1 / 11

Colposcopy

Colposcopy. High Grade Intraepithelial Lesions HSIL. Dr Barbara Kerkhoff Consultant Gynaecologist & Obstetrician. High Grade Intraepithelial Lesion. Preinvasive lesion Prevalence: 0.45% (USA) 70 – 75% HSIL  CIN 2/3 1 – 2% HSIL  Invasive cancer. Treatment option.

marshall
Télécharger la présentation

Colposcopy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Colposcopy High Grade Intraepithelial Lesions HSIL Dr Barbara Kerkhoff Consultant Gynaecologist & Obstetrician Bon Secours GP Study Day

  2. High Grade Intraepithelial Lesion • Preinvasive lesion • Prevalence: 0.45% (USA) • 70 – 75% HSIL  CIN 2/3 • 1 – 2% HSIL  Invasive cancer Bon Secours GP Study Day

  3. Treatment option • Excisional Techniques • LLETZ/ LEEP • Laser/ Knife cone biopsy • Local destructive Techniques • Laser Vaporisation • Cryotherapy • Diathermy • Cold Coagulation • Wedge biopsy (Pregnancy) • Hysterectomy Bon Secours GP Study Day

  4. Success of LLETZ Free of disease 5 yrs • Low risk 92% < 50yrs, complete excision • Medium risk 86% < 50yrs, incomplete excision > 50yrs, complete excision • High risk 58% > 50yrs, incomplete excision Bon Secours GP Study Day

  5. Causes of treatment failure Those women most likely to have persistent disease • Large volume disease • High grade disease • Incomplete excision • Immunosuppressed women Bon Secours GP Study Day

  6. Treatment failure For every 1000 women treated for CIN: • 4 will develop invasive cancer - 5.8% for women treatment for CIN 3 Bon Secours GP Study Day

  7. Why test for HPV? • High-Risk HPV DNA testing is more sensitive in detecting high grade disease than smear test.1 • A positive high-risk HPV result is an objective risk indicator for the development of high-grade disease and cancer.2 1. Clavel et al Brit J Cancer 2001;89;1616-1623 2. Lorenz A, Arch Pathol Lab med 2006;127;959-968 Bon Secours GP Study Day

  8. Test of cure? Double negative (Smear and HPV DNA) over 2 years  CURE! Nobbenhuis et all, Brit.J. Cancer 2001;84:796-801 Bon Secours GP Study Day

  9. LLETZ or ablation Follow up guidelines Invasion CIN or CGIN r/v 6 month cytology and HPV Cytopath or MDT YES Negative cytology or HPV Positive cytology or HPV Repeat colposcopy +/- bx Repeat tx if required 2. r/v in 18 month Negative cytology or HPV Positive cytology or HPV no Cytological surveillance annual smears for 10 years d/c to routine screening Bon Secours GP Study Day

  10. Core Messages to Patients • HPV is an infection, not a disease • HPV is not a marker for sexual behaviors, infidelity or timing of infection • HPV is very common • HPV is usually cleared by the immune system (90%) • HPV does not require tx in absence of CIN Bon Secours GP Study Day

  11. Cervical cancer should be considered a very rare complication of a very common virus.Thank you! Dr Barbara Kerkhoff Consultant Gynaecologist Bon Secours GP Study Day

More Related