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Colposcopy is a way for your doctor to use a special magnifying device to look

at your vulva, vagina, and cervix. If a problem is seen during colposcopy, a small
sample of tissue (biopsy) may be taken from the cervix or from inside the opening of
the cervix (endocervical canal). The sample is looked at under a microscope.
Colposcopy is usually done to look at the vagina and cervix when the result of a Pap
test is abnormal. Many abnormal Pap tests are caused by viral infections, such as
human papillomavirus (HPV) infection, or other types of infection, such as those
caused by bacteria, fungi (yeast), or protozoa (Trichomonas). Natural cervical cell
changes (atrophic vaginitis) related to menopause can also cause an abnormal Pap
test. In some cases, untreated cervical cell changes that cause abnormal Pap tests
may progress to precancerous or cancerous changes.
During colposcopy, your doctor uses a lighted magnifying device that looks like a pair
of binoculars (colposcope). The colposcope allows your doctor to see problems that
would be missed by the naked eye. A camera can be attached to the colposcope to
take pictures or videos of the vagina and cervix.
Your doctor may put vinegar (acetic acid) and sometimes iodine (Lugol's solution) on
the vagina and cervix with a cotton swab or cotton balls to see problem areas more
clearly.
Why It Is Done
Colposcopy is done to:
Look at the cervix for problem areas when a Pap test was abnormal. If an area of
abnormal tissue is found during colposcopy, a cervical biopsy or a biopsy
from inside the opening of the cervix (endocervical canal) is usually done.
Check a sore or other problem (such as genital warts) found on or around the
vagina and cervix.
Follow up abnormal areas seen on a previous colposcopy. Colposcopy can also be
done to see if treatment for a problem worked.
Look at the cervix for problem areas if an HPV test shows a high-risk type of HPV is
present.
How To Prepare
Tell your doctor if you:
Are or might be pregnant. A blood or urine test may be done before the
colposcopy to see whether you are pregnant. Colposcopy is safe during
pregnancy. If a cervical biopsy is needed during a colposcopy, the chance of
any harm to the pregnancy (such as miscarriage) is very small. But you may
have more bleeding from the biopsy. A colposcopy may be repeated about 6
weeks after delivery.
Are taking any medicines.
Are allergic to any medicines.
Have had bleeding problems or take blood thinners, such as aspirin or warfarin
(Coumadin).
Have been treated for a vaginal, cervical, or pelvic infection.

Do not have sexual intercourse or put anything into your vagina for 24 hours before
a colposcopy. This includes douches, tampons, and vaginal medicines. You will empty
your bladder just before your colposcopy.
You may want to take a pain reliever, such as ibuprofen (Advil or Motrin), 30 to 60
minutes before having a colposcopy, especially if a biopsy may be done. This can
help decrease any cramping pain that can be caused by the colposcopy.
Schedule your colposcopy for when you are not having your period. Heavy bleeding
makes it harder for your doctor to see your cervix. The best time to schedule a
colposcopy is during the early part of your menstrual cycle, 8 to 12 days after the
start of your last menstrual period.
You will need to sign a consent form that says you understand the risks of
colposcopy and agree to have the colposcopy done. Talk to your doctor about any
concerns you have regarding the need for the colposcopy, its risks, how it will be
done, or what the results will mean. To help you understand the importance of this
test, fill out the medical test information form.
How It Is Done
Colposcopy is usually done by a gynecologist, a family medicine physician, or a nurse
practitioner who has been trained to do the test. If a biopsy is done, the sample will
be looked at by a pathologist. Colposcopy can be done in your doctor's office.
You will need to take off your clothes below the waist. You will be given a covering
to drape around your waist. You will then lie on your back on an examination table
with your feet raised and supported by foot rests (stirrups).
Your doctor will put an instrument with smooth, curved blades (speculum) into your
vagina. The speculum gently spreads apart the vaginal walls so your doctor can see
inside the vagina and the cervix. See a picture of a pelvic examination with a
speculum .
