Abstract

This colposcopy manual was developed in the context of the cervical cancer screening research studies of the International Agency for Research on Cancer (IARC) and the related technical support provided to national programmes. It is thus a highly comprehensive manual, both for the training of new colposcopists and for the continuing education and reorientation of those who are more experienced. This manual offers a valuable learning resource, incorporating recent developments in the understanding of the etiology and pathogenesis of cervical intraepithelial neoplasia (CIN), as well as in colposcopy and cervical pathology.

Expertise in performing satisfactory, safe, and accurate colposcopic examinations requires high competence in the technical, interpretive, and cognitive aspects, and the capability to develop pragmatic and effective management plans and treatment. This comprehensive and concise manual covers all these aspects and serves as a useful handbook for acquiring the necessary skills for the visual recognition and interpretation of colposcopic findings and for developing the personal and professional attributes required for competence in colposcopy.

Contents

• Library Cataloguing Information
• [Dedication]
• Contributors
• Acknowledgements
• Foreword
• Abbreviations
• Chapter 1. The role of colposcopy in cervical precancer
  • 1.1. Traditional screening: rationale and practice
  • 1.2. Management of screen-positive women
  • 1.3. Clinical guidelines
  • 1.4. Risk assessment in patient management
  • 1.5. Screening and triage options in current practice
  • 1.6. Colposcopy
• Chapter 2. Anatomy of the uterine cervix and the transformation zone
  • 2.1. Tissue constituents of the cervix
  • 2.2. Ectropion or ectopy
  • 2.3. Squamous metaplasia
  • 2.4. Transformation zone (TZ)
• Chapter 3. Squamous intraepithelial lesions: cytology–histology correlation
  • 3.1. Current understanding of the natural history of cervical precancer
  • 3.2. Historical context
  • 3.3. HPV and the genesis of cervical cancer
  • 3.4. Cytology nomenclature
  • 3.5. Cytological and histological recognition of cervical precancer
• Chapter 4. The effect of oncogenic HPV on transformation zone epithelium
  • 4.1. Biomarker assessment
  • 4.2. Clinical utility of biomarkers
  • 4.3. Summary
• Chapter 5. Equipment for a colposcopic examination
  • 5.1. Colposcope
  • 5.2. Gynaecological couch and operator’s stool
  • 5.3. Camera system
  • 5.4. Computerized data management system
  • 5.5. Instrument trolley
  • 5.6. Reusable instruments
  • 5.7. Disposable equipment
  • 5.8. Cork boards and pins to mount LLETZ/LEEP specimens
• Chapter 6. A systematic approach to colposcopic examination
  • 6.1. Colposcopy training needs
  • 6.2. Equipment check
  • 6.3. Biopsy and electrosurgical excision
  • 6.4. Counselling
  • 6.5. Consent
  • 6.6. Privacy and support
  • 6.7. The colposcopy nurse attendant
  • 6.8. The colposcopic examination
• Chapter 7. Colposcopic terminology: the 2011 IFCPC nomenclature
  • 7.1. Terms that have been omitted from the 2011 IFCPC nomenclature
  • 7.2. General assessment
  • 7.3. Transformation zone type
  • 7.4. Excision type
  • 7.5. The excised specimen
  • 7.6. Colposcopic terminology of cervical epithelium
  • 7.7. Individual terms in the IFCPC nomenclature
• Chapter 8. Colposcopic appearance of the normal cervix
  • 8.1. After application of normal saline solution
  • 8.2. After application of 5% acetic acid
  • 8.3. Nabothian follicles
  • 8.4. Cervical polyps
  • 8.5. After application of Lugol’s iodine
  • 8.6. Congenital transformation zone
• Chapter 9. Inflammatory lesions of the cervix
  • 9.1. Wet preparation, cytological, and histological appearances of infection
  • 9.2. Colposcopic appearance of cervicovaginitis
  • 9.3. Colposcopic examination
  • 9.4. Specific infections
• Chapter 10. Colposcopic examination of the abnormal cervix
