FMGE 2023 Coaching Classes at Kings
Kings International Medical Academy (KIMA) provides best coaching for the FMGE exam in India. Dr. Vidhya, an expert in Obstetrics and Gynecology, taught our students a session on Premalignant Lesions of Cervix, bringing her vast knowledge and experience to the academy.
PREMALIGNANT LESIONS OF CERVIX:
- MC genital infection: HPV
{Mostly asymptomatic + clear spontaneously (1yr)}
- Premalignant ———> malignant = 10 to 15 years
- EVERSION – cervical opening after Puberty (by ESTROGEN)
- TRANSFORMATION ZONE – area b/w old and new Squamocolumnar junction
Has new sauamous cells (with HIGH MITOTIC activity)
- MCS for HPV infection – TRANSFORMATION ZONE
- ECTOCERVIX – Sqamous epi – Squamous cell CA (80%)
ENDOCERVIX – Columnar epi – ADENOCARCINOMA (20%)
- CONIZATION – biopcy from ENDO cervix
- COLPOSCOPY – from ECTOcervix (GREEN FILTER)
- PAP smear – George Nicholas Papanicolaou
Ectocervix – @transform zone – AYER’S SPATULA (3600)
Endocervix – CYTOBRUSH
Fixation: 95% ethyl alcohol/ethanol (before drying)
VACCINES:
Vaccines availabel for 9 (overall best GARDASIL 9)
Ideal age: 11 – 12 year
But can be given anywhere b/w 9 – 45 years (before 1st coitus)
Give to: Sexually active, lactation, immune compromise (HIV)
NEVER give to: PREGNANT (neoadjuvant used is HARM to child)
DOSES: <15yrs – 2 doses (0, 2 month)
>15 years – (0, 2, 6 month)
Duration of protection: 6.4 years efficacy: 100%
Prevent: cancers of – cervix, penile, vulva, vagina, anal, oropharyngeal, laryngeal. (So can be given to men also)
CIN 1: Follow up for 2 year (PAP + HPV DNA) –> If persist after 2 years –>CRYO
CIN 2, 3 —> LEEP
CIN 3: LEEP >> Coniztion >> Type 1 hysterectomy
Cervical Cancer Screening: Guidelines
Tests used: PAP smear
COTESTING: PAP (liquid) + HPV DNA test – 100% sensitivity
HPV triage: PAP (L) + HPV DNA + COLPOSCOPY
Before PAP: for 2 days
ABSTINENCE, NO vaginal douching/lubricant
Start screening @ 21 years (only in sexually active)
B/w 21-30yr – Every 3 yearly PAP (3test)
B/w 31 -65yr – Every 5 yearly (7 test) (COTESTING done)
@65 years STOP if all smear in the past 10 years are negative (-)ve
VIA – Visual Inspection c Acetic Acid
(Abnormal tissues temporarily appears white)
VILI – Visual inspection c LUGOL’S IODINE (SCHILLER’S TEST)
(NO GLYCOGEN in cancer cells – so no colour change)
Strength – 3-5%
LSIL ==> corresponds to CIN1
HSIL ==> to CIN2, 3
CIN 2 to become malignant: 10-15years
