TEALE FENNING

Nick Raine-Fenning · Posted: Mon Feb 26, 2007 5:37 pm Post subject: Severe dyskaryosis and colposcopy

A 28-year old woman is referred by her GP following a cervical smear which has revealed severe dyskayosis.

What are the implications of this finding? (4 marks)

Outline the principles of coloposcopy under such circumstances. (10 marks)

What advice would you give the patient following colposcopic treatment? (6 marks)
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Abik · Posted: Sun Mar 04, 2007 2:46 pm Post subject:

A 28-year old woman is referred by her GP following a cervical smear which has revealed severe dyskayosis.

What are the implications of this finding? (4 marks)

Severe dyskaryosis on a smear is likely to reflect underlying cervical intraepithelial neoplasia (CIN). Although the sensitivity of smears is not high, high grade CIN is often present with severe dyskaryosis. High grade CIN if left, will develop into invasive cervical cancer in a proportion of women and therefore treatment is justified.
This woman should therefore, be referred for colposcopy to diagnose and treat any underlying CIN in order to prevent development of cervical cancer.

Outline the principles of coloposcopy under such circumstances. (10 marks)

Colposcopy is the stereoscopic visualisation of the cervix in order to diagnose and treat CIN. The transformation zone, where the columnar epithelium has undergone metaplasia to squamous epithelium is where abnormalities lie and this should be visualised. The edge of the transformation zone is known as the squamo-columnar junction and should be clearly seen to ensure thorough insepction. Acetowhite is used to stain abnormal areas of the transformation zone. Schillers test, involving the application of Lugol's iodine to stain normal epithelium with high glycogen content can also assist in demarcation of abnormal areas. Visualisation alllows identification of abnormal vessels and areas of mosaicism/punctation to identify abnormal epithelium. Any abnormal area representing high grade CIN (2/3) shoud be biopsied and sent for histological diagnosis. CIN 1 or low grade will often spontaneously resolve and therefore in low risk patients can be left but monitored with follow-up.
Biopsy can be excisional during colposcopy to allow treatment at the same time as diagnosis.

What advice would you give the patient following colposcopic treatment? (6 marks)

Risk of infection, so avoid swimming/SI for ?long
Risk of secondary haemorrhage - give place to go.
Will have result within weeks and may need further treatment.
>90% should be cured
will need smear in 6 months and if OK 1 year and yearly thereafter for 10 years. High risk of further disease. Prevention of infection with HPV important - barrier contraception
Stop smoking
Risk of invasion - lowered if continues with programme

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

Again very good bubbling Abi, Laughing

III part can I add, pregnancy to be avoided for some time...(dont know how long Question

)
and if treated for low gr CIN, f/up for 2 years..
watery discharge expected if cryo done(though a good Dr. should not have done that) Wink

Nick, will further prevention from HPV be of help?????

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Excellent! Would it be worth to mention anything about future fertility? To reassure woman at first place that it's not cancer? Consent?

Abik · Posted: Mon Mar 05, 2007 9:33 am Post subject:

Bugger!
yes PRINCIPLES OF.... always include consent, thanks wolf-man!