Cervical pathology &management

With your blessings: 

With your blessings

Cervical pathology & management: 

Cervical pathology & management Dr Mini P Medical officer, G.A.D. Kudayathoor.

Anatomy : 

Anatomy

Physiology : 

Physiology Cervical mucus

Histology of cervix: 

Histology of cervix Glandular epithelium Cloumnar epithelium

Cervical mucus: 

Cervical mucus

Problems with the cervical mucus: 

Problems with the cervical mucus In some women, the cervical mucus may prevent the sperm from moving freely into the uterus. Such a barrier may be because of the following reasons: There is not enough of it to allow the sperm to move easily The mucus is too thick and sticky The mucus is not compatible with the husband's sperm.

Disease classification: 

Disease classification Congenital Traumatic Infections Malignancy

Congenital abnormalities: 

Congenital abnormalities Failure of fusion of the Müllerian ducts Congenital absence or hypoplasia of the cervix In utero exposure to non-steroidal oestrogens (such as diethylstilbestrol) and other non-steroidal oestrogens

Benign tumours: 

Benign tumours Fibroids (myoma/leiomyoma ): These smooth, firm masses are often solitary and account for about 3-8% of uterine myomata. Cervical endometriosis : Endometriosis in the cervix is relatively common and usually considered to be inoffensive. This may be apparent as blue-red or blue-black lesions 1-3 mm in diameter.

Ectropion, Polyp,Nabothian cyst: 

Ectropion, Polyp,Nabothian cyst

Abnormal growth: 

Abnormal growth Polyps endocervical cervical

Abnormality of form: 

Abnormality of form Stenosis -: Diathermy excision of cervical lesions is the most common cause of stenosis (it occurs in 1.3% of cases Other acquired causes include radiotherapy, infection, neoplasia and atrophy following a cone biopsy. It may also be associated with endometriosis Ectropion (previously called cervical erosion or abrasion) - this is when the central columnar epithelium extends out through and around the external os.

structural problems of the cervix: 

structural problems of the cervix Nabothian cysts (epithelial inclusion cysts/mucinous retention cysts) Laceration :

Problems with the cervix in pregnancy: 

Problems with the cervix in pregnancy Cervical incompetence Ectopic pregnancy in the cervix

Incompetent cervix : 

Incompetent cervix Previous surgery on the cervix Damage during a difficult birth Malformed cervix or uterus from a birth defect Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage DES (Diethylstilbestrol) exposure

Inflammatory conditions: 

Inflammatory conditions infectious (commonly endocervicitis) non-infectious (more often ectocervicitis).

Infectious cervicitis: 

Infectious cervicitis Symptoms abnormal yellow-green discharge, bleeding (especially postcoital), dysuria. Signs green/yellow/opaque mucopurulent discharge. Endocervical friability (bleeds easily).

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Common culprits Neisseria gonorrhoeae Chlamydia trachomatis , human papillomavirus and the herpes simplex virus

Candidiasis: 

Candidiasis

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Homogeneous discharge adhering to vaginal walls. Discharge in cervix

Trichomonas Vaginitis: 

Trichomonas Vaginitis

Strawberry cervix: 

Strawberry cervix

Cervicitis: 

Cervicitis

Cervical cause: 

Cervical cause Mucus polyp Chronic cervicitis Ectropion Cervical erosion.

Discharges : 

Discharges trichomonas monilial pyogenic Tromatic&neoplastic colour Yelloish/greenish white purulent Blood stained/purulent consistency Watery/frothy Thick flakes - - quantity copious scanty Is variable variable odour smells smells smells Offensive smell Irritating/non-irritating irritating Sever irritation Non-irritating Non-irritating Relationship to menstrution Worse just after menstrution Worse before menses No relationship No relationship

Abnormal vaginal discharges: 

Abnormal vaginal discharges Purulent vaginal discharge Thick,foul smelling vaginal discharge Mucoid vaginal discharge Blood stained ,pinkish vaginal discharge Thin/watery white vaginal discharge

Paithiki: 

Paithiki Sekam Lepam with balagopamganady thailam Parishekam with nyagrodhady kwatham if severe inflammation&foul smell Kwatham with guloochi,parpata,mustha,useera,dhanyaka,& dusparsaka if fever aggravates Menorrhagia –kwatham with darvi,laksha,triphala,& balatraya

Paithiki : 

Paithiki Pichu with chandanady –daha,mootrakrichra,paka Trayanthyady kwatha Pushyanuga choorna Choorna with palasa,dhataki,jambu…for stambhana or kashaya dharanam Aragwadady kwatha parishechanam Darvyady kwatham

Slaishmiki: 

Slaishmiki Rooksha& ushna medicines Vasthi with kadurasa drugs with gomootra Lepa with choorna of pippali,loha&pathya with honey Kshalanam with dhatakyady kashayam Jambwamrasarady thylam Samsodhana varthy-pipplyady Pathya-yava etc.

Kaphaja arthava dushti: 

Kaphaja arthava dushti Kwatha with kutaja,kaduka &aswagandha Yonidharanam with madanakalka Kshalanam with vastha/ mesha mootra

Non infectious : 

Non infectious Congestive Uterine prolapse Acquired retroverted uterus Pill use Vaginal adenosis Cervical erosion Consecutive deliveries Abortion Excessive coitus Over dose of ushna prabhava medicines

Non-infectious cervicitis: 

Non-infectious cervicitis Common culprits - cervical cancer mechanical trauma (tampons, pessaries, IUCDs) chemical irritants (douching, spermicides) systemic inflammatory disease such as Behçet's disease.

