Synopsis:

Colposcopy is the visual examination of the epithelial cervix using either uni- or binocular vision. Specific abnormalities associated with both squamous and glandular precancer can be identified especially after the application of a 5% acetic acid solution. After this application, the abnormalities become visible as a result to changes in the epithelium and blood vessels in the stroma. These changes occur within an area of the cervix called the transformation zone, an area bounded by the junction of vaginal epithelium and the glandular epithelium arising from the endocervix (canal). Within this area a change occurs in which glandular epithelium changes to squamous by a process of transformation, called metaplasia. The upper border of this metaplastic change is called the new squamo-columnar junction. The inability to see this junction means that abnormality may exist higher up in the endo cervix.

A sample of any abnormality within the transformation zone can be taken by a simple punch biopsy. Colposcopy is an essential part of the diagnosis and treatment of cervical precancer. It is indicated in the presence of abnormal cytology or in the finding of certain types of HPV and also when there are clinical symptoms and signs of the early invasive cancer.

Educational Objectives:

Upon completion of this educational activity, participants should be able to:

• Describe the anatomy, cytology, histology, and colposcopic findings of the normal and abnormal cervix.· Define the pathophysiology of lower genital tract neoplasia, including the role of HPV in preinvasive and invasive diseases of the cervix.
• Define the IFCPC colposcopy terminology.· Recognize the diagnostic characteristics of cervical abnormalities (minor-grade and major-grade cervical lesions as well as glandular lesions and cervical cancer) on cytologic, colposcopic, and histologic exam;
• Interpret and correlate cytologic, colposcopic, and histologic results.
• Describe treatment options to include cryosurgery and large loop excision of the transformation zone (LLETZ) of the cervix.
• Provide appropriate patient education and support.