scholarly journals A CASE OF CERVICAL INTRAEPITHELIAL NEOPLASIA - MANAGEMENT THROUGH AYURVEDA

2021 ◽  
Vol 9 (12) ◽  
pp. 3143-3150
Author(s):  
Deepthi. G. B ◽  
Gayathri Bhat. N.V
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Disease Incidence ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Treatment Modalities ◽  
Low Grade ◽  
Disease Manifestation ◽  
Mild Dysplasia

Introduction – Cervical cancer is the 2nd most leading prevalent cancer in India. There are an estimated 123,000 new cases of cervical cancer in India every year with 67,000 deaths in women alone. Cervical cancer in Recent studies shows that screening of cervical cancer reduces the disease incidence and disease mortality by 50%. Low- grade squamous intraepithelial lesion (LSIL) is a common abnormal result on a Pap smear cervical test. It’s also known as mild dysplasia. Methodology – Here is a case report of a patient aged 26yrs with complaints of white discharge per vagina with severe itching, on routine cervical screening investigations found to have Low grade squamous intraepithelial neoplasms. She was treated with Ayurvedic sthanika chikitsa (Local therapies) such as Yoni prakshalana (Vaginal douching), and Yoni pichu (Vaginal tamponing) for 7 days along with shaman chikitsa. Later PAP smear was repeated after 1 month of follow up and found to have negative for intraepithelial neoplasia. And there was relief in the symptoms following treatment. Results- In this case, there was a relief of symptoms and on follow up when Pap smear was repeated, there was negative for intraepithelial neoplasia. Ayurvedic treatment modalities such as Sthanika chikitsa which includes yoni prakshalana and Yoni Pichu are the line of treatment for various gynecological problems and help in reducing mortality and morbidity caused due to cervical cancer in India. Discussion- Here Low-grade squamous Intraepithelial neoplasia can be considered as the Sanchaya avastha and hence diagnosing the disease in its Sanchaya avastha i.e mild dysplasia, is important. During Sanchaya avastha there is localized neoplastic changes of cervical cells and there is Manifestation of Low-grade Intraepithelial Neo- plasia. In the later stages of Kriyakala (Stages of disease manifestation) the neoplasia turns into metastasis and further differentiation occurs which Manifests all the symptoms of Cervical Cancer. Hence treatment modalities such as Yoni prakshalana and yoni pichu helps in preventing later conditions such as cervical cancer. Keywords: Cervical Cancer, LSIL, Ayurveda, Sanchaya

The impact of microinvasive cancer of the cervix on women during follow-up

2008 ◽  
Vol 18 (6) ◽  
pp. 1289-1293 ◽  
Author(s):  
M. Cairns ◽  
N. M. Gray ◽  
M. E. Cruickshank
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Cervical Screening ◽  
Depression Scale ◽  
Intraepithelial Neoplasia ◽  
Postal Questionnaire ◽  
Depression Score ◽  
High Grade ◽  
The Impact

The psychologic and psychosexual sequelae of cervical screening and disease are well recognized but most research has focused on women with cervical intraepithelial neoplasia (CIN) or women with early (stage IB) to advanced cervical cancer. There has been little work looking at women with microinvasive cancer as a unique clinical identity. Many of these women have a similar diagnostic, treatment, and follow-up pathway to those with high-grade CIN. This could result in unrecognized and ongoing health concerns. We report on a questionnaire-based case–control study, comparing the concerns of women with microinvasive cervical cancer with those of women with high-grade CIN. Women with microinvasive cancer and controls with CIN2/3 diagnosed between 2000 and 2006, from a geographically defined population, were recruited and invited to complete a postal questionnaire consisting of the Hospital Anxiety and Depression Scale (HADS) and the Process Outcome Specific Measure (POSM). Twenty-eight women diagnosed with microinvasive cancer were identified and 18 participated (response rate 64%). Fifty-eight controls were matched by age and year of treatment with 26 responding (45%). About 18% of women with microinvasive cancer had a HADS depression score of 8 or more, compared to 12% of those with CIN (P= not significant). The HADS anxiety score of 8 or more occurred in 35% of each group. There were no significant differences in terms of POSM results for sexual activity, fertility, and developing cervical cancer in the future between cases and controls. We did not find a difference between women with a previous diagnosis of microinvasive cancer and those with high-grade CIN, in terms of ongoing concerns during their follow-up. We did not identify any additional concerns for women with microinvasive cancer in the care provided in the colposcopy service.

scholarly journals A Comparative Study between Conventional Pap Smear and Liquid-Based Cytology: A Clinco-Cytological Study of Iraqi Women with Some Health Problems of Cervix

