Colposcopy of Female Genital Tract

243 Pages·2017·11.3 MB·English

by  Sumita Mehta

Sumita Mehta
Poonam Sachdeva Editors
Colposcopy of
Female Genital Tract
123
Colposcopy of Female Genital Tract
Sumita Mehta (cid:129) Poonam Sachdeva
Editors
Colposcopy of Female
Genital Tract
Editors
Sumita Mehta Poonam Sachdeva
Department of Obstetrics and Gynecology Department of Obstetrics and Gynecology
Babu Jagjivan Ram Memorial Hospital Maulana Azad Medical College and Lok
New Delhi Nayak Hospital
India New Delhi
India
ISBN 978-981-10-1704-9 ISBN 978-981-10-1705-6 (eBook)
DOI 10.1007/978-981-10-1705-6
Library of Congress Control Number: 2016959470
© Springer Science+Business Media Singapore 2017
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Foreword
I t gives me immense pleasure to write the foreword for this book as it is edited by
my two young and dynamic colleagues who have been associated with me for a long
period and are trained by me.
Congratulations!
T he need of the hour is that more and more gynaecologists take interest in the
prevention of cervical cancer. It will not only help in decreasing the burden of this
disease but also help in reducing the morbidity and mortality caused by cervical
cancer. Over the years, the practice of medicine is becoming more and more evi-
dence based, and the same applies to the treatment of preinvasive lesions of the
cervix. If a gynaecologist with average skills can be trained properly to treat the
cases in the preinvasive stage, the need for treatment at full-fl edged oncology cen-
tres can be avoided.
T his book deals with screening methods for cervical cancer, like cytology, visual
methods and HPV testing. Colposcopy of the cervix, vagina and vulva has also been
described. The pitfalls of colposcopy in infections and pregnancy have also been
discussed in a precise way. Case discussions will help the learner to chalk out the
treatment of a particular case in the proper manner. This publication will help the
students, practising gynaecologists and oncologists in understanding the algorithm
in the management of preinvasive lesions.
T he chapters are comprehensive, up to date and educative. I wish all the best to
the editors and authors who have contributed to this book.

