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PRACTICE RECOMMENDATIONS: Practice Management Materials


VulvaVaginaCervixAnus


THE CERVIX: Colposcopy of the Uterine Cervix

• I. Introduction • V. Invasive Cancer of the Cervix
• II. Anatomy of the Uterine Cervix • VI. Colposcopy
• III. Histology of the Normal Cervix • VII: Cervical Cancer Screening and
Colposcopy During Pregnancy
• IV. Premalignant Lesions of the Cervix

The material that follows was developed by the 2002-04 ASCCP Section on the Cervix for use by physicians and healthcare providers. Special thanks to Section members:
  • Edward J. Mayeaux, Jr, MD, Co-Chair
  • Claudia Werner, MD, Co-Chair
  • Raheela Ashfaq, MD
  • Deborah Bartholomew, MD
  • Lisa Flowers, MD
  • Francisco Garcia, MD, MPH
  • Luis Padilla, MD
  • Diane Solomon, MD
  • Dennis O'Connor, MD

Please use this material freely. This material is an educational resource and as such does not define a standard of care, nor is intended to dictate an exclusive course of treatment or procedure to be followed. It presents methods and techniques of clinical practice that are acceptable and used by recognized authorities, for consideration by licensed physicians and healthcare providers to incorporate into their practice. Variations of practice, taking into account the needs of the individual patient, resources, and limitation unique to the institution or type of practice, may be appropriate.


I. AN INTRODUCTION TO THE NORMAL CERVIX, NEOPLASIA, AND COLPOSCOPY
The uterine cervix presents a unique opportunity to clinicians in that it is physically and visually accessible for evaluation. It demonstrates a well-described spectrum of histological and colposcopic findings from health to premalignancy to invasive cancer. Since nearly all cervical neoplasia occurs in the presence of human papillomavirus infection, the cervix provides the best-defined model of virus-mediated carcinogenesis in humans to date. The clinical use of colposcopy for the evaluation of cervical cytologic abnormalities allows the identification and successful management of most premalignant cervical lesions. Its usefulness and efficacy in cancer prevention is undisputed and unparalleled. Interest in colposcopy has grown steadily along with the incidence of cervical disease during the past three to four decades. More and more primary care physicians are receiving training in colposcopy. This has, no doubt, improved efforts to identify and manage cervical neoplasia appropriately.

This informational site is intended to serve as an introduction to the uterine cervix in health and disease and to the clinical use of colposcopy. It does not provide the scope of information or clinical training necessary to become a competent colposcopist. We do hope to provide answers to basic questions and also help determine if colposcopy should play a role in your clinical practice. If so, we hope you will attend one or more of the ASCCP's Comprehensive Courses, which are held throughout the year at varying locations throughout the United States. This should always be followed by a closely supervised period of clinical training during which an experienced colposcopist provides mentoring in the development of these skills. If you are in training or already trained in colposcopy and wish to review current information, this website may provide a useful review. If you want a more compressive review of current colposcopy or treatment practices, you may wish to attend an ASCCP's Comprehensive or Advanced Colposcopy Courses (or similar course).

II. Anatomy of the Uterine Cervix
Shape and Dimensions
Blood supply
Lymphatics / mucosal immunity
Support and Innervation


III. Histology of the Normal Cervix
Squamous epithelium
Glandular epithelium
Mucosal Immunity
Transformation Zone
Colposcopic and neoplastic significance of the Transformation Zone
Histology and Colposcopy of the Transformation Zone
Pregnancy-related changes
     

IV. Premalignant Lesions of the Cervix
Definition
Epidemiology and role of HPV
Spectrum of disease
      

V. Invasive Cancer of the Cervix
Characteristic features of cervical cancer
Diagnosis
Epidemiology
Staging
Treatment & Survival
     

VI. Colposcopy
Brief history of colposcopy
The colposcope & Instrumentation
Indications
Basic components of the Colposcopic Exam
Colposcopic appearance of benign lesions
Colposcopic appearance of low-grade lesions
Colposcopic appearance of high-grade lesions
Colposcopic appearance of malignant lesions


VII. Cervical Cancer Screening and Colposcopy During Pregnancy

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