The colposcope is moved near your vagina and your doctor looks through the
microscope at the vagina and cervix. Vinegar (acetic acid) or iodine (Lugol's solution)
may be used on your cervix to make abnormal areas more visible. Photographs or
videos of the vagina and cervix may be taken.
If areas of abnormal tissue are found on the cervix, your doctor will take a small
sample (cervical biopsy) of the tissue. Usually several samples are taken. The
samples are looked at under a microscope for changes in the cells that may mean
cancer may be present or is likely to develop. If bleeding occurs, a special (Monsel's)
liquid or silver nitrate swab may be used on the biopsy area to stop the bleeding.
If a sample of tissue is needed from inside the opening of the cervix (the
endocervical canal), a test called endocervical curettage (ECC) will be done. Since the
endocervical canal cannot be seen by the colposcope, a small sharp-edged tool
called a curette is gently put into the endocervical canal to take a sample. ECC takes
less than a minute to do and may cause mild cramping. An ECC is not done during
pregnancy.
Colposcopy and a cervical biopsy usually take about 15 minutes.

How It Feels
You may feel some discomfort when the vaginal speculum is inserted. You may feel a
pinch and have some cramping if a biopsy sample is taken.
Risks
In rare cases, a cervical biopsy can cause an infection or bleeding. Bleeding can
usually be stopped by using a special liquid or swab on the area.
After the test
If you have a biopsy, you may feel some soreness in your vagina for a day or two.
Some vaginal bleeding or discharge is normal for up to a week after a biopsy. The
discharge may be dark-colored if Monsel's solution was used. You can use a sanitary
pad for the bleeding. Do not douche, have sex, or use tampons for one week, to
allow time for your cervix to heal. Do not exercise for one day after your colposcopy.
Follow any instructions your doctor gave you. Call your doctor if you have:
Heavy vaginal bleeding (more than a normal menstrual period).
A fever.
Belly pain.
Bad-smelling vaginal discharge.
Results
Colposcopy is a way for your doctor to use a special magnifying device to look at
your vulva, vagina, and cervix.
Your doctor will talk to you about what he or she sees at the time of the colposcopy.
Lab results from a biopsy may take several days or more.
Colposcopy and cervical biopsy
Normal: The vinegar or iodine does not show any areas of abnormal tissue. The vagina
and cervix look normal.
A biopsy sample does not show any abnormal cells.
Abnormal: The vinegar or iodine shows areas of abnormal tissue. Sores or other
problems, such as genital warts or an infection, are found in or around the
vagina or cervix.
A biopsy sample shows abnormal cells. This may mean cervical cancer is
present or likely to develop.
What Affects the Test
Reasons you may not be able to have the colposcopy or why the results may not be
helpful include:
If you have sexual intercourse 24 hours before the colposcopy.
The use of douches, tampons, or vaginal creams or medicines 24 hours before the
colposcopy.
If you are having a menstrual period at the time of the colposcopy.
If a vaginal or cervical infection is present.
If you have gone through menopause. Hormonal changes may make it difficult to
see the cervical canal clearly.
What To Think About
Colposcopy is not usually used as a screening test for women at high risk for
cervical cancer. A Pap test is done for that purpose. But a colposcopy gives
you and your doctor more information if you have an abnormal result from a
Pap test.
Sometimes only abnormal cervical biopsy results are reported back to the woman.
Tell your doctor if you want to be informed of normal biopsy results.
If a colposcopy and cervical biopsy are normal, it is not likely that you have cell
changes that can lead to cervical cancer.
Another biopsy may be needed if a Pap test, colposcopy, and cervical biopsy show
different results. In some cases, a larger biopsy area, called a cone biopsy, is
removed. Special tools, such as laser or a heated loop, can be used to remove
a cone-shaped wedge of normal and abnormal tissue from the cervix. A cone
biopsy may treat the problem because all of the abnormal tissue is removed.
Your doctor will give you more instructions if a cone biopsy is needed.