2019 ◽  
pp. 2362-2370
Author(s):  
Huda Hameed K. Alabbody ◽  
Zahraa Adnan G. Al-Ghuraibawi
Keyword(s):  
Cervical Cancer ◽  
Uterine Cervix ◽  
Visual Inspection ◽  
Pap Smear ◽  
Cervical Screening ◽  
Health Problems ◽  
Low Grade ◽  
Sexually Active ◽  
Iraqi Women ◽  
Liquid Based Cytology

A cervical screening by Pap test is necessary in recognizing precancerous and cancerous cases to reduce mortality due to cervical cancer among women. Regular screening and follow up can make it easier to early diagnose and eventually, to treat and control cervical cancer.     This study aimed to detect atypical pathological changes of the vagina and uterine cervix of a sample of Iraqi women by macro- and micro-examination, and to determine the link with the demographic features. Also the study aimed to evaluate the two Pap smear techniques; the conventional and the base liquid methods.      The study included 50 women with genital health problems (18-50 years old) who were referred to the National Cancer Research Center (NCRC), the University of Baghdad, during the period from 1st April to 30st of September 2018. Both visual inspection of the uterine cervix and Papanicolaou smear were performed for all of the participants.      The results showed that most patient women (96%) were married and sexually active, with 51% being married under 20 years of age .Visual inspection of the cervix showed that 30% of the women had translucent, opaque or erosion lesions. Upon cytology examination, 92% of the women showed nonspecific inflammation, 70% revealed reactive squamous metaplasia, 10% had Koilocytotic atypia, and 8% suffered from cervical intraepithelial neoplasia (CIN1) or low grade squamous intraepithelial lesion (LGSIL). Contraception was used by 82% of the patients, while 36% used pills. The causes of the referral to the centre were abnormal vaginal discharge (44%) and post-coital bleeding "and\or" dyspareunia (20% each). Lastly, 74% of the participants did not make this test previously. Liquid-based cytology technique outperformed conventional pap smears because of improved fixation, decreased impurities factors, and standardization of cell transfer.     We conclude that routine screening and Pap smear testing for uterine cervix and vagina might be useful to prevent the occurrence of precancerous lesions in the genital system of sexually active women. We recommend to apply this test before and after treatment and to activate the cellular examination in the basal fluid method

scholarly journals Can biopsies be omitted after normal colposcopy in women referred with low-grade cervical cytology? A prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mette Mindedahl Jespersen ◽  
Berit Bargum Booth ◽  
Lone Kjeld Petersen
Keyword(s):  
Cervical Cancer ◽  
Cohort Study ◽  
Cancer Screening ◽  
Intraepithelial Neoplasia ◽  
Relative Increase ◽  
Low Grade ◽  
Squamocolumnar Junction ◽  
Study Participants ◽  
Cytology Screening

Abstract Background Controversy surrounds whether women with low-risk cytology screening results but a normal colposcopic assessment should have random biopsies taken. The aim of this study was to determine the yield of CIN2+ from one to four cervical biopsies in women with cytology of LSIL or ASCUS and a normal colposcopic impression. Methods Between January 2017 and September 2020, women over 18 years old referred for colposcopic examination due to either an abnormal smear (ASCUS+) or follow-up after previous cervical intraepithelial neoplasia (CIN) were invited to participate in the study. All study participants underwent colposcopic examination and had four biopsies taken. The biopsies were analyzed separately. Results In total, 1327 women with abnormal cervical cancer screening results or attending follow-up after a previous CIN diagnosis were enrolled in the study and examined by colposcopy. Of these, 173 were newly referred with cytology of LSIL or ASCUS and had a normal colposcopic impression and four adequate biopsies. Of these, 22.0% were diagnosed with CIN2+. When combining the results of the four biopsies, we found a 100% relative increase in CIN2+ cases compared to using only one biopsy (from 11.0% to 22.0%, P = 0.006). Conclusion As we found CIN2+ from random cervical biopsies in 22.0% of women with cytology of LSIL or ASCUS who had a normal colposcopic impression, we advocate performing four random cervical biopsies at the squamocolumnar junction in such women. Trial registration NCT04249856, January 31 2020 (retrospectively registered).

scholarly journals Clinical effectiveness of VIA and colposcopy based management of cervical intraepithelial neoplasia

2015 ◽  
Vol 47 (1-2) ◽  
pp. 16-20
Author(s):  
Zannatul Ferdous Jesmin ◽  
Afroza Khanam ◽  
Eti Saha ◽  
Md Mokter Hossain
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Screening Program ◽  
Precancerous Lesion ◽  
Intraepithelial Neoplasia ◽  
Post Treatment ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
Cin Iii

