Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical speculum examination Cervical speculum examination and taking a smear.and taking a smear.
Cusco
Sims
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Learning OutcomesLearning Outcomes
Able assemble the speculum Able assemble the speculum correctlycorrectlyAble to inspect vagina and cervix Able to inspect vagina and cervix using a speculumusing a speculumPerform a cervical smearPerform a cervical smear
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examination
1.1. Designed for the inspection of the Designed for the inspection of the cervix and vaginal walls.cervix and vaginal walls.
Bivalve (cusco) speculum is the instrument Bivalve (cusco) speculum is the instrument most commonly used to inspect the most commonly used to inspect the vaginavagina
2. Access to the cervix and fornices 2. Access to the cervix and fornices for bacteriological swabs and for bacteriological swabs and cervical smears.cervical smears.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
ExaminationExamination
GRIPGRIPGreet, rapport, introduce and identify, explain Greet, rapport, introduce and identify, explain procedureprocedure
Tell the patient the procedure is not Tell the patient the procedure is not painful, but may be a bit uncomfortable.painful, but may be a bit uncomfortable.Make sure:Make sure:
not menstruatingnot menstruatingno spermicide, lubricant, sexual intercourse no spermicide, lubricant, sexual intercourse in the previous 48 hours.in the previous 48 hours.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
PositionPosition
“Lie on the couch, put your heels together, draw them up to your bottom and let your knees flop apart”
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examinationWarm blades under a stream of tepid Warm blades under a stream of tepid water.water.Wear gloves, prepare the slide/bottleWear gloves, prepare the slide/bottleWrite name of the patient, date and time Write name of the patient, date and time of taking the specimen with of taking the specimen with pencilpencil not not pen if using pen if using slideslideHold the speculum with dominant hand, Hold the speculum with dominant hand, separate the labia and expose introitus separate the labia and expose introitus with nonwith non--dominant handdominant handTell the patient you are about to Tell the patient you are about to introduce the speculum and reassureintroduce the speculum and reassure
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examinationSlide the closed blades obliquely over Slide the closed blades obliquely over the fingers into the introitus , introduce the fingers into the introitus , introduce the instrument into the vaginathe instrument into the vagina
While inserting the instrument rotate it to While inserting the instrument rotate it to a clockwise direction until the anterior a clockwise direction until the anterior and posterior blades run along the and posterior blades run along the anterior and posterior vaginal walls with anterior and posterior vaginal walls with the handles pointing towards the anus or the handles pointing towards the anus or clitoris.clitoris.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examination
Maintain a downward pressure, on Maintain a downward pressure, on the speculum and press on the the speculum and press on the thumb piece to hinge the blades thumb piece to hinge the blades open to expose the vaginal vault open to expose the vaginal vault and cervix.and cervix.Adjust the light source to illuminate Adjust the light source to illuminate the vagina.the vagina.Inspect vagina and cervix.Inspect vagina and cervix.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Inspection of the vaginaInspection of the vagina
Discharge:Discharge:Normal Normal –– clear / milky, odourlessclear / milky, odourless
Increased during ovulation, pregnancy, breastIncreased during ovulation, pregnancy, breast--feeding, sexual arousalfeeding, sexual arousal
Cottage cheese / curdCottage cheese / curd--like: like: candidacandida (assoc. (assoc. with pain, itching, swelling and erythema of with pain, itching, swelling and erythema of the vulva)the vulva)Frothy, fishy odour: Frothy, fishy odour: TrichomoniasisTrichomoniasisAsymptomatic discharge: gonorrhoeaAsymptomatic discharge: gonorrhoea
UlcersUlcersForeign bodyForeign body
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Inspection of the cervixInspection of the cervix
Cervix normally points posteriorly Cervix normally points posteriorly and inferiorlyand inferiorly
Look for:Look for:DischargeDischargeCystsCystsPolypsPolypsUlceration or fungating growthUlceration or fungating growth
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Normal Normal with ectropion
cervicitis cancer
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical ScreeningNabothian cyst – mucus filled cervical cyst due to blockage of a mucus gland
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical polyp (appears to be descending through the os)
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical smearCervical smear
Cervical smear performed after Cervical smear performed after inspecting the cervix.inspecting the cervix.
