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7/26/2019 Cervical Speculum Examination
1/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical speculum examinationCervical speculum examination
and taking a smear.and taking a smear.
Cusco
Sims
7/26/2019 Cervical Speculum Examination
2/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Learning OutcomesLearning Outcomes
Able assemble the speculumAble assemble the speculumcorrectlycorrectly
Able to inspect vagina and cervixAble to inspect vagina and cervixusing a speculumusing a speculum
Perform a cervical smearPerform a cervical smear
7/26/2019 Cervical Speculum Examination
3/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examination
1.1. Designed for the inspection of theDesigned for the inspection of the
cervix and vaginal walls.cervix and vaginal walls.Bivalve (cusco) speculum is the instrumentBivalve (cusco) speculum is the instrument
most commonly used to inspect themost commonly used to inspect thevaginavagina
2. Access to the cervix and fornices2. Access to the cervix and fornices
for bacteriological swabs andfor bacteriological swabs andcervical smears.cervical smears.
7/26/2019 Cervical Speculum Examination
4/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
ExaminationExamination
GRIPGRIP
Greet, rapport, introduce and identify, explainGreet, rapport, introduce and identify, explainprocedureprocedure
Tell the patient the procedure is notTell the patient the procedure is not
painful, but may be a bit uncomfortable.painful, but may be a bit uncomfortable. Make sure:Make sure:
not menstruatingnot menstruating
no spermicide, lubricant, sexual intercourseno spermicide, lubricant, sexual intercourse
in the previous 48 hours.in the previous 48 hours.
7/26/2019 Cervical Speculum Examination
5/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
PositionPosition
Lie on the couch, put your heels together, draw them up toyour bottom and let your knees flop apart
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examination
Warm blades under a stream of tepidWarm blades under a stream of tepid
water.water. Wear gloves, prepare the slide/bottleWear gloves, prepare the slide/bottle
Write name of the patient, date and timeWrite name of the patient, date and time
of taking the specimen withof taking the specimen with pencilpencil notnotpen if usingpen if using slideslide
Hold the speculum with dominant hand,Hold the speculum with dominant hand,
separate the labia and expose introitusseparate the labia and expose introituswith nonwith non--dominant handdominant hand
Tell the patient you are about toTell the patient you are about to
introduce the speculum and reassureintroduce the speculum and reassure
7/26/2019 Cervical Speculum Examination
7/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examination
Slide the closed blades obliquely overSlide the closed blades obliquely over
the fingers into the introitus , introducethe fingers into the introitus , introducethe instrument into the vaginathe instrument into the vagina
While inserting the instrument rotate it toWhile inserting the instrument rotate it toa clockwise direction until the anteriora clockwise direction until the anteriorand posterior blades run along theand posterior blades run along the
anterior and posterior vaginal walls withanterior and posterior vaginal walls withthe handles pointing towards the anus orthe handles pointing towards the anus orclitoris.clitoris.
7/26/2019 Cervical Speculum Examination
8/41
Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
SwabsRemoving the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Speculum examinationSpeculum examination
Maintain a downward pressure, onMaintain a downward pressure, on
the speculum and press on thethe speculum and press on thethumb piece to hinge the bladesthumb piece to hinge the blades
open to expose the vaginal vaultopen to expose the vaginal vault
and cervix.and cervix.
Adjust the light source to illuminateAdjust the light source to illuminate
the vagina.the vagina.
Inspect vagina and cervix.Inspect vagina and cervix.
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Inspection of the vaginaInspection of the vagina
Discharge:Discharge:
NormalNormalclear / milky, odourlessclear / milky, odourless Increased during ovulation, pregnancy, breastIncreased during ovulation, pregnancy, breast--
feeding, sexual arousalfeeding, sexual arousal
Cottage cheese / curdCottage cheese / curd--like:like: candidacandida (assoc.(assoc.
with pain, itching, swelling and erythema ofwith pain, itching, swelling and erythema ofthe vulva)the vulva)
Frothy, fishy odour:Frothy, fishy odour: TrichomoniasisTrichomoniasis
Asymptomatic discharge: gonorrhoeaAsymptomatic discharge: gonorrhoea
UlcersUlcers
Foreign bodyForeign body
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Inspection of the cervixInspection of the cervix
Cervix normally points posteriorlyCervix normally points posteriorly
and inferiorlyand inferiorly
Look for:Look for:
DischargeDischarge
CystsCysts
PolypsPolyps
Ulceration or fungating growthUlceration or fungating growth
7/26/2019 Cervical Speculum Examination
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
NormalNormal with
ectropion
cervicitis cancer
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical ScreeningNabothian cyst mucus filled cervical cyst due to blockage of
a mucus gland
7/26/2019 Cervical Speculum Examination
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical polyp (appears to be descending through the os)
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical smearCervical smear
Cervical smear performed afterCervical smear performed after
inspecting the cervix.inspecting the cervix.The aim is to
sample cells
from the
transformation
zone (where the
epithelium
changes from
columnar tosquamous)
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical smearCervical smear -- methodsmethods
Newer method =Newer method = LBCLBC (( LiquidLiquidbasedbased
cytology )cytology ) Use cervex brush (see next slide)Use cervex brush (see next slide)
Dip brush into bottle of liquid fixativeDip brush into bottle of liquid fixative
Fewer inadequate samples. Being rolled outFewer inadequate samples. Being rolled outacross the UKacross the UK
Older method =Older method = slidesslides Use Aylesbury spatula (see next slide)Use Aylesbury spatula (see next slide)
Spray or dip in fixativeSpray or dip in fixative
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical smearCervical smear -- devicesdevices
LBCLBC
A cervex brush isA cervex brush iscommonly usedcommonly used
SlideSlide--basedbased
A wooden spatulaA wooden spatula
is used with a bifidis used with a bifidend (Aylesburyend (Aylesbury
spatula) .spatula) .
