Introduction Different approaches to screening and treatment of cervical precancer Anatomical considerations

Anatomical considerations Gross anatomy of female genital organs, External genitalia Internal genital organs Gross anatomy of the cervix Cervical epithelium Squamous epithelium Columnar epithelium Squamocolumnar junction (SCJ)

Physiological changes of the cervical epithelium

Ectropion Squamous metaplasia Transformation zone of the cervix Changes induced by pregnancy Atrophic changes Congenital transformation zone (CTZ)

Neoplastic changes of the cervical epithelium

Genesis of cervical cancer – Role of HPV HPV structure and types Genesis of precancerous lesions and cervical cancer Cervical intraepithelial neoplasia (CIN) Adenocarcinoma in situ (AIS) Cervical cancers

HPV tests – Variation between tests Instruments, consumables, and setup required

for collection of samples for HPV testing (provider-collected) for self-collection of samples for HPV testing

Procedure to collect samples for HPV testing

Sample collected by a health provider Counselling of a woman undergoing HPV testing History taking Preparation for sample collection for HPV testing Steps for inspection of the external genitalia Steps for insertion of the speculum and exposure of the cervix Steps for collection of cervical samples Steps for self-collection of samples Storage of the samples after collection, and transportation to the laboratory

Interpretation of HPV test results Management of women with a positive HPV test result

Management of women with a positive HPV test result The different strategies Triage with cytology Triage with VIA Triage with colposcopy

Treatment of cervical intraepithelial neoplasia – principles Steps to determine eligibility for ablative treatment

Criteria used to determine eligibility for ablative treatment Steps to determine eligibility for ablative treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment Steps for applying Lugol’s iodine to the cervix Pre-treatment assessment

Treatment by cryotherapy

Principles Cryosurgical unit Ancillary instruments and consumables Steps Side-effects and complications Post-treatment advice and follow-up Video

Treatment by thermal ablation

Principles The benchtop model The battery-operated model Complications Video

Using an HPV test as the test of cure in women treated for cervical abnormalities or cervical intraepithelial neoplasia (CIN) Infection prevention

Standard procedures for protection from infection Essential steps for infection prevention in a cervical cancer screening clinic Preparation of 0.5% chlorine solution

Case studies

VIA triage outcome (applicable in screen-and-treat setting only) – negative cases VIA triage outcome – positive cases VIA triage outcome – suspicious of cancer cases

Foreword Acknowledgement Authors Suggested citation Copyright

Home / Training / Manuals / Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide / Learning

Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

Filter by language: English / Français / Español

Anatomical considerations – Gross anatomy of the cervix

Click on the pictures to magnify and display the legends

The cervix is the lower part of the uterus and is cylindrical. The length of the cervix is about 3–4 cm, and its diameter is about 2.5 cm. It has two parts:

Supravaginal part: The upper part of the cervix, which remains above the vagina and is not visible during a speculum examination.
Portio vaginalis: The lower part of the cervix, which protrudes into the vagina through its anterior wall and is visible during a speculum examination.

The recesses created in the upper part of the vagina by protrusion of the portio vaginalis into the vagina are known as the vaginal fornices.

The part of the cervix that is visible during a speculum examination is the ectocervix. The cylindrical canal within the cervix is the endocervix. The endocervix and the ectocervix meet at the external os, which is an opening visible at the centre of the ectocervix. The endocervix joins the uterine cavity through the internal os.

The ectocervix has an anterior lip and a posterior lip. In nulliparous women, the external os is small and round and resembles a pinhole. In parous women with history of vaginal childbirth the opening of the ectocervix is wide, it is transversely slit, and its shape resembles that of a fish’s mouth.

The endocervical canal is a cylindrical space inside the cervix that opens into the vagina through the external os. The upper end of the endocervical canal opens into the body of the uterus through the internal os. The endocervix is lined with columnar epithelium and may not be visualized during a speculum examination of the cervix or during VIA. Endocervical visualization is possible after insertion of endocervical forceps (endocervical speculum).

The next section discusses the microscopic anatomy of the cervix.

IARC, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France - Tel: +33 (0)4 72 73 84 85 - Fax: +33 (0)4 72 73 85 75
© IARC 2024 - All Rights Reserved.