FMGE 2023 Coaching Classes at Kings

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)

Lab: stain used: PAPANICOLAOU stain

CONVENTIONAL PAP: 50%sensitivity

LIQUID PAP: 80% sense (BEST)

HIV (+) DES exposure Past HxANNUAL SCREENING done

HPV INFECTION: (protein: L1)

Total subtypes: 150

Affect lower genital tarct - 40

Benign - 25 (HPV 6, 11)

Oncogenic subtypes 15 (HPV 16>18>45>31>33)

VACCINES:

Vaccines availabel for 9 (overall best GARDASIL 9)

HPV	BIVALENT - CERVARIX	HPV 16, 18
2	CERVARIX
HPV 4	QUADRI - GARDASIL 4	16, 18, 6, 11
HPV 9	NANO - GARDASIL 9	16, 18, 6, 11, 45, 31, 33, 52,58

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 dyas

ABSTINENCE, NO vaginal douching/lubricant

Start screening @ 21 yrs (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%

Bethesda system - TREATMENT
ASC-US	Follow up (6 monthlyPAP + Annual HPV DNA ) * 2 years {if still + after 2 yr --> colposcopy + biopsy)
ASC-HLSIL / HSIL	COLPOSCOPY guided biopsy
AGC / AIS	CONIZATION (therapeutic itself)

CRYOTHERAPY	LEEP - Loop electrosyrgical excision procedure
Liquid Nitrogen (-40C) Ablative procedure Adv: No bleeding at all Painless - NO NEED FOR ANESTHESIA Dis: Ablative, cannot take tissue for HPE. Malignancy can missed Margin status NOT known OPD procedure	Inc bleeding, Painful, NEED ANESTHESIA (Local) Adv: tissue can be obtained (+) Margin status can KNOWN LLETZ - LARGE LOOP EXCISION OF TRANSFORMATION ZONE
CONIZATION - INDICATIONS: Abnormal endocervical PAP smear Visible lesion extending into endocervix (BORDERS NOT CLEARLY SEEN) CIN-3 Microinvasive cervical cancer (stage 1A1)