Colposcopy Made Easy—A Hands on Manual for Practising Doctors and Postgraduates Nidhi Gupta, Mukesh Chandra
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1Colposcopy Made Easy®: A Hands on Manual for Practising Doctors and Postgraduates
2Colposcopy Made Easy®: A Hands on Manual for Practising Doctors and Postgraduates
Nidhi Gupta MBBS MS (Obs and Gyn) FICMCH Dip USG (Ian Donald) MICOG Department of Obstetrics and Gynaecology SN Medical College, Agra, India Co-author Mukesh Chandra MS (Ob/Gyn) PhD (Sch) MAMS FICOG FICMCH FICMU Cert Diagnostic Ultrasound (New Zealand) Diploma Laparoscopic Surgery (Germany) Professor, Department of Obstetrics and Gynaecology SN Medical College, Agra, India
3Published by
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Colposcopy Made Easy®—A Hands on Manual for Practising Doctors and Postgraduates
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photo-copying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2009
9788184484663
Typeset at: JPBMP typesetting unit
Printed at: Replica Press
4Foreword
A high risk of cervical cancer exists amongst the women in India and many developing countries and the mortality rates from this disease remain high. There is a paucity of detection and efficient screening programs for the same. The facilities, expertise and the service delivery systems for the detection and treatment of precancerous and invasive cancers is largely lacking.
Planned and structured training to equip gynecologist and other health care personnel with skills in cervical cancer prevention is an important component of cervical cancer control initiative.
Colposcopy is an important diagnostic tool for the diagnosis and evaluation of cervical intraepithelial neoplasia (CIN) and preclinical invasive cancer. It allows magnified visualization of the site where cervical carcinogenesis occurs. It delineates the extent of lesion on the cervix and enables targeted biopsies along with directing treatment, e.g. cryotherapy, laser and loop electrosurgical excision procedure.
This basic manual is intended to simplify the learning of colposcopy so as to allow dissemination of the skills and facilities in low resource settings.
I hope this manual meets its multifaceted role of being used as a self learning tool and even a resource for short teaching course for practicing gynaecologists, teaching and learning aid for medical students, nurses and health care providers.
Prof Ramesh Chandra
Ex Vice Chancellor
Lucknow University
Retd. Professor and Head
Department of Obstetrics and Gynaecology
SN Medical College and Hospital, Agra, India
5Preface
Cervical cancer is one of the most common neoplastic disease affecting women with a combined worldwide incidence exceeded only by breast and colorectal cancer. The incidence in less developed countries is almost 1.6 times more than that in developed countries and in India it accounts for 80% of all the genital cancers in women.
Cervical cancer is a common malignancy which can potentially be treated due to its easy accessibility (to inspection, palpation and cytology) and a long interval between pre-invasive to clinically invasive cancer development. Many screening modalities are available for early detection of cervical cancer such as Pap smear, colposcopy, visual inspection, HPV DNA testing, etc.
The Pap smear has been the most widely used diagnostic modality since the 1959's, but it gives a significant number of false negative results (10-29% in various studies). Recently colposcopy has emerged as a valuable tool to confirm a cervical lesion. Lately the ASCCP consensus guidelines has recommended routine colposcopy instead of repeated Pap smears since there is a 53-76% likelihood of abnormal follow-up cytology results requiring eventual colposcopy. But, many researchers and the authors believe that simultaneous use of the above two modalities has a high accuracy rate of approximately 98% in detecting cervical cancers and are presently the “gold standard diagnostic modalities”.
Many books and manuals have been written on colposcopy by different authors in the past, but this book is different as it is neither a textbook of colposcopy nor of histopathology, contains no statistics or bibliographic references, but simply aims to be a practical guide giving gynaecologists the basic knowledge and enabling them to learn colposcopy on their own.6
I believe that this simple, easy to follow manual will boost up the number of colposcopists in India and help in early detection and management of cervical cancers improving the overall cure rates of this disease.
Nidhi Gupta
7Acknowledgements
With the deepest gratitude, I wish to thank every patient of cervical cancer who has come in my clinical practise and inspired me to write a manual on colposcopy.
I would like to acknowledge and express my gratitude to the following people for their magnificent support that they have always extended towards me.
First and foremost I am grateful to Prof. Dr Mukesh Chandra, my teacher and guide who asked me to compile a practical manual on colposcopy. I am thankful to him as he gave me a free hand to write this book and showed so much confidence in my abilities, that not even once did he enquire or interfere with the making of this manual. He was always there to encourage me for all the ideas and designs I had in mind for this manual.
For generously sharing their wisdom, love, divinity, I pay homage to all the stalwarts, organisations working in this field especially International Agency for Research on Cancer, books, publications and manuals that I have consulted.
I would like to acknowledge with gratitude all my teachers who have always encouraged me in my academic endeavours.
I would like to express my love and gratitude to all my friends, whose critical appraisal of my work has helped me to come out with my sixth book in a span of four years.
A very sincere thanks to my parents and brother who have always been on my side and whose love and support knows no limit—Prof. Dr MC Gupta, my philosopher, guide and friend; Dr Satya Suri, my courageous and beautiful mother, Dr Vinit Suri, my loving brother. This 8book is dedicated in the memory of Mr VK Suri and Mrs Savitri Gupta whose light and love continued to shine through me.
My sincere gratitude to Mr Vishnu Dutt Tiwari, Mr Tarun Duneja, Director (Publishing) and his team at Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, who have done an excellent work in coming out with this book in such a short duration of time.
A heartful thanks to my loving husband Mr Anurag Gupta, children, Abhishek and Akrishti for their unending support and help in all my ventures and above all “thank you almighty for your blessings”.