Setting up quality Colposcopy Services

It is important that quality colposcopy services are available in sufficient capacity to  enable effective diagnosis and treatment for women who have an abnormal screening test.

Quality assurance measures need to be in place including both individual patient care (evidence based guidance and training) as well as the organisation of the service ( facilities, staffing and systems management).

Checkout the video showcase to find out more about setting up a service

Low Grade Changes

The management of women with low grade abnormalities

The management of women with low grade abnormalities has long been a source of controversy. The problem is that many of these changes reflect a transient infection with the human papillomavirus (HPV) while others will persist and undergo malignant transformation.  Colposcopists need to balance the risk of women's anxiety with the risks of overtreatment.

How to manage women with CIN1

Histological features of cervical intreaepithelial neoplasia (CIN 1) are thought to represent the impact of a transient virus infection. The management depends of the presenting abnormality as well as the completeness of the colposcopic examination and type of transformation Zone (TZ).  The  majority will resolve spontaneously and will not need treatment but should have active surveillance  as part of the management plan.

Checkout the video showcase on the management of women with low grade changes 

The managment of women with persistent HPV infection

The knowledge that persistent infection with certain types of infection with the Human papillomavirus (HPV) has been fundemental to the accepted approach to cervical cancer prevention. Increasingly HPV testing is used as the primary test in cervical screening programmes. While the vast majority of HPV infections will clear within eighteen months, some infections persist. The management of these women presents colposcopists with real challanges while balancing the risks and harms of surveillance versus treatment.

Checkout the video showcase on the management of women with persistent HPV infection  

Colposcopic challenges

Some situations provide particular difficulties for the colposcopist. These include women living with HIV, pregnant and post menopaussal women as well as women with abnormal glandular disease. Colposcopy services should have guidance in place for managing these situations and there should be a mechanism for discussion difficult cases.

Special situations at colposcopy

The management of women at colposcopy should balance both risks and harms be tailored to the needs of the individual. Certain situations demand special consideration. These videos explore this further.

Checkout the video showcase on special situations at colposcopy

Mismatch case management

When planning the next step the colposcopist needs to look at the results of the original screening test, colposcopy findings and histology results. Particular focus is needed where there is a mismatch between these results. Multidiciplinary team meetings can provide a useful forum to review individual cases and form a plan. These videos provide more information.

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Vulval Disease

The management of women with chronic vulval disease requires a knowledge of chronic vulval benign conditions. This includes the pathophysiology, diagnosis, treatment and natural history of the multitude of presentations. This is of particular importance to the colposcopist to enable them to distinguish between benign and premalignant disease. 

Checkout the video showcase on disorders of the vulva

Treatment of CIN at colposcopy

Cervical screening reduces the risk of cervical cancer through the diagnosis and appropriate treatment of precancerous abnormalities. Effective treatment is essential to achieve a reduction in cervical cancer rates. Training is fundemental to quality treatment including  selection criteria, the risks and benefits of treatment as well as  "hands on" supervised learning.

Excisional Treatment

This treatment involves the excision of the transformation zone using a variety of methods.  These include Hysterectomy, Cold knife conisation, Laser conisation or Large loop excision of the Transformation Zone (LLETZ). 

The  Advantages of excision include the availability of a histological specimen which allows a more exact diagnosis as well as excluding invasive cancer and confirmation of the excision margins.

Checkout the video showcase on excisional treatment  

Ablative treatment

This treatment involves the destruction (ablation) of the transformation zone using a variety of methods.  These include Thermal ablation (cold coagulation), Cryotherapy and Laser ablation.  The selection of cases is very important as this type of treatment is only applicable where the entire transformation zone is completely visible and there needs to be no suspicion of glandular abnormalities or invasive cancer.

The  disadvantage of ablation includes the unavailability of a histological specimen which means that the completeness of treatment cannot be verified. 

The advantage of ablation is that it protects the integrity of the cervical stroma and therefore does not affect future pregnancies.

Checkout the video showcase on ablative treatment  

Follow up after treatment

The treatment of screen detected abnormalities reduces the risk of cancer by 90% , Women who have been treated have a residual risk of cancer which is five times that of women who have not needed a treatment. Follow up of these women is crucial to enable the detection of persistent or recurrent disease.

How to Follow up

The follow up of treated women should be tailored and should take into account the original histology - grade and type of abnormality as well as the presence or absence of clear margins.  There are variations between programmes on follow up policies but the incorporation of HPV testing as been very helpful with the negative predictive value of a negative HPV test allowing the safe earlier release from enhanced surveillance and fewer follow up tests  for treated women.

Checkout the video showcase on follow up