Colposcopy

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Definition

-  Miscroscopic (colposcope) examination of the cervix to detect cervical dysplasia & screen for cervical cancer

 

Features

-  Follow up test when Pap Smear results are abnormal

-  High grade abnormality

-  Several low grade abnormalities

-  Examination of post coital bleeding

-  Clinic procedure

-  Preferably performed when no menstrual bleeding

-  But can de done at any time

 

Complications

-  Allergy to iodine solutions

-  Post biopsy discomfort +/- 24 hrs

-  Slight blood discharge 5-6 days

-  Should avoid heavy physical activity, sex, swimming for 24-48 hrs

-  No tampons for 1 week

-  Heavy bleeding should present to Dr/hospital

-  No effect on fertility

 

Equipment

-  Colposcope

-  Vaginal speculum

-  Cotton swabs

-  Acetic acid (vinegar)

-  Iodine

 

Procedure

-  Patient in lithotomy position

-  Speculum inserted into vagina

-  Colposcope placed at entrance to vagina to examine cervix (magnification x 6-10)

-  Green light enhances bleeding

-  Cotton swab to remove excess cervical mucus

-  Acetic acid applied to cervix

-  Abnormal cells become white

-  +/- iodine solution applied to cervix

-  Normal cells become brown

-  +/- biopsy as indicated

 

Colposcopy

 

Results

-  Application of acetic acid to cervical dysplaisa causes uptake of water & white appearance

-  May indicate need for further treatment or repeat Pap Smears

 

 

Mx

-  If normal: annual Pap Smears until x2 normal then routine

-  LSIL seen or suspected +/- Bx but not treat (unless HSIL)

-  LSIL on histo: repeat Pap Smears annually until x2 normal then routine

-  HSIL seen or suspected: Bx then treat based on histology

-  LLETZ (Large Loop Excision of Transitional Zone), cone Biopsy, carbon dioxide laser, cold coagulation, radical diathermy, cryotherapy (not CIN 3)

-  Hysterectomy: co-existant gynae disease, early invasive disease..

  

 

 

Reference

 

Pic (cervix): www.hopkinsmedicine.org/cervicaldysplasia/treatment_1.htm

Pic (procedure): www.jostrust.org.uk/about-cervical-cancer/cervical-screening-smear-test-and-abnormal-cells/abnormal-cervical-screening-results/colposcopy