The aim is to sample cells from the transformation zone (where the epithelium changes from columnar to squamous)
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical smear Cervical smear -- methodsmethods
Newer method = Newer method = LBC LBC (( LiquidLiquid––based based cytology )cytology )
Use cervex brush (see next slide)Use cervex brush (see next slide)Dip brush into bottle of liquid fixativeDip brush into bottle of liquid fixativeFewer inadequate samples. Being rolled out Fewer inadequate samples. Being rolled out across the UKacross the UK
Older method = Older method = slidesslidesUse Aylesbury spatula (see next slide)Use Aylesbury spatula (see next slide)Spray or dip in fixativeSpray or dip in fixative
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical smear Cervical smear -- devicesdevices
LBCLBCA cervex brush is A cervex brush is commonly usedcommonly used
SlideSlide--basedbasedA wooden spatula A wooden spatula is used with a bifid is used with a bifid end (Aylesbury end (Aylesbury spatula) .spatula) .
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Liquid Based Cytology methodLiquid Based Cytology method
Use a cervex brushUse a cervex brush
Place the tip of the brush in the osPlace the tip of the brush in the osTwirl 10 timesTwirl 10 timesPlace brush in fixative bottle and dip Place brush in fixative bottle and dip / stir / squish vigorously to wash the / stir / squish vigorously to wash the cells off the brush into the bottlecells off the brush into the bottle
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Slide methodSlide method
The bifid end is used to harvest the The bifid end is used to harvest the cervical cells.cervical cells.Introduce the spatula through the Introduce the spatula through the speculum and position the bifid end speculum and position the bifid end at the os.at the os.Rotate through 360Rotate through 360°°
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
The desquamating cells are The desquamating cells are collected by rotating the spatula collected by rotating the spatula around the circumference of the around the circumference of the os and the lips of the cervix.os and the lips of the cervix.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Slide methodSlide method
Send sample to the labSend sample to the lab
Spread the cervical material onto the Spread the cervical material onto the labelled glass slide by stroking each labelled glass slide by stroking each side of the bifid end of the spatula side of the bifid end of the spatula along the glassalong the glass
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Slide methodSlide method
The cervical cells and some mucus The cervical cells and some mucus should cling to the glass.should cling to the glass.Immediately spray the slides with Immediately spray the slides with fixative or fix them by immersion in fixative or fix them by immersion in 95% alcohol95% alcoholDo not allow the sample to dry.Do not allow the sample to dry.
Some examples of cells processed with the Papanicolau stain
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
SwabsSwabs
If any ulcers, take swab from base of If any ulcers, take swab from base of ulcer.ulcer.
If infection suspected, take swab from If infection suspected, take swab from cervix or high vaginal.cervix or high vaginal.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Removing the speculumRemoving the speculum
Undo the thumb screwUndo the thumb screwSimultaneously withdraw the speculum Simultaneously withdraw the speculum and rotate the open blades to ensure that and rotate the open blades to ensure that the anterior and posterior walls of vagina the anterior and posterior walls of vagina can be inspected.can be inspected.Near the introitus, allow the blades to Near the introitus, allow the blades to closecloseTaking care not to pinch the labia or any Taking care not to pinch the labia or any hairs while withdrawing the speculum. hairs while withdrawing the speculum.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Ending the procedureEnding the procedure
Tell the patient that you have Tell the patient that you have finished , give a towel to the patient finished , give a towel to the patient to wipe herself.to wipe herself.
