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In the Name of God

In the Name of God. Dr.F Behnamfar MD. Screening of Cervical Cancer Pap smear and colposcopy. F.Behnamfar Gynecology Oncology Fellowship Associate Professor Isfahan University of medical Sciences. Epidemiology and Risk Factors. Second most common cancer among women worldwide

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In the Name of God

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  1. In the Name of God Dr.FBehnamfar MD

  2. Screening of Cervical CancerPap smear and colposcopy F.Behnamfar Gynecology Oncology Fellowship Associate Professor Isfahan University of medical Sciences

  3. Epidemiology and Risk Factors • Second most common cancer among women worldwide • 83% of cases in developing countries • 12,200 new cases and 4210 cancer related deaths in USA,2010 • 50-60 million pap tests are performed in the US each year,3.5 million abnormal and 2.5 million colposcopy each year

  4. Natural History • External genital warts ,1% • Cervical intraepithelial neoplasia (CIN) • Slow malignant transformation • long latency period for cervical cancer • CIN I,II,II

  5. Papanicolaou Smear • Conventional • Thin layer,liquid based Cytology report includes Adequacy General categorization Epithelial cell abnormality Glandular cell abnormality

  6. Abnormal pap smear HSIL ASCUS LSIL

  7. Cytology report includes • Adequacy • General categorization • Epithelial cell abnormality • Glandular cell abnormality

  8. Cytologic diagnosis • Pap test yeilds cytologic diagnosis • Diagnosis of CIN or cervical cancer requiers a tissue sample for histologic diagnosis

  9. Pap Test • Screening test rather than diagnostic test • Sensitivity and specificity • Liquid based/ conventional pap smear • Effectiveness No pap in last five years, risk of cervical cancer is threefold 90% risk reduction

  10. Follow up of abnormal cytology • ASCUS • ASC-H • AGC Risk for CIN 2-3 and AIS ,serious precursor of adenocarcinoma • LSIL(CIN I- HPV infection) • HSIL

  11. HPV test • High risk HPV,16-18… • Transient Infection • Screening • triage

  12. Screening Parameters • Initial screening • Discontinuing screening • Frequency of screening • Perior hysterectomy • HPV Vaccination

  13. THANKS

  14. Management HPV and CIN 1:Follow up(60-85% regress spontaneously in 2 years) CIN 2-3: LEEP (loop electro surgical exision of T zone) Cryo ,Laser,Hysterectomy

  15. Pap smear 79% reduction in cervical cancer 47-62%sensitivity(30% of cervical cancers…) Liquid based,80% sensitive Auto prep Inadequacy,repeat in 6-12 months Generally: negative for intraepithelial lesion Epithelial cell abnormality Other:glandular cell abnormalities

  16. Screening Beginning at 21y,or 3y after onset of sexual activity Can stop at 70 Yearly<30 2-3 years>30(if pap&HPV neg) HPV>99%sensitive

  17. Cervical Cancer 3rd most common gyn cancer in USA Squamous most common Adenocarcinoma increasing Clinically staged Risk factors Evaluation(vaginal bleeding,post coital,irregular, post menopausal) Discharge Obvious tumor Suspicious ,colposcoy biopsy,conization

  18. Staging Stage I(1a1, 1a2 ,1b1, 1b2) StageII StageIII StageIV

  19. Surgery Cone biopsy Simple hysterectomy Radical hysterectomy-Pelvic and para-aortic lymphadenectomy

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