Women with human immunodeficiency virus (HIV) have a higher chance of
developing cervical cancer. A colposcopy is recommended for all women with HIV
and an abnormal Pap test.


Colposcopy (Ancient Greek: kolpos hollow, womb, vagina + skopos "look
at") is a medical diagnostic procedure to examine an illuminated, magnified view of
the cervix and the tissues of the vagina and vulva.[1] Many premalignant lesions and
malignant lesions in these areas have discernible characteristics which can be
detected through the examination. It is done using a colposcope, which provides an
enlarged view of the areas, allowing the colposcopist to visually distinguish normal
from abnormal appearing tissue and take directed biopsies for further pathological
examination. The main goal of colposcopy is to prevent cervical cancer by detecting
precancerous lesions early and treating them. The procedure was developed in 1925
by the German physician Hans Hinselmann, with help from Helmut Wirths.[2][3]
A specialized colposcope equipped with a camera is used in examining and collecting
evidence for victims of rape and sexual assault.
Indications[edit]
Most women undergo a colposcopic examination to further investigate a cytological
abnormality on their pap smears. Other indications for a patient to have a
colposcopy include:
assessment of diethylstilbestrol (DES) exposure in utero,
immunosuppression such as HIV infection, or an organ transplant patient
an abnormal appearance of the cervix as noted by a primary care provider
as a part of a sexual assault forensic examination[4] done by a Sexual Assault
Nurse Examiner
Many physicians base their current evaluation and treatment decisions on the report
"Guidthe Management of Cytological Abnormalities and Cervical Cancer Precursors",
created by the American Society for Colposcopy and Cervical Pathology, during a
September 2001 conference.[5]
Procedure[edit]


Colposcope
During the initial evaluation, a medical history is obtained, including gravidity
(number of prior pregnancies), parity (number of prior deliveries), last menstrual
period, contraception use, prior abnormal pap smear results, allergies, significant
past medical history, other medications, prior cervical procedures, and smoking
history. In some cases, a pregnancy test may be performed before the procedure.
The procedure is fully described to the patient, questions are asked and answered,
and the patient then signs a consent form.
A colposcope is used to identify visible clues suggestive of abnormal tissue. It
functions as a lighted binocular microscope to magnify the view of the cervix, vagina,
and vulvar surface. Low power (2 to 6) may be used to obtain a general impression
of the surface architecture. Medium (8 to 15) and high (15 to 25) powers are
utilized to evaluate the vagina and cervix. The higher powers are often necessary to
identify certain vascular patterns that may indicate the presence of more advanced
pre-cancerous or cancerous lesions. Various light filters are available to highlight
different aspects of the surface of the cervix. Acetic acid solution and iodine solution
(Lugol's or Schiller's) are applied to the surface to improve visualization of abnormal
areas.
Colposcopy is performed with the woman lying back, legs in stirrups, and buttocks at
the lower edge of the table (a position known as the dorsal lithotomy position). A
speculum is placed in the vagina after the vulva is examined for any suspicious
lesions.
Three percent acetic acid is applied to the cervix using cotton swabs. Areas of
acetowhiteness correlate with higher nuclear density. The squamocolumar junction,
or "transformation zone", is a critical area on the cervix where many precancerous
and cancerous lesions most often arise. The ability to see the transformation zone
and the entire extent of any lesion visualized determines whether an adequate
colposcopic examination is attainable.
Areas of the cervix which turn white after the application of acetic acid or have an
abnormal vascular pattern are often considered for biopsy. If no lesions are visible,
an iodine solution may be applied to the cervix to help highlight areas of
abnormality.
After a complete examination, the colposcopist determines the areas with the
highest degree of visible abnormality and may obtain biopsies from these areas
using a long biopsy instrument, such as a punch forceps, SpiraBrush CX or
SoftBiopsy. Most doctors and patients consider anesthesia unnecessary; however,
some colposcopists now recommend and use a topical anesthetic such as lidocaine
or a cervical block to decrease patient discomfort, particularly if many biopsy
samples are taken.
