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Colposcopy

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  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