Thin watery white discharge: 

Thin watery white discharge Yonidharanam with cloth impregnated with nyagrodha kwatha Varthy with plaksha with honey Varthy with choorna of lodhra,priyangu&madhuka with honey Fumigation with sarala,guggla&yava+ honey Mudga yoosham……

Cervical Cancer Prevention : 

Cervical Cancer Prevention General Cervical cancer prevention depends upon detection and treatment of high-grade (CIN2,3) cervical lesions most likely to progress to invasive cancer in the absence of treatment. Two primary cervical screening tests are now in use The Pap test, which includes the conventional Pap smear and the liquid-based Pap test.

Pathogenesis: 

Pathogenesis Site where squamous epithelium of vagina meets columnar epithelium of endocervix known as squamocolumnar junction (SCJ) Before puberty: SCJ located just inside the cervical os At puberty, increasing levels of estrogen lead to squamous metaplasia of columnar epithelium to squamous epithelium Results in repositioning of the SCJ further towards the uterus

Pathogenesis (2): 

Pathogenesis (2) Region between the old and new SCJs known as the transformation zone Transformation zone is the site of 95% of the cervical cancer development Since zone is located within the cervical os, unable to be viewed during routine pelvic exam Exposure of transformation zone to carcinogens begins process of intraepithelial neoplasia While exact role of carcinogens in this process remains poorly understood, it is clear that HPV and cigarette smoking can cause dysplasia at the transformation zone

Evaluating the Pap Smear: 

Evaluating the Pap Smear First, the smear is evaluated for adequacy of sample Secondly the sample is categorized as “normal” or “other” Lastly, all sample categorized as “other” are further specified as infection, inflammation, or various stages of cancer

Precursor Lesions: 

Precursor Lesions Reason for thorough classification schemes for intraepithelial lesions is to determine the likelihood of such lesions progressing to overt cancer Usual progression from mild dysplasia to overt cancer takes 7-8 years Precursor lesions characterized as mild dysplasia have 65% chance of spontaneously regressing, 20% chance of remaining the same, 15% chance of worsening

Reasons for Good Prognosis for Cervical Cancer: 

Reasons for Good Prognosis for Cervical Cancer Presence of an easily identifiable precursor lesion Slow progression of cancer Access to cheap non-invasive diagnostic tools (Pap Smears and Culposcopy) Simple and effective treatments

Effect of diet to prevent cervical cancer: 

Effect of diet to prevent cervical cancer Flavonoids to Reduce Cervical Cancer Risk Flavonoids are chemical compounds in fruits and vegetables that are thought to be a leading source protection against cancer. Apples Asparagus Black beans Broccoli Cabbage Garlic Lettuce Onions Soy Spinach

C.I.N.: 

C.I.N. a viral stage of productive infection which is usually self-limited neoplastic transformation in a minority of HPV-related lesions.

COLUMNAR EPITHELIUM: 

Immature squamous metaplasia RISK FACTORS Normal mature squamous DYSPLASTIC CELLS metaplastic epithelium CIN CIS Invasive ca COLUMNAR EPITHELIUM

Our scope: 

Our scope Prevent the mild/moderate dysplasia cases Treatment of infections Immnomodulation

Kshara karma: 

Kshara karma “Arbudamapi vranabhedo vranakarathwath(sha)” One among 60 upakrama of vrana Sarva sastra anusastranam sreshta Chedya bhedya karma

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Mamsa pradoshaja vyadhy Raised or abnormal growth chronic condition In dusodhya

Slide 50: 

Direct application to the area affected Sloughing of abnormal cells by chedana , bhedana & lekhana karma Normal cells develop after destruction of abnormal cells Easy procedure Cost effective Time needed for treatment less Complication very less

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Begin as vranasopha, manifest as vrana, grandhi, vidradhy, arbuda Progression to deeper layers with involvement of subsequent dhatus makes the disease krichrasadhya/ yapya/ Asadhya Long interval Easy accessibility Effective treatment methods,

KSHARA KARMA: 

KSHARA KARMA CURE THE CONDITION ARREST THE PROGRESSION PREVENT RECURRANCE.

Role of local treatment: 

Role of local treatment

Immune boosters: 

Immune boosters Rasayana

Effect of customs: 

Effect of customs ROLE OF OUR TRADITIONAL CULTURE

Role of cervix in producing abnormal vaginal discharges: 

Role of cervix in producing abnormal vaginal discharges

SUMMARY: 

SUMMARY Evaluation and management of gynecologic infections and abnormalities require the ability to recognize normal structures and physiology.

SUMMARY: 

SUMMARY From that point, one must be able to categorize the problem into an anatomical, traumatic malignancy, or infection problems.

SUMMARY: 

SUMMARY Knowing the key signs and symptoms for each of these categories will ensure your ability to reach the best assessment without the common hospital aid at your disposal in the field environment.

SYMBOL OF HOPE: 

SYMBOL OF HOPE

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QUESTIONS???