Cervical cancer develops from early precancerous lesion known as cervical intraepithelial neoplasia (CIN). Khulna Medical college Hospital provides primary screening for preventing cervical cancer and a secondary referral centre for management of CIN by colposcopy. Primary objective of this study was to do an audit between January 2012 to February 2014 to update clinical efficacy of colposcopy based diagnosis, treatment and follow up of 510 CIN cases and also to document any shortcomings in existing services and suggestion for early rectification. Colposcopic findings in our study group were: 309(60.6%) cases were CIN-1, 124 (24.3%) cases was CIN II, and 49 (9.6%) cases were CIN III. Suspicious of invasive lesion was in 7 (1.4%) abnormal looking cervix and biopsy was done in 21(4.1%). Treatment procedure was done with individualization of cases and options were cold coagulation, Loop electrosurgical excision procedure (LEEP), hysterectomy, biopsy and post treatment follow up. Histopathological diagnosis was documented in 387 cases, where CINI was found in 161 (31.6%), CIN II in 92 (18%), CIN III in 26 (5.1%), non specific Inflammatory cervicitis in 87(17.1%), Squamous cell carcinoma in 15(2.9%), abnormalities consistent with koilocytic atypia in 6 (12%) and reports missed in 123 (24.1%). Cases results showed Positive predictive value (PPV) of 53% and 68% respectively for low grade (CIN I) and high grade lesion (CIN II, III). 481 patient were eligible for post treatment follow up but only 99 (20.5%) patient came and among them 74 (74.7%) were colposcopically negative, 25 (25.2%) had residual CIN and Risk Ratio (RR) was 0.25. Colposcopy is gold standard for diagnosis of CIN but our screening program is opportunistic and far way from population based. Histopathological correlation were often inaccurate with colposcopic diagnosis in practice and about one third case reports were missed. Majority of women did not complete follow up protocol. Residual or recurrent CIN lesion in dropped out cases would be a concern in near future. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22557 Bang Med J (Khulna) 2014; 47 : 16-20

Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 376 ◽  
Author(s):  
Joseph Tota ◽  
Salaheddin M. Mahmud ◽  
Alex Ferenczy ◽  
François Coutlée ◽  
Eduardo L. Franco
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Human Error ◽  
Pap Smear ◽  
Cervical Screening ◽  
Screening Tests ◽  
Hpv Testing ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs

Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.

scholarly journals Enhanced Detection of Cervical Cancer and Precancer Through Use of Imaged Liquid-Based Cytology in Routine Cytology and HPV Cotesting

2018 ◽  
Vol 150 (5) ◽  
pp. 385-392 ◽  
Author(s):  
R Marshall Austin ◽  
Agnieszka Onisko ◽  
Chengquan Zhao
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Pap Smears ◽  
Adenocarcinoma In Situ ◽  
Hpv Testing ◽  
Liquid Based Cytology ◽  
Positive Results

AbstractObjectivesCervical screening strives to prevent cervical cancer (CxCa), minimizing morbidity and mortality. Most large US reports on cytology and human papillomavirus (HPV) cotesting of women aged 30 years and older are from one laboratory, which used conventional Papanicolaou (Pap) smears from 2003 to 2009.MethodsWe quantified detection of CxCa and precancer (cervical intraepithelial neoplasia 3/adenocarcinoma in situ [CIN3/AIS]) in 300,800 cotests at Magee Womens Hospital since 2005. Screening histories preceding CxCa and CIN3/AIS diagnoses were examined to assess the contribution of cytology and HPV testing. Cotesting utilized Food and Drug Administration-approved imaged liquid-based cytology (LBC) and from-the-vial HPV tests.ResultsLBC identified more women subsequently diagnosed with CxCa and CIN3/AIS than HPV testing. HPV-negative/cytology-positive results preceded 13.1% of CxCa and 7.2% of CIN3/AIS diagnoses.ConclusionsLBC enhanced cotesting detection of CxCa and CIN3/AIS to a greater extent than previously reported with conventional Pap smear and HPV cotesting.

scholarly journals Loss to follow-up of women with initial cervical cytology of ASC-US/LSIL in Tocantins, Brazil

2021 ◽  
Vol 10 (6) ◽  
pp. e27910615660
Author(s):  
Jucimária Dantas Galvão ◽  
Felipe Campos ◽  
Fábio Russomano
Keyword(s):  
Cervical Cancer ◽  
Record Linkage ◽  
Pap Smear ◽  
Cancer Control ◽  
Uterine Cervical Cancer ◽  
Cervical Cytology ◽  
Low Grade ◽  
Loss To Follow Up ◽  
Intraepithelial Lesion