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Liquid Based Cytology methodLiquid Based Cytology method
Use a cervex brushUse a cervex brush
Place the tip of the brush in the osPlace the tip of the brush in the os
Twirl 10 timesTwirl 10 times Place brush in fixative bottle and dipPlace brush in fixative bottle and dip
/ stir / squish vigorously to wash the/ stir / squish vigorously to wash thecells off the brush into the bottlecells off the brush into the bottle
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Slide methodSlide method
The bifid end is used to harvest theThe bifid end is used to harvest the
cervical cells.cervical cells. Introduce the spatula through theIntroduce the spatula through the
speculum and position the bifid endspeculum and position the bifid endat the os.at the os.
Rotate through 360Rotate through 360
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
The desquamating cells areThe desquamating cells arecollected by rotating the spatulacollected by rotating the spatula
around the circumference of thearound the circumference of the
os and the lips of the cervix.os and the lips of the cervix.
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Slide methodSlide method
Send sample to the labSend sample to the lab
Spread the cervical material onto theSpread the cervical material onto the
labelled glass slide by stroking eachlabelled glass slide by stroking each
side of the bifid end of the spatulaside of the bifid end of the spatula
along the glassalong the glass
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Slide methodSlide method
The cervical cells and some mucusThe cervical cells and some mucus
should cling to the glass.should cling to the glass. Immediately spray the slides withImmediately spray the slides with
fixative or fix them by immersion infixative or fix them by immersion in95% alcohol95% alcohol
Do not allow the sample to dry.Do not allow the sample to dry.
Some examples of cells processed with the Papanicolau stain
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
SwabsSwabs
If any ulcers, take swab from base ofIf any ulcers, take swab from base of
ulcer.ulcer.
If infection suspected, take swab fromIf infection suspected, take swab from
cervix or high vaginal.cervix or high vaginal.
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Removing the speculumRemoving the speculum
Undo the thumb screwUndo the thumb screw
Simultaneously withdraw the speculumSimultaneously withdraw the speculumand rotate the open blades to ensure thatand rotate the open blades to ensure that
the anterior and posterior walls of vaginathe anterior and posterior walls of vagina
can be inspected.can be inspected. Near the introitus, allow the blades toNear the introitus, allow the blades to
closeclose
Taking care not to pinch the labia or anyTaking care not to pinch the labia or any
hairs while withdrawing the speculum.hairs while withdrawing the speculum.
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Ending the procedureEnding the procedure
Tell the patient that you haveTell the patient that you have
finished , give a towel to the patientfinished , give a towel to the patientto wipe herself.to wipe herself.
Send samples to labSend samples to lab
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Further ReadingFurther Reading
Why screen regularly with smearWhy screen regularly with smear
testtest What is CIN ?What is CIN ?
What are the stages ?What are the stages ?
How do we treat ?How do we treat ?
How does CIN differ from invasiveHow does CIN differ from invasivecancercancer
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Further readingFurther reading
http://www.cancerscreening.nhs.uk/http://www.cancerscreening.nhs.uk/
cervical/publications/cervicalpocket2cervical/publications/cervicalpocket2004.pdf004.pdf
http://www.gfmer.ch/Books/Cervicalhttp://www.gfmer.ch/Books/Cervical
_cancer_modules/Aided_visual_ins_cancer_modules/Aided_visual_ins
pection_atlas.htmpection_atlas.htm
http://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.gfmer.ch/Books/Cervical_cancer_modules/Aided_visual_inspection_atlas.htmhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdfhttp://www.cancerscreening.nhs.uk/cervical/publications/cervicalpocket2004.pdf7/26/2019 Cervical Speculum Examination
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Jump menu
Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical ScreeningCervical Screening
GeneralGeneral screeningscreening criteriacriteria
The disease should be responsible forThe disease should be responsible forsignificant morbidity or mortality in the targetsignificant morbidity or mortality in the targetpopulationpopulation
The natural history of the disease should beThe natural history of the disease should beknownknown
Intervention at an early stage should beIntervention at an early stage should be
effective in preventing the conditioneffective in preventing the condition A screening programme should be cost effectiveA screening programme should be cost effective
Treatment should cause low morbidityTreatment should cause low morbidity
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical ScreeningCervical Screening
Almost four million women areAlmost four million women are
screened each yearscreened each year
42% fall in incidence of cervical42% fall in incidence of cervicalcancer between 1988 and 1997cancer between 1988 and 1997attributable to screeningattributable to screening
Mortality rates in 2000 were 60%Mortality rates in 2000 were 60%lower than 30 years earlierlower than 30 years earlier
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical ScreeningCervical Screening
The screening programme in England andThe screening programme in England andWales invites all women between 25 and 64Wales invites all women between 25 and 64
years for threeyears for three-- or fiveor five--yearly screening.yearly screening.
