Done by Noor Al khawaja What is pap smear The papanicolaou Test Is the mainstay of cervical cancer Screening It involves exofilating cells from The transformation zone of the cervix to enable examination of these Cells Microscopicaly For detection of precancerous and cancerous lesion ID: 934758
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Slide1
Management of abnormal pap smear
Done by: Noor
Al- khawaja
Slide2What is pap smear?
The papanicolaou Test Is the mainstay of cervical cancer Screening.
It involves exofilating cells from The
transformation zone of the cervix to enable examination of these Cells Microscopicaly For detection of precancerous and cancerous lesions
Slide3Slide4Slide5What is abnormal smear?
Abnormal due to Inadequacy/unsatisfactory
Abnormal due to inflammation
Abnormal due to infectionAbnormal due to dysplastic changes
Slide6Unsatisfactory Pap test result :
Slide7What is the management of inadequate smear?
Slide8Inflammation on Pap smear results, does not indicate any particular pathology. Therefore, does not necessitate routine treatment.
What is the management of inflammatory smear?
Slide9Possible causes of inflammatory smear :
1.
Infection
2. Chronic cervicitis 3. Atrophic cervicitis 4. Chemical or mechanical irritation to cervix (tampon, douching)
Slide10COMMON INFECTIONS
…
Tricomonas
vaginalis Fungal ie candidiasis Bacterial Vaginosis ActinomycesHerpes Simplex Managed by treating the organism.
Slide11Slide12Squamous cell Changes:
Slide13Slide14Slide15Slide16What is the recommended management for dysplastic changes?
Slide17Slide18ATYPICAL SQUAMOUS CELL :
Undetermined Significance (ASC-US) :
abnormal cytologic changes that are suggestive of squamous intraepithelial lesion (SIL) but are qualitatively and quantitatively less than those of a definitive SIL diagnosis.
Cannot Exclude High Grade Lesion (ASC-H)
Cells that likely consist of a mixture of true high-grade squamous intraepithelial lesion and other findings that mimic such lesion But lack criteria for
defenitive
interpretation
Slide19Slide20Slide21Low-grade squamous intraepithelial lesions (LSIL. CIN 1
Lesions associated with human papillomavirus (HPV) infection. These tend to be associated with transient changes that regress over time
Slide22Preceded by LSIL or less
:
Patients with CIN 1 preceded (LSIL), (ASC-US), or cytology that is negative for intraepithelial lesion or malignancy (NILM) but positive for human
papillomavirus
(HPV) are at low risk for the development of cervical cancer, and observation is therefore recommended
Slide232_When
preceded by HSIL cytology
an immediate diagnostic excisional procedure or observation (HPV testing and colposcopy at one year) is acceptable.
3_When
preceded by ASC-H cytology
Observation is recommended
A diagnostic
excisional
procedure is not recommended:
Slide24Slide25Slide26HIGH GRADE INTRAEPITHELIAL LESSION (HGSIL)/ CIN 2-3
CIN 2-3 is a cervical cancer precursor
CIN 2 and 3 are discussed together because histologic distinction between the two grades of CIN is poorly reproducible and both grades have an increased risk for progression to cancer.
Slide271_
If histologic HSIL is unspecified (reported as histologic HSIL or HSIL [CIN 2,3] without distinction
Treatment is preferred
. Observation
(with colposcopy and HPV testing at 6 and 12 months) is acceptable.
2_If
CIN 2 is specified
:
•
Treatment is recommended.
•Observation (with colposcopy and HPV testing at 6 and 12 months for up to two years) is acceptable
Slide283_If
CIN 3 is
specified
Slide29Slide30observation is the preferred approach for CIN 1 because these lesions are likely to regress. Because some CIN 2 lesions will regress, observation is an option for some patients, such as those who plan future childbearing and are concerned about the potential adverse obstetric outcomes (eg, preterm delivery) after an
excisional
procedure.
CIN 3, however, is a direct precursor to cervical cancer, and treatment, not observation, is always recommended.
Slide31Excisional
treatments
_cold knife conization,
_ loop electrosurgical excision procedure (LEEP; also called large loop excision of the transformation zone [LLETZ])._ laser
conization
.
Ablative treatments
include cryotherapy, CO
2
laser ablation, and thermal ablation (eg, diathermy, cold coagulation).
. Hysterectomy
is unacceptable as a primary treatment for CIN but is an option for patients who are incompletely treated with excision or ablation or who have recurrent CIN.
Slide32Methods of local ablation
1)
Cryotherapy
acts on the principle of crystallizing the intracellular water at temperature of –90°C. It uses either nitrous oxide or carbon dioxide. Depth of tissue destruction is 5 mm. This method is ideal for minor degree and localized CIN lesions.
2)
Cold coagulation
destroys cervical tissue at a temperature of 100–120°C. It does not need any anesthesia. Depth of tissue destruction is about 4
mm.
3)
Electro
diathermy
destroys cervical tissue up to a depth of
8–10 mm using
a unipolar needle electrode. It is done under general
anesthesia.
4)
carbon
dioxide laser t
hrough
colposcopic
guidance—can destroy the epithelium by vaporization up to a depth of 7 mm. The method is of choice when CIN extends onto the
vaginal fornices
Slide33