CHAPTER 4: SCREENING FOR CERVICAL CANCER

Chapter 5: Diagnosis and Management of Precancer 131Figure 5.1 Cervical punch biopsy forceps5Endocervical curettageIf a woman has a positive Pap test, but no abnormal areas are observed withcolposcopy, there may be a lesion in the cervical canal. In this case, the endocervixcan be examined with a special speculum and a sample of cells can be obtained withan endocervical curette for microscopic diagnosis. Endocervical curettage is a simpleprocedure, in which some of the surface cells are gently scraped from the cervicalcanal. The cells are then sent to a laboratory for examination. The procedure takes onlya few minutes.Colposcopy, biopsy and endocervical curettage are almost painless (although they maycause brief cramping) and do not require anaesthesia. After a biopsy or endocervicalcurettage, the woman should abstain from sexual intercourse until she has no moredischarge or bleeding; this usually means a couple of days. If this is not possible, sheshould use condoms.Chapter 5: Diagnosis and Management of PrecancerProvidersIf a colposcope, biopsy forceps and a endocervical curette are available, colposcopy,biopsy and endocervical curettage can be performed at primary care level by trainedand skilled physicians, nurses and other health care providers. More commonly, theyare performed as outpatient procedures at secondary level (district hospital).Indications for colposcopy and biopsyColposcopy and biopsy should be performed:• on women with an abnormal screening test;• if suspicious lesions are seen on the cervix on speculum examination;• to map abnormalities before cryotherapy or LEEP.