1. PRE-INVASIVE DISEASE OF THE CERVIX CERVICAL INTRAEPHELIAL NEOPLASIA DR. AMEL AL-SAYED Asst. Prof. & Consultant Ob/Gyne Dept.

2.  The Unique accessibility of the cx to cell and tissue study and to direct physical examination has permitted intensive investigations of the nature of malignant lesions of the cervix  A pre-invasive lesion may be present years before malignant transformation  Pre-invasive lesions are reversible  It is theoretically possible to eradicate most deaths resulting from cervlcal ca by using diagnostic and therapeutic techniques now available

3. Recommendations of screening of ACOG together with the American Cancer Society All women who are or who have been sexually active and reached the age of 18 should undergo an annual Pap Test and Pelvic exam. After a woman has had three or more consecutive satisfactory annual examinations with normal findings, the Pap Smear may be performed less frequently according to her physician. It should be stressed that the aim of performing a Pap Test is to screen for intra epithelium lesions and not to diagnose cervical Ca.

4.  How to perform a Pap Test Epidemiology: 1.Younger patients 2.Early intercourse 3.Multiparity 4.Multiple sexual partners 5.HPV virus infection 6.Lack of use of Barrier Contraception 7.Smoking 8.Jews

5.  HPV Virus -Many types 6, 11, 16, 18, 30, 31, 33, etc. -Causes condylomata acuminata -Type 16, 18, commonly associated with Cx. Ca.

6.  Interpretation of Pap Smear CIN IMild dysplasia CIN IIModerate dysplasia CIN IIISevere dysplasia or carcinoma in situ

7.  Bethesda System  Adequacy of cells  Infections  Epitheliam cell abnormality  Epitheliam cell abnormality a.Atypias (AUDS) Atypia of undetermined significance b.Squamous intra ipethial lesions (SIL) 1.Low grade SIL=CIN I 2.High grade SIL-CIN II + III

8.  If you encounter an abnormal Pap Smear colposcopy must be performed  Abnormal colposcopic findings: A.Atypical transformation zone 1.Keratosis 2.Acetowhire epithelium 3.Punctation 4.Mosavism 5.Atypical vessels B.Suspect frank invasive Ca C.Unsatisfactory colposcopic findings

9.  Rx of Abnormal Pap Smear ♦ Observation ♦Laser ♦Cautary ♦Cautary ♦Cryo ♦Cryo ♦Loop excision ♦Loop excision ♦Podophyllin or TCA ♦Podophyllin or TCA ♦Conization ♦Conization ♦TAH ♦TAH