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Low Grade ChangesThe management of women with low grade abnormalitiesThe 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.
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The managment of women with persistent HPV infectionThe 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 infectionWatch HereThe management of women with multizonal diseaseThe prevalence of HPV related diseases of the lower genital tract have been rising in parallel with the prevalence of CIN. How to manage women with multizonal diseaseColposcopists need to be aware of the potential for the presence of HPV related changes outside of the cervix when performing colposcopy and to examine the vagina, vulva and perianal areas as they place the speculum. Familiarity with biopsy techniques and treatment options are essential to enable holistic care and to reduce the risk of lower genital tract malignancies Checkout the video showcase on multizonal diseaseWatch Here
Setting up quality Colposcopy ServicesIt 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).
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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 colposcopyThe 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 colposcopyWatch Here
Mismatch case managementWhen 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. Checkout the video showcase on mismatch casesWatch HereVulval 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 vulvaWatch HereTreatment of CIN at colposcopyCervical 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 TreatmentThis 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 treatmentWatch HereAblative treatmentThis 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.
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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 upThe 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 upWatch HereThe management of women with cervical cancer
Cervical cancer screening aims to reduce the incidence and mortality of cervical cancer though the detection and treatment of premalignant changes of the cervix. For well screened populations there is a shift towards diagnosis at an early stage with improved chances of survival and better treatment options. For women who have have not have access to cervical cancer prevention, more cancers are diagnosed at a more advanced stage with worse cure rates and greater morbidity.
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