Colposcopy of Female Genital Tract

Transcription

1 Colposcopy of Female Genital Tract

2 Sumita Mehta Poonam Sachdeva Editors Colposcopy of Female Genital Tract

3 Editors Sumita Mehta Department of Obstetrics and Gynecology Babu Jagjivan Ram Memorial Hospital New Delhi India Poonam Sachdeva Department of Obstetrics and Gynecology Maulana Azad Medical College and Lok Nayak Hospital New Delhi India ISBN ISBN (ebook) DOI / Library of Congress Control Number: Springer Science+Business Media Singapore 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Science+Business Media Singapore Pte Ltd. The registered company address is 152 Beach Road, #22-06/08 Gateway East, Singapore , Singapore

4 Foreword It gives me immense pleasure to write the foreword for this book as it is edited by my two young and dynamic colleagues who have been associated with me for a long period and are trained by me. Congratulations! The need of the hour is that more and more gynaecologists take interest in the prevention of cervical cancer. It will not only help in decreasing the burden of this disease but also help in reducing the morbidity and mortality caused by cervical cancer. Over the years, the practice of medicine is becoming more and more evidence based, and the same applies to the treatment of preinvasive lesions of the cervix. If a gynaecologist with average skills can be trained properly to treat the cases in the preinvasive stage, the need for treatment at full-fledged oncology centres can be avoided. This book deals with screening methods for cervical cancer, like cytology, visual methods and HPV testing. Colposcopy of the cervix, vagina and vulva has also been described. The pitfalls of colposcopy in infections and pregnancy have also been discussed in a precise way. Case discussions will help the learner to chalk out the treatment of a particular case in the proper manner. This publication will help the students, practising gynaecologists and oncologists in understanding the algorithm in the management of preinvasive lesions. The chapters are comprehensive, up to date and educative. I wish all the best to the editors and authors who have contributed to this book. New Delhi, India Swaraj Batra v

5 Preface Cervical cancer is the fourth most common cancer in women, and a large majority of the global burden of this disease occurs in the less developed countries. Out of the total new cases detected worldwide in 2013, more than one-fifth occurred in India. This is a disease which affects women in their prime and adversely impacts their social and economic health along with their physical health. Cervical cancer is one of the diseases that can be detected in the preinvasive stage through routine screening methods. Timely diagnosis and treatment of preinvasive disease can prevent invasive cancer and also the morbidity and mortality associated with it. Keeping this intention, we have arranged this book into three different parts with 16 chapters, covering all aspects of cervical pre-malignant disease. Part 1 covers the normal anatomy and physiology of the cervix, as it is very important to know the normal to differentiate it from what is abnormal. A chapter on pathology of preinvasive lesions is also included. Part 2 examines in detail how invasive cervical cancer is largely preventable if preinvasive lesions are detected early using effective screening methods. This section includes a chapter on screening via conventional cytology and treatment algorithms if abnormal cytology is detected. Furthermore, visual screening methods which have emerged as an important screening tool in low-resource settings have also been discussed in detail. Tests for detection of HPV infection and the clinical implications thereof are also elucidated. A chapter on primary prevention of HPV infection, the cause of the majority of cervical cancers, using HPV vaccination is also included. Part 3 is exclusively on colposcopy. There are separate chapters on the tissue basis of colposcopy, the technique of colposcopy, the terminology and grading systems in practice, and colposcopic appearance of intraepithelial lesions. All the chapters that describe the colposcopic features in detail have abundant pictures and illustrations to facilitate easy comprehension. There is a chapter on colposcopy of the vulva and vagina too because intraepithelial lesions of the lower genital tract are multifocal and interrelated. The management of intraepithelial lesions using ablative and excisional methods is also explained in detail. vii

6 viii Preface We hope this book will serve as a comprehensive and practical guide for timely diagnosis and optimal treatment of cervical preinvasive disease to all practising gynaecologists, gynae oncosurgeons and postgraduate students which will go a long way in bringing down the incidence of cervical cancer. New Delhi, India Sumita Mehta Poonam Sachdeva Editors

7 About the Editors Dr. Sumita Mehta is Specialist and In-charge, Department of Obstetrics & Gynecology at Babu Jagjivan Ram Memorial Hospital, Delhi, India. She is the secretary of Indian Society of Colposcopy and Cervical Pathology. She has also been the editor of Association of Obstetricians & Gynecologists of Delhi and is a reviewer for many international journals like EJORB, IJOC, and JCDR. Her area of special interest is in the field of gynecologic oncology, especially cervical cancer. She has conducted several colposcopy workshops all over India and has delivered numerous lectures in various academic forums. She is the author of 7 books and has over 75 publications in national and international journals of repute. Her peers hold her in high esteem for her academic and professional acumen. Dr. Poonam Sachdeva is Specialist, Obstetrics & Gynecology at Lok Nayak Hospital attached to Maulana Azad Medical College, Delhi, India. Her area of interest is preventive oncology and high-risk obstetrics. She has conducted many live workshops on colposcopy all over India. She has contributed chapters in various books and is also the author of many publications in national and international journals. She is also the editor of Labor Ward Protocols and Scientifi c Proceedings of AICOG. She is an active member of national societies like FOGSI, AOGD, NARCHI, and ISCCP and has participated as organizing team and faculty in various conferences. It has been her dream to publish this book to highlight the original work of various authors from all over India. Endless efforts of Dr. Sumita Mehta have made this dream come true. ix

