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Dr.Niraj Mahajan
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Cervical Cancer Screening

By AdminPosted On 05-Oct-2016

1. Cervical Cancer Screening Methods

Which of the following is/are NOT the Cervical Cancer Screening method?a) PAP smear (Cervical cytology)b) VIA (Visual inspection with acetic acid)c) VILI (Visual inspection with lugol's iodine)d) Visual inspection of cervixe) Colposcopyf) CervicographyCorrect Answer: e) Colposcopy is a diagnostic test for cervical cancer. All other are screening tests. The first step in finding cervical cancer is often an abnormal Pap test result or any of the Cervical Cancer Screening methods like VIA, VILI etc. This will lead to further tests which can diagnose cervical cancer. Cervical cancer may also be suspected if symptoms like abnormal vaginal bleeding or pain during intercourse are present.VIA (Vinegar test) has demonstrated high sensitivity for detecting CIN and cervical cancer. VIA has the advantage of requiring only low-technology equipment and the result is available within a couple of minutes. Among developing countries that usually have low resources, however, Pap smear programs are complex and costly to run and have failed to reach a significant proportion of women. Even under ideal conditions, false-negative rates for pap smear as high as 29 percent have been reported. VIA have several screening advantages – minimal requirement of infrastructure and equipment, immediate result, preliminary screening of high risk cases for referral and, not the least, it can be performed by trained paramedical workers.

2. Cervical cytology : Cervical Cancer Screening

Best stain for studying cervical cytology

a) Pap
b) Giemsa
c) Haematoxylin & Eosin
d) Wrights stain
e) Leishman stain

Correct Answer: a) Pap. The Papanicoalou stain is a polychrome stain made up of one natural nuclear stain, hematoxylin, and two cytoplasmic stains, Orange G and EA-65. The stain method is ideal for evaluation of wet-fixed cytologic preparations because it allows for visualization of details that are critical in making cytologic diagnoses.

3. VIA Positive : Cervical Cancer Screening

There will be well defined opaque acetowhite area, with regular margins, in the cervix any lip, abutting the squamo-columnar jucntion. CIN and invasive cancer cells has increased nuclear activity and DNA content. This nuclear protein coagulated by acetic acid producing Acetowhitening.

4. VILI Positive : Cervical Cancer Screening

Visual inspection of the cervix with Lugol's iodine: There will be saffron-yellow area of iodine non-uptake in the cervical lip abutting the squamo-columnar jucntion. Intermediate and superficial layer cells in the squamous epithelium of ectocervix contain abundant glycogen. Glycogenation sign of normal maturation. Abnormal maturation (dysplasia or cancer) lack glycogen. Glycogen is Iodophylic which is the principle in VILI. So dysplastic areas and cancerous area wont take up the iodine where as normal epithelium will take up the iodine.

5. Cervical Biopsy

30-year-old woman attends for a routine cervical smear test and an abnormal result is noted. But the specimen is unsuitable for further grading. A colposcopy is carried out which demonstrates a macroscopically normal cervix with an area of apparent thickening at the transformation zone. A biopsy is carried out which does not reveal invasive malignancy. What is she most likely suffering from which neoplasia?

a) Invasive squamous cell carcinoma
b) Cervical intraepithelial neoplasia (CIN)
c) Condyloma
d) Normal
e) Ectropion

Correct Answer: b) Cervical intraepithelial neoplasia (CIN). As biopsy did not reveal any malignancy and options c,d,e are not neoplasia whereas CIN is. Ectropion is a normal physiological finding in a reproductive age group and Condyloma refers to an infection of the genitals.

6. Confirmatory test for cervical cancer diagnosis.

a) Pap smear
b) ultra sound
c) Schillers Iodine Test
d) Cervical Biopsy
e) VIA

Correct Answer: d) Cervical Biopsy. VIA, VILI and PAP smear are screening tests for cervical cancer. If screening test is positive, next test is colposcopy. Cervical Biopsy is a diagnostic test for cervical cancer which is performed with Colposcopy.  

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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