Dept. of Gynecology BMCHRC is one of the premiere cancers institute in this part of the country.The dept. of Gynecology deals with the early detection. Screening,  prevention & Management off all Females Cancers.We are committed to one aim of screening minimum women especially for Cervical, Breast cancers. We organize camps very frequently & provide free services to the Camp patients.

Pap smears, Colposcopy, Ultrasound & Mamerography are done free of cost for Camp patients & also for citizens with the aim to reduce the morbidity & morality related to various Gynecological malignancies.  

Pap Test

The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. Significant changes can be treated, thus preventing cervical cancer. The test was invented by and named after the prominent Greek doctor Georgios Papanikolaou, but was also independently invented by Romanian scientist Aurel Babeş.[1] An anal Pap smear is an adaptation of the procedure to screen and detect anal cancers.

In taking a Pap smear, a tool is used to gather cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium.

It is generally recommended that females who have had sex seek regular Pap smear testing. Guidelines on frequency vary, from annually to every five years. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in three to twelve months. If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing.

• Abnormal results are reported according to the Bethesda system. They include:
  • Atypical glandular cells (AGC)
  • Atypical squamous cells of undetermined significance (ASCUS)
  • Atypical squamous cells of undetermined significance (ASC-US)
  • Atypical squamous cells - cannot exclude HSIL (ASC-H)
  • Low grade squamous intraepithelial lesion (LGSIL or LSIL)
  • High grade squamous intraepithelial lesion (HGSIL or HSIL)
  • Squamous cell carcinoma
  

Effectiveness

Prior to the introduction of the Pap test, carcinoma of the cervix was a leading cause of death in women. Since the introduction of the Pap test, deaths caused by carcinoma of the cervix have been reduced by up to 99% in some populations where women are screened regularly .Failure of prevention of cancer by the Pap test can occur for many reasons, including not getting regular screening, lack of appropriate follow up of abnormal results, and sampling and interpretation errors.^[.

 

 

Pap Smears




What is a Pap smear?


A Pap smear is a test your doctor does to check for signs of cancer of the cervix. The cervix is part of your uterus (womb). During a Pap smear, your doctor takes a sample of cells from your cervix to be tested and examined.

To take the sample, your doctor will put a special instrument called a speculum into your vagina. This helps open your vagina so the sample can be taken. Your doctor will gently clean your cervix with a cotton swab and then collect a sample of cells with a small brush, a tiny spatula or a cotton swab. This sample is put on a glass slide and sent to a lab to be checked under a microscope.

 



 

 

What is the sample checked for?

The cells on the slide are checked for signs that they're changing from normal to abnormal. Cells go through a series of changes before they turn into cancer. A Pap smear can show if your cells are going through these changes long before you actually have cancer. If caught and treated early, cervical cancer is not life-threatening. This is why getting regular Pap smears is so important.

 

What do the results mean?

A normal Pap smear means that all the cells in your cervix are normal and healthy.
An abnormal Pap smear can be a sign of a number of changes in the cells on your cervix:
• Inflammation (irritation). This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV) the herpes virus or many other infections.
• Abnormal cells. These changes are called cervical dysplasia. The cells are not cancer cells, but may be precancerous (which means they could eventually turn into cancer).
• More serious signs of cancer. These changes affect the top layers of the cervix but don't go beyond the cervix.
• More advanced cancer.

 

How often should I have a Pap smear?

You should have your first Pap smear when you start having sex or by age 18.

Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause.

Certain things put you at higher risk of cervical cancer. Your doctor will consider these when recommending how often you should have a Pap smear.

If you're older than 65, talk with your doctor about how often you need a Pap smear. If you've been having Pap smears regularly and they've been normal, you may not need to keep having them.

 

How reliable is the test?

No test is perfect, but the Pap smear is a reliable test. It has helped drastically lower the number of women who die of cervical cancer.

Sometimes the test may need to be redone because there were not enough cells on the slide. The lab will tell your doctor if this happens.

ThinPrep, PAPNET and FocalPoint are ways to make Pap smears more accurate. ThinPrep is a way of preparing the sample of cells that makes it easier to spot abnormalities. PAPNET and FocalPoint are computer systems that help lab technicians find abnormal cells. These options may not be available in all areas, and they may increase the cost of a Pap smear.

 

What should I do before the test?


Plan to have your test done at a time when you aren't having your menstrual period. Don't douche, use a feminine deodorant or have sex for 24 hours before the test.
What happens if my Pap smear is abnormal?
If the results of your Pap smear are abnormal, your doctor may want to do another Pap smear or may want you to have a colposcopy.

A colposcopy gives your doctor a better look at your cervix and allows him or her to take a sample of tissue (called a biopsy). Your doctor will use an instrument called a colposcope to shine a light on your cervix and magnify it. Your doctor will explain the results and discuss treatment options with you.

