SCREENING FOR CERVICAL CANCER - for screening

SCREENING FOR CERVICAL CANCER

1. SCREENING FOR CERVICAL CANCER BY ANAS

2. SCREENING Primary goal of screening is prevention of cervical cancer. The methods include CERVICAL CYTOLOGY HPV DNA TESTING VISUAL INSPECTION

3. 1. CERVICAL CYTOLOGY It include: TRADITIONAL PAP SMEAR LIQUID BASED CYTOLOGY A.PAP TEST Cervical cells are studied for presence of premalignancy. Technique- Patient is placed in dorsal position and Cusco speculum is inserted. An Ayre’s spatula is taken and its longer end is fixed at external os. Rotated through 360 degree over the transition region. It is then spread over a glass slide and immersed in equal parts of 95% ethyl alcohol and ether and kept for 2hrs to fixation. Followin this slide is air dried and stained with Papanicolaou stain.

4. LIMITATIONS 50% Sensitivity Sampling errors and preparation errors possible Interpretation errors B.LIQUID BASED PREPARATIONS A liquid based medium is used to collect the cytology samples and preserve the collected cervical cells. Sensitivity 80% Sample is collected with an endocervical brush Sample is rinsed in a while containing liquid preservative Two systems of liquid based cytology approved by FDA: THIN PREP PAP TEST and AUTO CYTO PREP Another method is AUTOMATED IMAGE GUIDED SLIDE SCREENING SYSTEM

5. 2.HPV DNA TEST Can be used as a primary screening test or as an adjunctive test in evaluating abnormal cervical cytology. More helpful in women>30years, in whom transient HPV infection is less likely. HPV DNA testing has higher specificity and sensitivity compared to cervical cytology. Option of cell sampling is there .

6. 3.VISUAL INSPECTION TECHNIQUES A.VIA – Visual inspection with acetic acid B.VILI- Visual inspection with Lugols Iodine VIA Visual inspection of cervix after the application of 3-5% acetic acid. If the cervical epithelium contains an abnormal load of cellular protein acetic acid coagulates the protein leading to an opaque and white appearance. This is called VIA pstv. VILI Generally performed after VIA.Requires application of LUGOLS IODINE, a compound which reacts with glycogen resulting in a brown or black discoloration. Positive if it turns to yellow.

7. RECOMMENDATIONS FOR SCREENING WHO GUIDELINES Screening once in three years,starting from 30yrs till 50 After 50 screening interval increase to once in 5 yrs until 65 At 65,if previous 3 smears are normal, screening can be stopped In those who had hysterectomy and those who have no prior history of CIN can also stop the screening women who had hysterectomy and history of CIN 2/3 should continue screening INDIAN GUIDELINES Age to start in good resource setting is 25 yrs and in limited resources is 30 yrs It recommends primary hpv test every 5 yrs or cytology every 3 yrs in a good resource setting VIA every 5 yrs

8. BETHESDA SYSTEM Developed by AMERICAN SOCIETY FOR COLPOSCOPY AND CERVICAL PATHOLOGY To manage women with abnormal smears

9. COLPOSCOPY Is a method of visualization of cervix under magnification Cervix exposed using a cusco speculam Normal saline is used to clear any discharge and then 3% acetic acid is applied Acetic acid is mucolytic and coagulates protiens so areas of high nuclear density will appear aceto-white If lugols iodine is applied mature glycogen containing squamous epithelium will stain mahagoni brown. Transformation zone is visualized and abnormal areas biopsied.This is termed as colposcopically directed biopsy

10. ENDOCERVICAL CURETTAGE Should also be done with colposcopy to evaluate an abnormal smear especially in case of glandular lesions. It can evaluate tissue within the endocervical canal which is not visualised in colposcopy.