  • 10.1. Acetowhiteness
  • 10.2. Vascular patterns
  • 10.3. Other markers of abnormality
  • 10.4. Margin status
  • 10.5. Leukoplakia (hyperkeratosis)
  • 10.6. Condylomata
  • 10.7. Lesion size
  • 10.8. Iodine uptake
  • 10.9. Summary
• Chapter 11. Treatment of cervical intraepithelial neoplasia (CIN)
  • 11.1. Excision or destruction of the transformation zone
  • 11.2. Pre-treatment conditions
  • 11.3. Destructive methods
  • 11.4. Excisional methods
  • 11.5. Electrosurgery for CIN
  • 11.6. Safety issues with LLETZ
  • 11.7. A practical approach to the LLETZ procedure
  • 11.8. Post-LLETZ wound management
  • 11.9. Management of the specimen
  • 11.10. Post-treatment advice to patients
  • 11.11. Complications after LLETZ
  • 11.12. See-and-treat
  • 11.13. Modifications of LLETZ technique: SWETZ; type 2 and type 3 excisions
  • 11.14. Comparison of treatment success rates between LLETZ, thermal coagulation, and cryocautery
  • 11.15. Follow-up after treatment of CIN
• Chapter 12. Glandular abnormalities, adenocarcinoma in situ, and glandular intraepithelial neoplasia
  • 12.1. Glandular disease
  • 12.2. Management of suspected glandular dysplasia
  • 12.3. Excisional treatment with CGIN: what type and how big?
  • 12.4. Anatomical distribution of CGIN
  • 12.5. Individualizing treatment with CGIN
• Chapter 13. Microinvasive squamous cervical cancer
  • 13.1. Early preclinical microinvasive disease of the cervix (stages IA1 and IA2)
  • 13.2. Clinical features of microinvasive disease
  • 13.3. Colposcopic recognition of microinvasive disease
  • 13.4. Management of suspected microinvasive disease
  • 13.5. Stage 1B and greater
  • 13.6. Histopathology
  • 13.7. Treatment of squamous microinvasive cervical cancer
• Chapter 14. Surgical management of early invasive cervical cancer
  • 14.1. Diagnosis and staging
  • 14.2. Principles of surgical treatment of early cervical cancer
  • 14.3. Radical hysterectomy for cervical cancer
  • 14.4. Pelvic lymphadenectomy for cervical cancer
  • 14.5. Fertility preservation in cervical cancer
  • 14.6. Minimal access surgery in cervical cancer
  • 14.7. Adjuvant therapy after surgery
  • 14.8. Survival after treatment of early-stage cervical cancer
  • 14.9. Surgical management of early cervical cancer during pregnancy
  • Key points
• Chapter 15. Non-surgical management of cervical cancer
  • 15.1. Radiotherapy
  • 15.2. Chemotherapy
  • 15.3. Concurrent chemoradiotherapy
  • 15.4. Neoadjuvant chemotherapy
  • 15.5. Non-surgical options by stage
  • 15.6. The need for cancer diagnosis and treatment infrastructure in LMICs
• Chapter 16. Follow-up after treatment of cervical intraepithelial neoplasia (CIN)
  • 16.1. Risk of development of invasive disease in treated women
  • 16.2. Current guidelines
  • 16.3. Oncogenic HPV testing after treatment
  • 16.4. Specific circumstances
  • 16.5. Summary
• Chapter 17. Pregnancy, contraception, menopause, and hysterectomy
  • 17.1. Management of CIN during pregnancy
  • 17.2. Contraception and CIN
  • 17.3. Hormone replacement therapy and CIN
  • 17.4. Hysterectomy and treatment of CIN
• Chapter 18. Quality assurance: fail-safe protocols and clean equipment
  • 18.1. Standard operating procedures
  • 18.2. Protection against infection
  • 18.3. Decontamination
  • 18.4. Cleaning
  • 18.5. Sterilization or high-level disinfection
  • 18.6. Quality assurance of equipment safety and sterility
  • 18.7. Spaulding’s classification of medical instruments (modified)
  • 18.8. Decontamination of surfaces in the screening clinic
• References
• Annex 1. Transformation zone types
• Annex 2. Standard form for documenting the examination findings
• Annex 3. 2011 IFCPC colposcopic terminology of the cervix
• Annex 4. The Swede score
• Annex 5. Preparation of 5% acetic acid, Lugol’s iodine solution, and Monsel’s paste
• Disclosures of interests
• Sources