Cervical Cancer
The cervical cancer is common between the cancers of the woman, the estimation reaches the number of 500.000 cases per year to world-wide scale, near 80% appear in the developing countries, of these cases in the world pass away around 200.000 women to the year by this disease.
In the United States of North America the incidence of CC by 100.000 women is calculated in 8 and for Israel in 4.2, whereas for Peru and Mexico numbers of 54,6 and 50 cases occur, respectively.
Histological changes
The uterine cervical cancer initiates with changes in the cells of the epithelial tissue of the uterine cervix, which initially is normal, but gradually they are become precancerous.
The cervical cancer does not appear spontaneously as an injury of "de novo" but that epithelial cervical is a tissue that is constantly experiencing predictable changes as much in state of health as of disease.
Colposcopy
Colposcopy is the procedure used in gynecology to examine the epithelial tissue of the lower female genital tract applying a set of knowledge to also evaluate its morphology its alterations, giving like result a diagnosis. The instrument that is used to make the colposcopy is the colposcope, increases the size of the image and similar to a stereoscopic microscope behaves, takes advantage of the faculty of the vision of the human being with both eyes that jointly with the brain allows to see three-dimensional space images, to obtain this in a stereoscopic optical system like is it colposcope, this one must provide the vision with the epithelial tissue of the cervix from two separated objective lenses, forming an angle similar to which form between the axes of the eyes (between 7 to 12 degrees) when observing a near object, same that gives two images different from this one, one for each eye, giving like result the perception in three dimensions and facilitating therefore the work, because an wide depth of field is offered to manipulate between the objective and the uterine cervical tissue.
“Since using these convergent beams are making your eyes more relaxed and your brains less fatigue".
The background is that the gynecologist, working with colposcope and without, is always adapted to near vision whereas with the parallel beams your eyes need to adapt from near vision (without colposcope) to far vision (colposcope with parallel beams).
Courtesy of Mr. Jürgen Scheiblich.
Colposcopic technique
The colposcopy technique consists of inserting vaginal specula with the patient on guard gynecological position and to place colposcope to few centimeters (20 to 40 cm) of the vaginal introit, reason why the instrument never touches to the woman. Focusing the apparatus delicately the observation of the tissue of feminine tract is made then, their morphology and its vascular patrons for this aim are used the technique of acetic acid and the test of Schiller.
At the moment by means of a special device which have most of the colposcopes are possible to be registered the images by means of cameras, camcorders or to be sent this one to a computer by means of a digital camera giving this one printed and with the diagnosis to store itself in writing in the clinical file.
The tests used to date for the determination of the degree of the injury according to the Reid colposcopic index, are the test of acetic acid and the test of well-known Shiller like the test of iodine.
Acetic Acid Test.
The application of acetic acid when the tissue of the mucousa is affected by HPV produces a coagulation of proteins, as it is the intracellular queratina of the epithelial cells making to epithelial less transparency approximately to the 40 seconds. To the whitening that appears in these ill epithelial is called acetowhite to its, between more queratinized it is, more whitening will be seen.
Basically the colposcopist to make a diagnosis takes into account if it finds pathological signs of neoplasias, the degree of whitening, the size and the form of the edges of the injury as well as the vascular pattern making with this a diagnosis based on the degrees of called severity colposcopic index that goes from the qualification of the low degree to the high degree or been healthy.
Shiller Test.
The test of Schiller or test of Iodine consists of the application of a solution of Lugol (iodine) in the epithelial surface, the healthy cells catch the glycogen of this solution dyeing itself of brown color, while the infected ones with HPV are disabled to take this stain, is to say a test of positive Schiller to neoplasia, describes disease because the colorant did not take epithelial cells, this one will see like a clear zone, negative Schiller to neoplasia is equivalent to that the epithelial cells took the colorant reason why they are healthy.
Colposcopic index.
To the degrees of observed the pathological signs of neoplasias by means of colposcopy are called colposcopic index. Diverse opinions between the colposcopists according to their experience exist on which scheme to use.
In the scheme of Reid to determine the degree of neoplasia this one studies the thickness, color, contour and vascular atypia, uses the test of acetic acid and the test of Shiller, at the moment to this scheme some authors have carried out him some modifications and " Modified Reid Scheme" is called.
The scheme of Coppleson to determine the degree of neoplasia is based on then acetic acid reaction.
Getting a Colposcopy Exam
NHS Cervical Cancer Screening Modules 1 to 4