Screening tests for cervical carcinoma and prevention

Screening tests for cervical malignancy and prevention

• Screening tests

• PAP smear screening test –

  • Cells from transformation zone are smeared and examined under microscope or by auto mated image analysis. 

  • PAP smear was taken by scrapping the squamocolumnar junction gently by Ayre’s spatula and cytobrush. Then  immediately fix the slides or taken materials in 95% alcohol. Then stain them by papanicolau stain

• Recent system or reporting cervical smears are BETHESDA SYSTEM 

•  Specimen type – conventional smear or liquid based cytology

• Specimen adequacy

• Interpretation or result

  • Negative for intraepithelial lesions

  • Epithelial cell abnormality

    • Squamous cell 

      • ASC (Atypical squamous cells)

        • ASCUS – Atypical squamous cells of unknown significance

        • ASC-H – Atypical squamous cells – cannot exclude High grade squamous intraepithelial lesion

      • LSIL -Low grade squamous intraepithelial lesion .

      • HSIL -High grade squamous intraepithelial lesion

      • Squamous cell carcinoma

    • Glandular cell
      • Atypical glandular cells

        • Endocervical cells or endometrial cells/ glandular cells  (NOS or specify in comment)

        • Endocervical cells, favour neoplastic or Endometrial cells favour neoplastic

      • Endocervical Adenocarcinoma insitu

      • Adenocarcinoma

    • Other malignant neoplasm

• Molecular method –

  • Testing for the presence of HPV DNA in cervical scrape (high sensitivity but low specificity)

Recommendations for frequency of screening

• First smear – at 21 yrs or within 3 years of onset of sexual activity

• After the age of 30 yrs –

  • normal cytology and negative for HPV DNA – screened for every 5 years

  • Normal cytology but HPV DNA positive – 6 to 12 months

• If PAP cytology is abnormal, then colposcopic examination of cervix and vagina is performed

• Colposcopic examination

  • Reveals CIN lesion as white patches on cervix after application of 5% acetic acid.

  • Areas of acetowhite correlates with higher nuclear density.

  • Also distinct vascular mosaic or punctuation can be appreciated. these patterns are due to stippled appearance of capillaries and abnormal patterns of small blood vessels in the affected area

• If there is no abnormality then 5% Lugols iodine is applied on the walls of the vagina and cervix. Normal portion of the cervix stains dark brown where as dysplastic region does not stain and appear pale in colour

• Abnormal appearing areas are biopsied

• In biopsy if its

  • LSIL- local ablation (cryotherapy)

  • HSIL – cervical conization

  • Squamous cell carcinoma – hysterectomy with adjuvant radiotherapy

• Cervical cancer prevention by vaccination –

  • Recommended for girls and boys by the age of 11 to 12 years, as well as young men and women upto age 26years

  • Two vaccines are available which provides protection for 10 years against

    • high risk HPV types 16 and 18

    • Low risk HPV types 6 and 11

  • Example of vaccines – Gardasil and Cervarix

References :

1. Robbins and Cotrans: Pathologic basis of diseases.9th edition