Following any biopsies, an endocervical curettage (ECC) is often done. The ECC
utilizes a long straight curette, a Soft-ECC curette employing fabric to simultaneously
collect tissue or a cytobrush (like a small pipe-cleaner) to scrape the inside of the
cervical canal. The ECC should never be done on a patient who is pregnant. Monsel's
solution is applied with large cotton swabs to the surface of the cervix to control
bleeding. This solution looks like mustard and turns black when exposed to blood.
After the procedure this material will be expelled naturally: patients can expect to
have a thin coffee-ground like discharge for up to several days after the procedure.
Alternatively, some physicians achieve hemostasis with silver nitrate.
Complications[edit]
Significant complications from a colposcopy are not common, but may include
bleeding, infection at the biopsy site or endometrium, and failure to identify the
lesion. Monsel's solution and silver nitrate interfere with interpretation of biopsy
specimen, so these substances should not be applied until all biopsies have been
taken. Some women experience a degree of discomfort during the curettage, and
many experience discomfort during the biopsy.
Colposcopy with biopsy does not cause infertility or subfertility.[6]
Follow up[edit]
See also: Cervical cancer#prevention
Adequate follow-up is critical to the success of this procedure. Human
Papillomavirus (HPV) is a common infection and the underlying cause for most
cervical dysplasia. Patients should be counseled on the benefits of safe sex for
reducing their risks of contracting and spreading HPV.[7] One study suggests that
prostaglandin in semen may fuel the growth of cervical and uterine tumours and
that those who are affected may benefit from the use of condoms.[8][9]
Smoking predisposes one to developing cervical abnormalities. A smoking cessation
program should be part of the treatment plan for patients who smoke.
Treatments for significant lesions include cryotherapy, loop electrical excision
procedure (LEEP), and laser ablation.


Adaptations to environmental stress: Growth alterations

A. Atrophy:
Diagnosis: the decrease in tissue mass and the cell decreases in size. The cell has just
enough organelles to survive, ie less mitochondria then normal cells, therefore, just
trying to eek it out until whatever it needs to stimulate can come back.
B. Hypertrophy
Increase of the SIZE of cell, not number Scenario: A cell biology question: what is the
N of this? Hypertrophy of a cardiac muscle (permanent muscle), suppose there is a
block just before the G2 phase. What is the number of chromosomes? Answer: # of
csomes is 4N, b/c it already underwent synthesis: already doubled.
1 N = sperm (23 csomes)
2 N = normal (diploid cell)
3 N = trisomy
4 N = double the number
C. Hyperplasia
Increase in the # of cells. In normal proliferative gland, there are thousands of
mitoses, therefore see more glands with hyperplasia.
D. Metaplasia
Replacement of one adult cell type by another.
E. Dysplasia
Is really an atypical hyperplasia.
Tissue evidence of carcinogenic factors at work
Metaplasia: an initial change from normal cells to a different cell type (such as
chronic irritation of cigarette smoke causing ciliated pseudostratified
epithelium to be replaced by squamous epithelium more able to withstand
the insult).
Dysplasia: an increasing degree of disordered growth or maturation of the tissue
(often thought to precede neoplasia) such as cervical dysplasia as a result of
human papillomavirus infection. Dysplasia is still a reversible process.
However, once the transformation to neoplasia has been made, the process
is not reversible.
1. Hyperplasia is any abnormal multiplication of cells.
Hyperplasia refers to an abnormal increase in cellular quantity (i.e.,
constantly dividing cells). Hyperplastic growth in cell number usually results
in organ enlargement or (benign) tumor formation, but sometimes it is
noticeable only under a microscope. Hyperplasias only form benign tumors
(unless further DNA damage/cellular mutations occur) because the cells of a
hyperplastic growth remain subject to normal regulatory control
mechanisms. This stands in contrast to neoplastic growth (the process
underlying malignant tumors), in which cells replicate/proliferate in a non-
physiological manner which is unresponsive to normal stimuli.
