Singer & Monaghan’s Cervical and Lower Genital Tract Precancer 3rd Edition PDF – Diagnosis and Treatment

Singer & Monaghan’s Cervical and Lower Genital Tract Precancer 3rd Edition PDF



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Preface

It is now 20 years since the first edition of this text was produced and 14 years since the second edition came out. Much has happened in that time, and certainly this edition is timely. My colleague John Monaghan, who co-authored the first two editions, retired from clinical medicine during this time and is now pursuing a new career well away from medicine. However, we have his name in the title in recognition of his major contribution to the field of gynecologic oncology and colposcopy. In his place comes Ashfaq Khan, who is highly experienced in the management of cervical and lower genital tract precancer with a major interest in molecular pathology and biomarkers.
We have been assisted by two experts in their respective fields, Professor Jacob Bornstein from Nahariya, Israel, has revised the chapter on vulval intraepithelial neoplasia (Chapter 9). He is aptly suited to undertake this task, being the President of the International Society for the Study of Vulvovaginal Disease and with vast experience in this field. Dr. Rupali Aurora from University College Hospital, London, is an experienced gynecological pathologist; she has rewritten the chapter on histopathology (Chapter 1) and the chapter on screening (Chapter 5). Dr. Quek Swee Chong was an assistant author for the second edition and now works in Singapore; he has contributed valuable comments to the management chapters in this edition.
Since the last edition, many new developments have come on stream. Human papillomavirus—already confirmed as the major etiological agent for cervical and most lower genital tract precancers 14 years ago—is now more easily detected. Many studies examining its role in screening have matured and this has led to its incorporation inmany national screening programs for detecting cervical precancer. This has led to a decrease in the use of cytology, although this technique is still widely employed throughout the world. In respect of this text, we have replaced the very detailed chapter on cytology that appeared in the second edition by a general chapter on screening, which, although discussing cytology, considers in some detail the increasing role of human papillomavirus in clinical practice. The role of biomarkers is also emphasized in this new edition.
Treatment of cervical precancer has undergone changes in the last few years, particularly a trend towards more conservative management. This was prompted by the publication some 6 years ago showing the increase in premature births and premature rupture of membranes in respect of excisional procedures used in treating cervical precancers. The introduction of these new conservative concepts is critically examined. New operative techniques such as the electrocautery needle for excision are also discussed.
We have seen since the last edition a challenge to the efficacy of colposcopy, and it would seem as though the challenge is more related to the under performance of many clinicians undertaking colposcopy who unfortunately have a lack of training and limited clinical experience. A number of studies— particularly the UK’s Tombola study—and results from Professor Petry’s unit in Warsburg, Germany, have shown the efficiency of colposcopy when undertaken by trained individuals. Colposcopy is still the most important aspect in the management of the abnormal cervical smear or a positive human papillomavirus result. Notwithstanding this criticism of colposcopy, there is an increased need for high-quality teaching of colposcopy and attendant subjects concerned with the management of cervical precancer. New techniques—especially those involving online teaching—will become more common in the future, and hopefully these electronic techniques will improve the quality of colposcopy. Indeed one of us (A.S.) has just produced an online course in colposcopy, covering much discussed in this text (www.colposcopycourses.com).
Precancers of the lower genital tract now present the gynecologist with specific problems. The presence of human papillomavirus and the role of smoking are major causation factors, and the recognition of these lesions in the vagina, vulva, and perianal area is described in detail with the latest management protocols clearly explained.
When we wrote the preface to the first edition JohnMonaghan and I clearly stated that “for the clinician seeking wider horizons this text is not simply a colposcopy atlas but a comprehensive statement of the wide range of skills needed to diagnose and manage any or all of the precancerous conditions of the lower genital tract.” The philosophy that underlined the first two editions is clearly expounded in this statement, and we hope very much that we have continued with this tradition.We commend this new edition to the modern clinician, not only those undertaking training but also those in established practice where regular updating is essential.


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