New Delhi, India Swaraj Batra
v
Pref ace
Cervical cancer is the fourth most common cancer in women, and a large majority
of the global burden of this disease occurs in the less developed countries. Out of the
total new cases detected worldwide in 2013, more than one-fi fth occurred in India.
This is a disease which affects women in their prime and adversely impacts their
social and economic health along with their physical health. Cervical cancer is one
of the diseases that can be detected in the preinvasive stage through routine screen-
ing methods. Timely diagnosis and treatment of preinvasive disease can prevent
invasive cancer and also the morbidity and mortality associated with it.
K eeping this intention, we have arranged this book into three different parts with
16 chapters, covering all aspects of cervical pre-malignant disease. Part 1 covers the
normal anatomy and physiology of the cervix, as it is very important to know the
normal to differentiate it from what is abnormal. A chapter on pathology of prein-
vasive lesions is also included. Part 2 examines in detail how invasive cervical can-
cer is largely preventable if preinvasive lesions are detected early using effective
screening methods. This section includes a chapter on screening via conventional
cytology and treatment algorithms if abnormal cytology is detected. Furthermore,
visual screening methods which have emerged as an important screening tool in
low-resource settings have also been discussed in detail. Tests for detection of HPV
infection and the clinical implications thereof are also elucidated. A chapter on
primary prevention of HPV infection, the cause of the majority of cervical cancers,
using HPV vaccination is also included.
Part 3 is exclusively on colposcopy. There are separate chapters on the tissue
basis of colposcopy, the technique of colposcopy, the terminology and grading sys-
tems in practice, and colposcopic appearance of intraepithelial lesions. All the chap-
ters that describe the colposcopic features in detail have abundant pictures and
illustrations to facilitate easy comprehension. There is a chapter on colposcopy of
the vulva and vagina too because intraepithelial lesions of the lower genital tract are
multifocal and interrelated. The management of intraepithelial lesions using abla-
tive and excisional methods is also explained in detail.
vii
viii Preface
We hope this book will serve as a comprehensive and practical guide for timely
diagnosis and optimal treatment of cervical preinvasive disease to all practising
gynaecologists, gynae oncosurgeons and postgraduate students which will go a long
way in bringing down the incidence of cervical cancer.
New Delhi, India Sumita Mehta
Poonam Sachdeva
Editors
About the Editors
Dr. Sumita Mehta is Specialist and In-charge, Department of Obstetrics &
Gynecology at Babu Jagjivan Ram Memorial Hospital, Delhi, India. She is the sec-
retary of Indian Society of Colposcopy and Cervical Pathology. She has also been
the editor of Association of Obstetricians & Gynecologists of Delhi and is a reviewer
for many international journals like EJORB, IJOC, and JCDR.
Her area of special interest is in the fi eld of gynecologic oncology, especially
cervical cancer. She has conducted several colposcopy workshops all over India and
has delivered numerous lectures in various academic forums. She is the author of 7
books and has over 75 publications in national and international journals of repute.
Her peers hold her in high esteem for her academic and professional acumen.
Dr. Poonam Sachdeva is Specialist, Obstetrics & Gynecology at Lok Nayak
Hospital attached to Maulana Azad Medical College, Delhi, India. Her area of inter-
est is preventive oncology and high-risk obstetrics. She has conducted many live
workshops on colposcopy all over India. She has contributed chapters in various
books and is also the author of many publications in national and international jour-
nals. She is also the editor of Labor Ward Protocols and Scientifi c Proceedings of
AICOG . She is an active member of national societies like FOGSI, AOGD,
NARCHI, and ISCCP and has participated as organizing team and faculty in various
conferences. It has been her dream to publish this book to highlight the original
work of various authors from all over India. Endless efforts of Dr. Sumita Mehta
have made this dream come true.
ix
Contents
Part I Cervix
1 Anatomy and Physiology of Cervix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Anshul Grover and Divya Pandey
2 Pathology of Preinvasive Lesions of the Cervix . . . . . . . . . . . . . . . . . . . 17
Satinder Kaur
Part II Screening for Cervical Cancer
3 Visual Inspection Methods for Cervical Cancer Prevention . . . . . . . . . 33
Swati Priya and Krishna Agarwal
4 Cytology as a Screening Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Vani Bharani and Bharti Bharani
5 Management Recommendations in Abnormal Cytology . . . . . . . . . . . . 61
Amita Suneja and Upasna Pandit
6 HPV Detection and Clinical Implications . . . . . . . . . . . . . . . . . . . . . . . . 73
Sumita Mehta and Sumiti Mehta Dixit
7 HPV Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Saritha Shamsunder and Deepika Pannu
Part III Colposcopy
8 Colposcopy: The Scientific Basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Raksha Arora and Sheenam Jain
9 Colposcopic Technique, Scoring and Documentation . . . . . . . . . . . . . 111
Pakhee Aggarwal
10 Colposcopic Appearance of Normal Cervix . . . . . . . . . . . . . . . . . . . . . 121
Kavita N. Singh and Poorva Badkur
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xii Contents
11 Colposcopic Evaluation of Preinvasive and Early Cervical
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Sruthi Bhaskaran
12 Preinvasive Lesions in Pregnancy and Menopause . . . . . . . . . . . . . . . 143
Aruna Nigam , Sumedha Sharma , and Pikee Saxena
13 Colposcopic Examination in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 155
Sumita Mehta and Anshuja Singla
14 CIN: Ablative Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Veena Rahatgaonkar
15 Excisional Procedures for Treatment of Intraepithelial Lesions . . . . 183
Mala Srivastava and Ankita Srivastava
16 Colposcopy of Vulva and Vagina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Divya Pandey and Sumita Mehta
Part IV Case Discussion
17 Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Sweta Balani
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233