Send samples to labSend samples to lab
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
SummarySummaryNNecessary equipmentecessary equipment
CuscoCusco’’s speculums speculumCervix brushCervix brushSpecimen bottleSpecimen bottleMicrobiology swabsMicrobiology swabsWater based lubricantWater based lubricantTissuesTissues
IIntroduce yourselfntroduce yourselfIdentify patient (full name and DOB)Identify patient (full name and DOB)PProcedure rocedure ––
Explain what you are going to do and Explain what you are going to do and what she may experiencewhat she may experience
PermissionPermissionObtain informed consentObtain informed consent
PPrivacyrivacyPositionPosition
Heels together, draw heels towards Heels together, draw heels towards bottom, let knees flop apartbottom, let knees flop apart
LLightightEExposurexposure
Remove clothing from the waist Remove clothing from the waist down, cover with blanketdown, cover with blanket
Wash hands, don glovesWash hands, don glovesLabel bottle and open the lidLabel bottle and open the lidAssemble speculumAssemble speculumIf not in warmer, warm under tapIf not in warmer, warm under tapUse fingers to keep blades shutUse fingers to keep blades shutWarn patientWarn patientSeparate labiaSeparate labiaInsert with rotating motionInsert with rotating motionAvoid touching clitorisAvoid touching clitorisUnder direct vision open the blades Under direct vision open the blades and angle the speculum accordingly and angle the speculum accordingly so that cervix comes into viewso that cervix comes into viewInspect cervix and lateral vaginal Inspect cervix and lateral vaginal wallswallsInsert tip of cervex brush into osInsert tip of cervex brush into osRotate 10X, sample whole cervixRotate 10X, sample whole cervixRemove brush and dip vigorously into Remove brush and dip vigorously into bottlebottleRemove the speculum gently, rotate Remove the speculum gently, rotate to inspect anterior and posterior to inspect anterior and posterior vaginal wallsvaginal wallsLet the blades close carefullyLet the blades close carefullyOffer patient some tissues to wipe Offer patient some tissues to wipe herself, cover her with blanket and herself, cover her with blanket and leave the curtained arealeave the curtained area
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Further ReadingFurther Reading
Why screen regularly with smear Why screen regularly with smear testtestWhat is CIN ?What is CIN ?What are the stages ?What are the stages ?How do we treat ?How do we treat ?How does CIN differ from invasive How does CIN differ from invasive cancercancer
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Further readingFurther reading
http://www.cancerscreening.nhs.uk/http://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2cervical/publications/cervicalpocket2004.pdf004.pdf
http://www.gfmer.ch/Books/Cervicalhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_ins_cancer_modules/Aided_visual_inspection_atlas.htmpection_atlas.htm
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical ScreeningCervical ScreeningGeneralGeneral screeningscreening criteriacriteria
The disease should be responsible for The disease should be responsible for significant morbidity or mortality in the target significant morbidity or mortality in the target population population The natural history of the disease should be The natural history of the disease should be known known Intervention at an early stage should be Intervention at an early stage should be effective in preventing the condition effective in preventing the condition A screening programme should be cost effective A screening programme should be cost effective Treatment should cause low morbidity Treatment should cause low morbidity
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical ScreeningCervical Screening
Almost four million women are Almost four million women are screened each year screened each year
42% fall in incidence of cervical 42% fall in incidence of cervical cancer between 1988 and 1997 cancer between 1988 and 1997 attributable to screening attributable to screening
Mortality rates in 2000 were 60% Mortality rates in 2000 were 60% lower than 30 years earlier lower than 30 years earlier
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical ScreeningCervical ScreeningThe screening programme in England and The screening programme in England and Wales invites all women between 25 and 64 Wales invites all women between 25 and 64 years for threeyears for three-- or fiveor five--yearly screening. yearly screening.
It is recommended that women 25 to 49 are It is recommended that women 25 to 49 are screened threescreened three--yearly and 50 to 64 five yearly. yearly and 50 to 64 five yearly.
Women over 65 are only called if they have not Women over 65 are only called if they have not had a smear since age 50, or have had a recent had a smear since age 50, or have had a recent abnormality. abnormality.
