Introduction:

The introduction of widespread screening for cervical cancer has led to a significant decline in the incidence and mortality of cervical cancer.

The screening done for cervical cancer is the papanicolaou (Pap) smear.

According to the U.S. Preventive Services Task Force “The goal of cytological screening in cervical cancer is to sample the transformation zone (the area where physiologic transformation from columnar endocervical epithelium to squamous-ectocervical epithelium takes place and where dysplasia and cancer arise.”

Types of cervical cancer:

There are two main types of cervical cancer; squamous cell carcinomas (80 to 90 %) and adenocarcinomas (10 to 20%).

Technique of Papanicolaou Smear:

Papanicolaou smear spicemens (for cytological examination) must be taken from a non-menstruating patient.

The smear should be spread on a single slide, and fixed or rinsed directly into preservative solution if a thin layer slide system (Thin Prep) is to be used.

A wooden or plastic spatula can be used to obtain the specimen from the squamocolumnar junction. Specimen may also be taken from the endocervix with a cotton swab or nylon brush.

The cytological report of a pap smear:

There are several ways of reporting the cytological report of a pap smear. The CIN classification is the most common classification used

Classification Systems for Papanicolaou Smears:

Numerical:

1,2,3,4,5

Dysplasia:

i)Benign

ii)Benign with inflammation

iii)Mild dysplasia

iv)Moderate dysplasia

v)Severe dysplasia

vi)Carcinoma in situ

v)Invasive cancer

Cervical Intraepithelial Neoplasia CIN:

i)Benign

ii)Benign with inflammation

iii)CIN I

iv)CIN II

v)CIN III

vi)Invasive cancer

Bethesda System:

i)Normal

ii)Normal, ASC-US (atypical squamous cells of undetermined significance.

iii)Low grade SIL (squamous intraepithelial lesion).

iv)High grade SIL (squamous intraepithelial lesion).

v)Invasive cancer.

Major Risk Factors of Cervical Carcinoma (Cervical Cancer)

The risk factors can be classified into viral and behavioral.

The most important risk factor is the Human Papilloma Virus (HPV, high risk strains).HPV is found in 95% to 100% of all squamous cell cancers.

The most common forms of HPV infections resolve spontaneously (usually within 5 years). In some women the infection may persist giving severe lesions.

Other risk factors include early sexual activity,history of STD’s ,multiple sexual partners,smoking, age, failure to receive screening,nutrition, immune status and genetic polymorphisms which can affect the entry of HPV DNA into cervical cells.

References:

Pages 734 to 735, Chapter 17 .Gynaecology. Current Medical Diagnosis and Treatment 2006. 45th Edition.Edited by Lawrence M. Tierney,Jr. Stephen J. McPhee and Maxine A. Papadakis.

Pages 435 to 437. The Female Genetalia, Chapter 12. Bates Guide toPhysical Examination and History Taking.

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