COLPOSCOPY IN THE

EARLY DETECTION OF
CERVICAL CANCER
DR.K UMADEVI M D,DGO
DEPT OF GYNAEC ONCOLOGY
KIDWAI MEMORIAL INSTITUTE
OF ONCOLOGY,BANGALORE
 COLPOSCOPE
• Optical
• Binocular
• Stereoscopic
• Magnified
• Illuminated
• Instrument used to
visualise the study of
lower female genital
tract
 COLPOSCOPY OF LOWER
FEMALE GENITAL TRACT
Object :connective tissue of cx/vagina
Filter :consists of mucosa[sq epi]of cx/vagina]
The colposcopic appearance depends on:
1.Nature & physiological or pathological
variations of the mucosa
• Study of surface epithelium
2.Variation in structure & blood supply of
connective tissue
• Study of vascularity
ANATOMICAL & CLINICAL
DEFINITIONS
The Ectocervix
• Not synonymous with squamous epith
• The part of cx visible during clin exam

The Endocervix
• The part of cervical canal not visible without
use of some additional technique
• Not synonymous with columnar epith
 UTERINE CERVIX
• THE CLINICAL EXTERNAL OS
Point beyond which one ceases to see the
mucosa of the cervical canal during P/S
examination
• THE ANATOMICAL EXTERNAL OS
Point beyond which the ant & post walls of
the cervical canal begin to separate ,studied
on hysterectomy specimens on sagittal
sections
SQUAMOCOLUMNAR JUNCTION
• Not synonymous with the external os.
• Point where the strf. Squamous epithelium
meet the glandular epithelium of the cx.
• VARIATIONS OF SITE OF THE
SQUAMO-COLUMNAR JUNCTION
• Variation in relation to age
• Variation in relation to shape of the ext os.
UTERINE CERVIX-AGE RELATED
UTERINE CERVIX-AGE RELATED
UTERINE CERVIX
HISTOLOGY OF CERVIX UTERI
HISTOLOGY OF CERVIX UTERI
• The Columnar epithelium
• Synonym of glandular epithelium.
• Consists of a single layer of cylindrical cells
with a round basal nucleus & an apical pole
laden with mucus.
• Stains with Alcian Blue on histolo. Section
• “Reserve cells” are flattened cells with
scarcely visible cytoplasm.
• Glandular mucosa is not smooth
CHANGES IN THE CERVIX DUE TO
REAGENTS USED DURING
COLPOSCOPY
TECHNIQUE OF COLPOSCOPY
TECHNIQUE OF COLPOSCOPY
• OPTICAL CHARACTERISTICS.
• FRONTAL DISTANCE [FOCAL LENGTH]
The distance which separates the frontal lens of
the apparatus from the surface of cx.
225 to 250 mm is necessary to permit
manipulation of instrument.
• MAGNIFICATION
Varies betw x4 to x60
magnification of x10 to x12.5 is sufficient
magnification of x15 is necessary for
endocervical examination.
 DIAMETER OF THE FIELD
• Is an important factor.
• Smaller when the enlargement is greater.
• For a good view whole cx is necessary.
• 18 to 20mm in diameter with x10.
• DEPTH OF THE FIELD
• is the distance which separates 2 extreme
points situated in the optical axis of the
apparatus & seen clearly together.
• Depth is shorter when magnification is
greater
 LIGHT SOURCE
• Should be sufficient ,about 30,000 Lux.

• Should be centered permanently.

• Should not be changed during examination.

 THE STAND -COLPOSCOPE
• Should permit easy obsn under max cond
for gynaecologist.
• Easy accessibility vertically and laterally.
• To be inclined along the axis of vagina.
• Will depend on the space availability in the
exam room& habits of each examiner.
• GOOD STAND IS JUST AS ESSENTIAL
AS A GOOD OPTICAL SYSTEM.
 COLPOSCOPE-APPLIANCES
• Main objective lens
• Magnification Changer
• Binocular tubes
• Eye pieces
• Filter
• Light Source
• Stand
TECHNIQUE OF
COLPOSCOPY
WHEN SHOULD COLPOSCOPY BE
CARRIED OUT?
• Betwn 8th &12th day of menstrual cycle.
• Anytime with postmenopausal women.
• Defer colpo when there is severe
infection/macroscopic obvious growth.
• Treat with anti infective therapy locally &
systemically.
• Ethinyl Estradiol 10mcg daily for 8-10days
for senile vaginitis along with antiinfective
therapy.
INDICATIONS FOR COLPOSCOPY
EVALUATION OF ABNORMAL EPITH
A. To localise the lesion.
B. To select the biopsy site.
C. To manage abnormal pap-preg
EVALUATION OF NORMAL PAPSMEAR
A.Suspicious cx/vagina
B.H/o post coital bleeding
C.H/o presence of depigmentation of EG
D. Presence of leukoplakia
HOW SHOULD COLPOSCOPY
BE CARRIED OUT?
• Bivalve speculum 28mm/36mm
• Introduction of cusco speculum
• Examination of ext genitalia/vagina
• Examination before acetic acid
• Apply lukewarm normal saline
• Apply 3-5% acetic acid to cx
• By greenfilter examination[SOS]
• Apply Schillers/Lugols iodine
• Documentation