 

What puts me at risk for cervical cancer?

Risk factors for cervical cancer
• Starting to have sex early (before age 18)
• Having had many sexual partners
• Being infected with an STI or having had a sex partner who has an STI
• Smoking
The main risk factors for cervical cancer are related to sexual practices (see the box to the right). Sexually transmitted infections (STIs) may make your cells more likely to undergo changes that can lead to cancer. STIs include HPV, herpes, gonorrhea and chlamydia. HPV is the virus that can cause genital warts. It seems to be very closely connected with these changes.

 

Is there anything I can do to avoid getting cervical cancer?

You may be able to reduce your risk of cervical cancer if you:
• Delay sexual intercourse until you're 18 years of age or older.
• Make sure both you and your partner are tested for STIs.
• Limit your number of sex partners.
• Always use latex condoms to protect against sexually transmitted infections (STIs). (Remember condoms aren't 100% effective.)
• Avoid smoking.

 

Colposcopy

 

Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination. It is done using a colposcope, which provides an enlarged view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies for further pathological examination. The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treating them. The procedure was developed in 1925 by the German physician Hans Hinselmann

In this diagram, the canal of the cervix (or endocervix) is circled at the base of the womb. The vaginal portion of the cervix projects free into the vagina. The transformation zone, at the opening of the cervix into the vagina, is the area where most abnormal cell changes occur.

 

 

Indications for colposcopy

 

Most women undergo a colposcopic examination to further investigate a cytological abnormality on their pap smears. Other indications for a woman to have a colposcopy include:
• assessment of diethylstilbestrol (DES) exposure in utero,
• immunosuppression such as HIV infection, or an organ transplant patient
• an abnormal appearance of the cervix as noted by a physician.

 

Colposcope

 

During the initial evaluation, a medical history is obtained, including gravidity (number of prior pregnancies), parity (number of prior deliveries), last menstrual period, contraception use, prior abnormal pap smear results, allergies, significant past medical history, other medications, prior cervical procedures, and smoking history. In some cases, a pregnancy test may be performed before the procedure. The procedure is fully described to the patient, questions are asked and answered, and she then signs a consent form.

A colposcope is used to identify visible clues suggestive of abnormal tissue. It functions as a lighted binocular microscope to magnify the view of the cervix, vagina, and vulvar surface. Low power (2× to 6×) may be used to obtain a general impression of the surface architecture. Medium (8× to 15×) and high (15× to 25×) powers are utilized to evaluate the vagina and cervix. The higher powers are often necessary to identify certain vascular patterns that may indicate the presence of more advanced precancerous or cancerous lesions. Various light filters are available to highlight different aspects of the surface of the cervix. Acetic acid solution and iodine solution (Lugol's or Schiller's) are applied to the surface to improve visualization of abnormal areas.

Colposcopy is performed with the woman lying on her back, legs in stirrups, and buttocks at the lower edge of the table (a position known as the dorsal lithotomy position). A speculum is placed in the vagina after the vulva is examined for any suspicious lesions.
After a complete examination, the colposcopist determines the areas with the highest degree of visible abnormality and may obtain biopsies from these areas using a long biopsy instrument. Some doctors consider anesthesia unnecessary, however, many colposcopists now recommend and use a topical anesthetic such as lidocaine or a cervical block to diminish patient discomfort, particularly if many biopsy samples are taken.

Following any biopsies, an endocervical curettage (ECC) is often done. The ECC utilizes a long straight curette to scrape the inside of the cervical canal. The ECC should never be done on a pregnant woman. Monsel's solution is applied with large cotton swabs to the surface of the cervix to control bleeding. This solution looks like mustard and becomes black in color when exposed to blood. After the procedure

this material will be expelled naturally: women can expect to have a thin coffee-ground like discharge for up to several days after the procedure.

Three percent acetic acid is applied to the cervix using cotton swabs. The transformation zone is a critical area on the cervix where many precancerous and cancerous lesions most often arise. The ability to see the transformation zone and the entire extent of any lesion visualized determines whether an adequate colposcopic examination is attainable.
Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular pattern are often considered for biopsy. If no lesions are visible, an iodine solution may be applied to the cervix to help highlight areas of abnormality.

 

Complications

 

Significant complications from a colposcopy are not common, but may include bleeding, infection at the biopsy site or endometrium, and failure to identify the lesion. Monsel's solution and silver nitrate interfere with interpretation of biopsy specimen, so these substances should not be applied until all biopsies have been taken. Most patients experience some degree of pain during the curettage, and almost all experience pain during the biopsy.

 

Follow up

 

Adequate follow-up is critical to the success of this procedure. Human Papilloma Virus (HPV) is a common infection and the underlying cause for most cervical dysplasia. Women should be counseled on the benefits of safe sex for reducing their risks of contracting and spreading the HPV virus.