Abstract:
In all developing countries due to lack of education women come to the Gynae Clinics with Carcinoma of Cervix in its advanced stage, resulting in high mortality. All over the world it has become a routine practice to screen women in order to detect Carcinoma of Cervix in its early stage i.e., in its pre-invasive stage, also termed as Cervical Intraepithelial Neoplasia (CIN). These pre-invasive forms are thought to progress for mild to moderate to severe dysplasia’s (CIN I, CIN II, CIN 111), ultimately to invasion carcinoma, although some may regress. There are no means available to predict the behavior of a dysplastic lesion. Usually, the interval between the appearance of precursor cervical lesion and the development of invasive carcinoma is 10-15 years. Various epidemiological studies reveal a high incidence of the carcinoma of cervix in women with the following factors:
• An early age of first coitus.
• Parity and early age of first pregnancy.
• Unstable marital history.
• High rate of sexually transmitted disease.
A study was conducted by the treatment of Gynae, Unit III, Civil Hospital, Karachi, to screen women in order to detect Carcinoma of Cervix in its early stage. It was not possible to screen all women attending Gynae and antenatal clinics due to financial restraints and failure on the part of the patient to follow up. Therefore, women were selected at random and not necessarily with a complaint pertaining to the disease.
All women included in the study had a detailed proforma filled (copy enclosed) and had a cervical smear taken for exfoliative cytology by standard technique. All smears were seen and reported by a trained cytologist.
Cervical smears were classified as under:
• Class I Normal cells
• Class II Inflammatory cells
• Class III Mild Dysplasia
• Class IV Moderate Dysplasia
• Class V Severe Dysplasia
Pap smears of Classes III, IV, V and with magnificent cells i.e., Invasive Carcinoma, were termed as “Positive smears”. All patients of positive smears were subjected to colpomicroscopy (Visualization of cervix with magnification). Coloscopy was found to be significant if there was abnormal vascular pattern and appearance of white areas on application of 3% acetic acid. This is because of nuclear density of malignancy. Patients with significant colposcopy had biopsies taken under the colopomicroscope, so that the biopsy could be taken from suspicious areas. This is known as colposcopy biopsy. The punch biopsy/ biopsies were sent for reporting by a pathologist.
On confirmation of diagnosis, relevant treatment was carried out.