It is recommended that women 25 to 49 areIt is recommended that women 25 to 49 arescreened threescreened three--yearly and 50 to 64 five yearly.yearly and 50 to 64 five yearly.
Women over 65 are only called if they have notWomen over 65 are only called if they have nothad a smear since age 50, or have had a recenthad a smear since age 50, or have had a recent
abnormality.abnormality.
In Scotland the programme is slightly different, with womenIn Scotland the programme is slightly different, with womenbetween the ages of 20 and 60 being invited for screening everybetween the ages of 20 and 60 being invited for screening everythree years.three years.
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical IntraepithelialCervical Intraepithelial
NeoplasiaNeoplasia CIN ICIN I-- Dysplasia in the basal 1/3Dysplasia in the basal 1/3
CIN 2CIN 2-- Dysplasia extending to middlesDysplasia extending to middles1/31/3
CIN 3CIN 3-- Dysplasia involving the wholeDysplasia involving the whole
epithelium but the basal membrane isepithelium but the basal membrane isintact.intact.
DysplasiaDysplasia
basal hyperplasiabasal hyperplasia -- multimulti--layering of basal cellslayering of basal cells nuclearnuclear pleiomorphismpleiomorphism
increased mitotic activityincreased mitotic activity
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
IncidenceIncidence
2400 new cases per year in England and2400 new cases per year in England and
WalesWales
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
AgeAge
Rare under 20yrsRare under 20yrs
Peak 45Peak 45--55yrs55yrs Peaks earlier in pts from lowerPeaks earlier in pts from lower
socioeconomic groupssocioeconomic groups
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Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
Risk factorsRisk factors
AgeAge
Lower social classLower social class
HPV infection (types 16 and 18 mainly)HPV infection (types 16 and 18 mainly)
Large numbers of sexual partnersLarge numbers of sexual partners
Partner with many previous partnersPartner with many previous partners
SmokingSmoking
ImmunosuppressionImmunosuppression
Early age of 1Early age of 1stst intercourse and 1intercourse and 1stst pregnancypregnancy
Abnormal smearAbnormal smear
Oral contraceptive use rather than barrierOral contraceptive use rather than barrier
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Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
PathologyPathology -- micromicro
80% squamous carcinoma of80% squamous carcinoma of
transformation zonetransformation zone
Rest are adenocarcinomaRest are adenocarcinoma
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
PathologyPathology macromacro
Ulceration or mass on cervix thatUlceration or mass on cervix that
bleeds easilybleeds easily
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Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
Common PresentationsCommon Presentations
During routine smearDuring routine smear
Postcoital bleedingPostcoital bleeding Intermenstrual bleedingIntermenstrual bleeding
Postmenopausal bleedingPostmenopausal bleeding
Offensive vaginal dischargeOffensive vaginal discharge
PainPain
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Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Cervical CancerCervical Cancer
InvestigationsInvestigations
Urgent referral for colposcopyUrgent referral for colposcopy Direct visualisationDirect visualisation
Green lightGreen lightabnormal blood vesselsabnormal blood vessels
Acetic acidAcetic acidcauses coagulation of nuclearcauses coagulation of nuclearproteins, hence areas of high nuclear densityproteins, hence areas of high nuclear densityappear whiteappear white
IodineIodineSchillerSchillers tests testabnormal immatureabnormal immatureepithelium doesnepithelium doesnt contain glycogen andt contain glycogen andtherefore doesntherefore doesnt stain with iodinet stain with iodine
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Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
Other testOther test
FBCFBC
U&EU&E
LFTLFT
Serum CaSerum Ca Chest XChest X--rayray
CT scanCT scan
In advanced disease considerIn advanced disease considercystoscopy / sigmoidoscopycystoscopy / sigmoidoscopy
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Title page
Speculum examination
Inspection of vagina
Inspection of cervix
Cervical smear
methods
devices
Slide method
Liquid-based cytology
Swabs
Removing the speculum
Ending the procedure
Summary
Further reading
Cervical Cancer
incidence
age
risk factors
pathology micro
pathology macro
presentation
investigation
Cervical Screening
TreatmentTreatment
Depend on the stage of the diseaseDepend on the stage of the disease
Cone biopsyCone biopsy
Radiotherapy Stage IRadiotherapy Stage I--IVIV
Chemotherapy for some casesChemotherapy for some cases
Radical
Hysterectomy