8 Contents Part I Cervix 1 Anatomy and Physiology of Cervix Anshul Grover and Divya Pandey 2 Pathology of Preinvasive Lesions of the Cervix Satinder Kaur Part II Screening for Cervical Cancer 3 Visual Inspection Methods for Cervical Cancer Prevention Swati Priya and Krishna Agarwal 4 Cytology as a Screening Tool Vani Bharani and Bharti Bharani 5 Management Recommendations in Abnormal Cytology Amita Suneja and Upasna Pandit 6 HPV Detection and Clinical Implications Sumita Mehta and Sumiti Mehta Dixit 7 HPV Vaccination Saritha Shamsunder and Deepika Pannu Part III Colposcopy 8 Colposcopy: The Scientific Basis Raksha Arora and Sheenam Jain 9 Colposcopic Technique, Scoring and Documentation Pakhee Aggarwal 10 Colposcopic Appearance of Normal Cervix Kavita N. Singh and Poorva Badkur xi

9 xii Contents 11 Colposcopic Evaluation of Preinvasive and Early Cervical Cancer Sruthi Bhaskaran 12 Preinvasive Lesions in Pregnancy and Menopause Aruna Nigam, Sumedha Sharma, and Pikee Saxena 13 Colposcopic Examination in Pregnancy Sumita Mehta and Anshuja Singla 14 CIN: Ablative Therapies Veena Rahatgaonkar 15 Excisional Procedures for Treatment of Intraepithelial Lesions Mala Srivastava and Ankita Srivastava 16 Colposcopy of Vulva and Vagina Divya Pandey and Sumita Mehta Part IV Case Discussion 17 Cases Sweta Balani Appendices

10 Contributors Krishna Agarwal, MS Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India Pakhee Aggarwal, MS (O&G), MICOG, MRCOG (London) Commonwealth Fellow in Gyne Oncology, Delhi, India Department of Obstetrics and Gynecology, Fortis Healthcare (Fortis Memorial Hosp, Gurgaon, Flt Lt Rajan Dhall Hospital and Aashlok Hospital Delhi), Delhi, India Raksha Arora, MD Department of Obstetrics and Gynecology, Santosh Medical College, Ghaziabad, UP, India Poorva Badkur, MS Department of Obstetrics and Gynecology, NSCB Govt. Medical College, Jabalpur, MP, India Sweta Balani, MS Department of Obstetrics and Gynecology, Sant Parmanand Hospital, Delhi, India Bharti Bharani, MS Dysplasia Clinic, Indore, India Vani Bharani, MD Dysplasia Clinic, Indore, India Sruthi Bhaskaran, MS Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India Sumiti Mehta Dixit, DGO Department of Obstetrics and Gynecology, Babu Jagjivan Ram Memorial Hospital, Delhi, India Anshul Grover, DGO, DNB Department of Obstetrics and Gynecology, Babu Jagjivan Ram Memorial Hospital, Delhi, India Sheenam Jain, MBBS Department of Obstetrics and Gynecology, Santosh Medical College, Ghaziabad, UP, India Satinder Kaur, MD, DNB Fellowship Gyne Oncology and Diploma Advanced Gyne Endoscopy, Consultant Gyne Oncologist, Dharamshila Hospital and Research Centre, Delhi, India xiii

11 xiv Contributors Sumita Mehta, DGO, DNB, MAMS, MICOG Department of Obstetrics and Gynecology, Babu Jagjivan Ram Memorial Hospital, Delhi, India Aruna Nigam, MS Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Delhi, India Divya Pandey, MS Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Upasna Pandit, MS Department of Obstetrics and Gynecology, Subharti Medical College, Meerut, India Deepika Pannu, MS Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Swati Priya, MS Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India Veena Rahatgaonkar, MD, DGO Department of Obsterician and Gynecologist and Colposcopist, Deenanath Mangeshkar Hospital and Research Center, Pune, India Pikee Saxena, MD Department of Obstetrics and Gynecology, Lady Hardinge Medical College and Associated SSK Hospital, Delhi, India Saritha Shamsunder, MD, FRCOG Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Sumedha Sharma, MS Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Delhi, India Kavita N. Singh, MS, PhD (Gyn.Oncology), FICOG Department of Obstetrics and Gynecology, NSCB Govt. Medical College, Jabalpur, MP, India Anshuja Singla, DNB Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India Mala Srivastava, DGO, DNB, MICOG Institute of Obstetrics and Gynecology, Sir Ganga Ram Hospital, New Delhi, India Ankita Srivastava, MBBS Department of Obstetrics and Gynecology, Sri Aurobindo Institute of Medical Sciences, Indore, India Amita Suneja, MD, MAMS Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India