In Scotland the programme is slightly different, with women In Scotland the programme is slightly different, with women between the ages of 20 and 60 being invited for screening every between the ages of 20 and 60 being invited for screening every three years. three years.
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical Intraepithelial Cervical Intraepithelial NeoplasiaNeoplasia
CIN ICIN I-- Dysplasia in the basal 1/3 Dysplasia in the basal 1/3
CIN 2CIN 2-- Dysplasia extending to middles Dysplasia extending to middles 1/31/3
CIN 3CIN 3-- Dysplasia involving the whole Dysplasia involving the whole epithelium but the basal membrane is epithelium but the basal membrane is intact.intact.
DysplasiaDysplasiabasal hyperplasia basal hyperplasia -- multimulti--layering of basal cells layering of basal cells nuclear nuclear pleiomorphismpleiomorphismincreased mitotic activityincreased mitotic activity
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
IncidenceIncidence
2400 new cases per year in England and 2400 new cases per year in England and WalesWales
<1000 deaths annually<1000 deaths annually
½½ of women who present with late stage of women who present with late stage disease have never had a smeardisease have never had a smear
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
AgeAge
Rare under 20yrsRare under 20yrsPeak 45Peak 45--55yrs55yrsPeaks earlier in pts from lower Peaks earlier in pts from lower socioeconomic groupssocioeconomic groups
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical CancerRisk factorsRisk factors
AgeAgeLower social classLower social classHPV infection (types 16 and 18 mainly)HPV infection (types 16 and 18 mainly)Large numbers of sexual partnersLarge numbers of sexual partnersPartner with many previous partnersPartner with many previous partnersSmokingSmokingImmunosuppressionImmunosuppressionEarly age of 1Early age of 1stst intercourse and 1intercourse and 1stst pregnancypregnancyAbnormal smearAbnormal smearOral contraceptive use rather than barrierOral contraceptive use rather than barrier
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
Pathology Pathology -- micromicro
80% squamous carcinoma of 80% squamous carcinoma of transformation zonetransformation zone
Rest are adenocarcinomaRest are adenocarcinoma
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
Pathology Pathology –– macromacro
Ulceration or mass on cervix that Ulceration or mass on cervix that bleeds easilybleeds easily
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
Common PresentationsCommon Presentations
During routine smearDuring routine smearPostcoital bleedingPostcoital bleedingIntermenstrual bleedingIntermenstrual bleedingPostmenopausal bleedingPostmenopausal bleedingOffensive vaginal dischargeOffensive vaginal dischargePainPain
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Cervical CancerCervical CancerInvestigationsInvestigations
Urgent referral for colposcopyUrgent referral for colposcopyDirect visualisationDirect visualisationGreen light Green light –– abnormal blood vesselsabnormal blood vesselsAcetic acid Acetic acid –– causes coagulation of nuclear causes coagulation of nuclear proteins, hence areas of high nuclear density proteins, hence areas of high nuclear density appear whiteappear whiteIodine Iodine –– SchillerSchiller’’s test s test –– abnormal immature abnormal immature epithelium doesnepithelium doesn’’t contain glycogen and t contain glycogen and therefore doesntherefore doesn’’t stain with iodinet stain with iodine
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
Other testOther test
FBCFBCU&EU&ELFTLFTSerum CaSerum CaChest XChest X--rayrayCT scanCT scanIn advanced disease consider In advanced disease consider cystoscopy / sigmoidoscopy cystoscopy / sigmoidoscopy
Jump menuTitle page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology – micro
pathology – macro
presentation
investigation
Cervical Screening
TreatmentTreatment
Depend on the stage of the diseaseDepend on the stage of the disease
Cone biopsyCone biopsy
Radiotherapy Stage IRadiotherapy Stage I--IVIVChemotherapy for some casesChemotherapy for some cases
Radical Hysterectomy