Objective: The study aims to characterize loss to follow-up of women with initial cytological diagnosis of atypical squamous cells of undetermined significance, possibly non-neoplastic (ASC-US), or low-grade squamous intraepithelial lesion (LSIL), in Tocantins State, Brazil, from 2011 to 2013. Study Design: Cervical cytology data from the Information System on Uterine Cervical Cancer (SISCOLO) was used to identify women with initial diagnosis of ASC-US or LSIL in 2011. Nominal database record linkage was used to identify women with previous altered Pap smear results (who were excluded) and those who returned (versus failed to return) by the year 2013. Results: Record linkage identified 1,174 women with diagnoses of ASC-US (65.9%) or LSIL (34.1%) and without previous altered tests. According to the data, 55.9% and 53.5%, respectively, failed to undergo follow-up tests in the subsequent years. Conclusion: Failure to return for repeat cervical cytology suggests a missed opportunity for diagnosis and treatment of women with precursor lesions or cervical cancer not detected in the initial cytology, thus compromising the effectiveness of cervical cancer control in the State of Tocantins.

scholarly journals The incidence of cervical intraepithelial neoplasia in antenatal women by screening: a study in a semi urban area in Telangana, India

2017 ◽  
Vol 6 (7) ◽  
pp. 2887
Author(s):  
Beera Neelima ◽  
V. G. Vanamala
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Pap Smear ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
Efficient Treatment ◽  
Child Bearing ◽  
Cervical Disease ◽  
The Mean ◽  
Epithelial Lesion

Background: Cervical intraepithelial neoplasia is a premalignant cervical disease which may lead to cervical cancer. The screening of the cervical cancer includes the screening of cervical cytology as well as testing for oncogenic human papilloma viruses (HPV) since most of the precursor lesions appear in the women of child bearing age. The purpose of the present study was to evaluate the incidence of cervical intraepithelial neoplasia in antenatal women by screening with papanicolaou smear.Methods: Macroscopic abnormalities such as cervicitis, polyps, erosions, nabothian cysts, hypertrophied cervix, growths and ulcers were noted. A cervical smear using Ayre’s spatula was taken from the ecto cervix and spread on to a labeled slide and immediately fixed.Results: Majority of the women were in the age group of 20-30 years in the study group. The overall mean age of the women in the study was around 25 years. The mean age at the time of menarche was around 14 years and at the time of marriage was approximately 22 years. On Pap smear, 55.2% of the 1000 cases were normal, with inflammation seen in 408 (40.8%) of the cases. 20 (2%) of the patients in our study had low grade squamous intra epithelial lesion, while 7 patients (0.2%) had high grade squamous intra epithelial lesion with two cases showing CIN II grading and 5 with CIN I.Conclusions: An early detection of the same can lead to a proper and efficient treatment.

scholarly journals Smartphone-Enhanced Training, QA, Monitoring, and Evaluation of a Platform for Secondary Prevention of Cervical Cancer: Opportunities and Challenges to Implementation in Tanzania

2020 ◽  
pp. 1114-1123
Author(s):  
Karen Yeates ◽  
Erica Erwin ◽  
Zac Mtema ◽  
Frank Magoti ◽  
Simoni Nkumbugwa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Visual Inspection ◽  
Screening Program ◽  
Cervical Screening ◽  
Monitoring And Evaluation ◽  
Visual Assessment ◽  
Cervical Cancer Prevention ◽  
Supportive Supervision ◽  
Health Providers

PURPOSE Until human papillomavirus (HPV)–based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who “graduated” from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.

Women’s health concern in Jordan: knowledge, practice and barriers toward cervical cancer screening

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Roqia Saleem Maabreh ◽  
Raya Yousef Al-Husban ◽  
Hekmat Yousef Al-Akash ◽  
Noha Al-Shdayfat
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Pap Smear ◽  
Cervical Screening ◽  
Health Concern ◽  
Cancer Awareness ◽  
Early Screening ◽  
Cross Sectional ◽  
Content Type ◽  
Knowledge Barriers

Purpose Cervical cancer (CC) is one of the most important health issues faced by women worldwide. The purpose of this study is to identify Jordanian women’s knowledge, barriers and measures pertaining to risk factors and screening choices of CC (Pap smear tests). Design/methodology/approach This study applied a cross sectional design by collecting data from a convenient sample of 200 women between 20 and 70 years of age in health and public centers in Jordan. Data was then analyzed using the descriptive statistical tools of SPSS, version 21. Findings The findings revealed that 55.5% of the participants had no information about the Pap smear, and 75% did not know the risk factors. Moreover, 50% of the sample did not know where to take the test, and 50% reported a lack of encouragement from the husband to undertake the test. More than half of the participants (56.5%) expressed fear that cervical screening would be a painful examination even though they reported not having any previous experience with the test. Originality/value Based on these findings, public education about CC screening is essential, including advertising and a campaign similar to the breast cancer awareness programs in Jordan, as a way of encouraging early screening to improve the health of women.

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