from: https://www.who.int Shanmugham D, Vijay A, Rangaswamy T. Colposcopic evaluation of patients with persistent inflammatory Pap smear. Sch J App Med Sci. 2014;2(3B):1010-1013. Rampuria S, Chandwaskar N. Comparative study of Pap smear and colposcopy with cervical biopsy. Int J ReprodContraceptObstet Gynecol. 2023;12(7):2113-2118. doi:10.18203/2320-1770.ijrcog20231919. Bhatla N, Gulati A, Mathur SR, Rani S, Anand K, Muwonge R, et al. Evaluation of cervical screening in rural North India: Visual inspection with acetic acid, cytology and HPV testing as screening methods. BJOG. 2006;113(7):882-6. doi:10.1111/j.1471-0528.2006.01016.x.

20. Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385-94. doi:10.1056/NEJMoa0808516. American College of Obstetricians and Gynecologists . Updated Guidelines for Management of Cervical Cancer Screening Abnormalities. ACOG Practice Advisory. October 2020. (Reaffirmed 2024). Available from: https://www.acog.org Sellors JW, Sankaranarayanan R. Colposcopy and Treatment of Cervical Intraepithelial Neoplasia : A Beginner’s Manual. Lyon: International Agency for Research on Cancer; 2003. Sachan , P. L., et al. (2018). A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation. Asia-Pacific Journal of Oncology Nursing, 5(3), 337-340. Garg , R., & Desai, R. (2017). Cytologic and colposcopic evaluation of all symptomatic women at tertiary care centre. International Journal of Advances in Medicine, 4(3), 799-804.Rampuria, S., & Chandwaskar , N. (2023).

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