Hyperplasia may be due to a number of causes, including: increased
exertion/stress (as in the case of muscle use), chronic inflammatory
response, hormonal dysfunctions, or compensation for damage or disease
elsewhere. Sometimes, hyperplasia is a natural response and completely
normal/harmless; for instance, the growth and multiplication of milk-
secreting glandular cells in the breast as a response to pregnancy is
considered hyperplastic cell growth.
Other times, however, hyperplasia can cause (non-cancerous) medical
problems. If an infant consumes too much sugar in his/her first year of life,
his fat cells (adipocytes) will greatly multiply in number (hyperplasia), and
later in life he will be at higher risk for hyperplastic obesity, obesity caused
by an increase of the number of fat cells. This stands in contrast to
hypertrophic obesity, where a person has a normal quantity of adipocytes,
but each of those fat cells is abnormally large in size.
2. Metaplasia is the transformation of one type of tissue into another.
Metaplasia (change in form) refers to the exchanging of one type of
differentiated cell type for another mature differentiated cell type. This
change can be a normal physiological change, such as in the ossification of
cartilage to form bone, or it can be in response to external stimuli, as in the
case of chronic smokers who experience metaplasia from normal respiratory
epithelium to (more resilient) squamous epithelium (due to irritation of their
laryngeal epithelium).
Generally speaking, metaplasia occurs because a persons cells in a particular
location arent robust enough to handle the stress (external stimulus) that
they are exposed to; thus, these cells are replaced by cells of another type
that can better withstand the new environment. The new cells arent less
mature than the previous cells, but they normally dont belong there and are
unsuited to perform normal functions.
In addition to smoke irritation, other causes of metaplasia include: vitamin A
deficiency (columnar/cuboidal/transitional cells become stratified
squamous), kidney stones or worm infestation (transitional cells become
stratified squamous), and acid reflux (e.g, Baretts Esophagus). Even though
some metaplasias like Barretts esophagus are considered pre-cancerous, if
the stimulus that caused the metaplasia is removed, tissues can return to
their normal pattern of differentiation. If a metaplasia isnt addressed in a
timely fashion though, it can become dysplasia and/or turn cancerous.
3. Heteroplasia is abnormal grown without stimulus.
Heteroplasia (sometimes called alloplasia) is like metaplasia except it refers
to the abnormal growth without a stimulus (e.g., the growth of bone in a site
where there is normally fibrous connective tissue). The growth can result in
formation of abnormal tissue or of normal tissue in an abnormal locality. The
term, heteroplasia, is used much less frequently in medical literature than
the other five plasias discussed in this article.
4. Dysplasia is pre-cancer
Dysplasia refers to any disordered growth and maturation of an epithelium,
which is still reversible if the factors driving it are eliminated. The description
is similar to that of metaplasia, but there are several key differences.
Metaplasia is not considered a part of carcinogenesis, and while dysplasias
show a delay in maturation/differentiation of cells within tissues (e.g.,
expansion of immature cells with a corresponding decrease in
number/change in location of mature cells), metaplasias have cells of one
mature/differentiated type replace cells of another mature/differentiated
type.
Another way to describe dysplasias is by pathology: dysplasia is often the
earliest form of pre-cancerous lesion recognizable in a pap smear or in a
biopsy by a pathologist. Dysplasias can be low grade or high grade. The risk of
a low-grade dysplasia transforming into a high-grade dysplasia (and
eventually to cancer) is low. High-grade dysplasia is often synonymous with
carcinoma in situ. These dysplasias represent a more advanced progression
towards malignant transformation, and the risk of high-grade dysplasias
transforming into cancer is high. When the entire epithelium is dysplastic and
no normal epithelial cells are present, the growth is termed a neoplasia.
5. Neoplasia is tumor growth
Neoplasia occurs when cells have lost control of their physiologic processes.
Neoplastic cells grow uncontrollably, and when people talk about cancer or
carcinoma, they are usually referring to neoplasms (tumors). Neoplastic
epithelium is termed carcinoma. Once a neoplasm has started, it is not
reversible.
