Screening of cervical cancer ppt for mbbs

screening of cervical cancer ppt for mbbs student.

1. SCREENING OF CERVICAL CANCER By:- ASHISH DIWACH 2nd year MBBS Student GMC NAGAPATTINAM Date:-4/07/2024

2. Concept of this screening:- The basic concept behind screening is early diagnosis and treatment of CIN(Cervical intraepithelial necrosis). This will help us to prevent developing cervical cancer. Screening has significantly reduced mortality from cervical cancer. Paps Smear HPV DNA testing VIA- Visual inspection with acetic acid VILI- Visual inspection with Lugol’s Iodine Screening Methods:-

3. PAP SMEAR:- Conventional Pap Smear:- In this sample taken from Transformation Zone and Endocervix. Sample taken with the help of:- AYRE’s Spetula Cytobrush After taking samples two slides are made. Slides are not allowed to air dry and immediately put in fixative. Now a days 95%ethanol is use as fixative.

4. Staining is done by Papanicolaou Method. Smears are screened microscopically by eye or with automated image analysis system. Sample taken with the help of Cervex Brush. After taking sample this brush dip in fixative and shaken inside fixative. By shaking all the indivisual cells get disperse in the fixative. Slides are made using this sample after staining. There are some advantages of LBC then Conventional method as we get clearer slides and chances of unsatisfactory smear are less. We can do HPV DNA testing by the same sample also. Liquid based cytology:-

5. Cervex brush Conventional Pap smear Liquid based cytology Sensitivity of single Pap smear is about 50%. Specificity of Pap smear is about 85%.

6. Pap Smear Reports:- Reporting of the Pap smear is done by BETHESDA SYSTEM . Atypical squamous cells of undetermined significance (ASCUS). Low grade squamous intraepithelial lesions (LSIL):- changes associated with HPV,atypical change,mild dysplasia/CIN1 High grade squamous intraepithelial lesions (HSIL):-moderate to severe dysplasia/CIN2,3 In LSIL vaginal epithilial cell have clear halo around nucleus and these cells called KOILOCYTES and these cells are marker of HPV infection of veginal cells. In HSIL nucleus become displastic,increase in size and nucleus to cytoplasm ratio is increased. Epithelial cell abnormalities:-

7. CIN as seen in Papanicolaou smear (a) Normal exfoliated superficial squamous cells.(b)LSIL-Koilocytes (c)HSIL-CIN2 (d) HSIN-CIN3

8. VIA & VILI Both of these screening are based on see and treat approach. In these we just need a speculum and 5%acitic acid/Lugol’s Iodine and a white light. Firstly introduce the speculum and tap acetic acid/Lugol’s iodine with the help of cotton and examine. Abnormal area with acetic acid look white in colour and with Lugol’s Iodine it look yellow in colour.

9. Screening Protocol:- Screening starts after the age of 21years irrespective of the age of onset of intercourse. Repeat every 3 yearly using Paps smear alone. If we are using Paps & HPV DNA testing ( contesting) for screening then repeat after every 5 yearly. HPV DNA testing should be begins after the age of 30 years in a women. We stop screening at the age of 65 years if she has regular screening in past 10 years If a women have normal cytology result but test positive for high risk HPV DNA then she should repeat cervical cytology every 6 to 12 months. HIV positive women screened annually.

10. If the screen test comes abnormal then we have to identify CIN for this Colposcopic examination of the cervix and vagina is performed to identify the lesion. The goal of colposcopy is to identify the abnormal looking area to biopsy. In colposcopy mucosa is examined with a magnifying glass following application of acetic acid,which highlights abnormal epithelium as white spots(aceto-white area). Then after these highly abnormal appearing areas are biopsied. Women with biopsy confirmed LSIL can be followed in a conservative fashion.

11. Bibliography:- ROBBINS & COTRAN PATHOLOGICAL BASIS OF DISEASE 10th EDITION VOLUME 2

12. THANK YOU