Note: The term tumor is often used synonymously with neoplasm, but a
tumor can refer to any uncontrolled cellular growth, whether it is
inflammatory, hemodynamic, or neoplastic in origin. Additionally, not all
neoplasms are malignant. Benign (non-cancerous) neoplasms include: uterine
fibroids and melanocytic nevi (skin moles).
6. Anaplasia implies advanced cancer
Anaplasia is the most extreme disturbance in cell growth encountered in the
spectrum of cellular proliferations and is characteristic of highly malignant
and metastatic cancers (Wikipedia, Last Accessed: 2/24/09). Anaplastic cells
have lost total control of their normal functions and many have deteriorated
cell structures. Anaplastic cells often have abnormally high nuclear-to-
cytoplasmic ratios, and many are multinucleated. Additionally, the nuclei of
anaplastic cells are usually unnaturally-shaped or oversized nuclei.
Cells can become anaplastic in two ways: neoplastic tumor cells can
dedifferentiate to become anaplasias (the dedifferentiation causes the cells
to lose all of their normal structure/function), or cancer stem cells can
increase in their capacity to multiply (i.e., uncontrollable growth due to
failure of differentiation).

Displasia : hilangnya keseragaman sel individu ex; endometrial kanker,adalah
merujuk kepada pembentukan dan perkembangan sel secara tidak beraturan.
fenomena ini mungkin diiringi dengan metaplasia skuama seperti dalam bronkus
atau serviks dan hiperplasia epitelium skuama hasil dari pengasalan kepada cahaya
matahari. antara perubahan yang berlaku termasuklah peningkatan mitosis,
penghasilan sel yang tidak normal dan sel bercenderung menyimpang daripada
susunan asal. pembentukan dan bagaimana displasia terjadi masih tidak diketahui
tetapi sentiasa berasosiasi dengan bermulanya malignan dan displasia seringkali
ditemui dalam epitelium serviks uterus
Metaplasia: pertumbuhan sel abnormal yang terkendali, pada sel pernapasan,
adalah melibatkan perubahan yang berlaku ke atas tisu yang telah mengalami
perbedaan pada berbagai bentuk, selalunya dari kelas yang sama tetapi tidak
mengkhusus. biasanya metaplasia berlaku pada lapisan epitelium kelenjar dan tisu
perantara, seringkali berasosiasi dengan hiperplasia. Metaplasia adalah suatu
mekanisme adaptasi. pengasalan dari berpanjangan bronkus kepada asap rokok
membawa kepada metaplasia skuama pada epitelium bronkial. proses ini adalah
berbalik sepenuhnya. bila rangsangan seperti aktivitas merokok dihentikan epitelium
metaplastik kemungkinan dapat kembali normal
Hyperplasia jumlah sel bertambah pada (or "hypergenesis") is a general term
referring to the proliferation of cells within an organ or tissue beyond that which is
ordinarily seen (e.g. constantly dividing cells). Hyperplasia may result in the gross
enlargement of an organ, the formation of a benign tumor, or may be visible only
under a microscope. Hyperplasia is different from hypertrophy that the adaptive cell
change in hypertrophy is by increased cellular size only unlike in hyperplasia by
increased cellular number.
accretionary: peningkatan kompak jaringaniinterseluler
Multiplikatif Penambahan jumlah sel oleh pembelahan sel melalui mitosis
Auksetik Peningkatan ukuran sel
Accretionary Peningkatan komponen jaringan inter seluler
Campuran Pola campuran dengan arah dan kecepatan yang berbeda
derajat deferensiasi : proses perkembangan sel menjadi sel dengan fungsi /morfologi
yang berbeda dari sel asal
involusi: uterus yang mengecil setelah melahirkan
stadium: T tumor, N nodus/ kelenjar getah bening regional, M metastasis
limfoma:
neoplasma kumpulan sel abnormal yang terbentuk oleh sel sel yang tumbuh terus
menerus secara tidak terbatas, tidak berkoordinasi dengan jaringan sekitarnya &
tidak berguna bagi tubuh

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