Smear for oncocytology - description of the procedure and its types

A smear for oncocytology (Papanicolaou analysis, Pap test) is a method of microscopic examination of cells that are taken from the surface of the cervix and its canal. This method makes it possible to identify precancerous changes in the cervical epithelium, or more precisely, cervical intraepithelial neoplasia of varying severity.

Due to the fact that the frequency of oncological pathologies is growing all over the world, and cervical cancer occupies one of the first places among cancer diseases in women, oncocytology of the cervix is ​​primarily aimed at the early detection of cancer cells and precancerous processes, i.e. conditions that, if left untreated, can lead to cancer.

And especially the Papanicolaou test is recommended for women who are at risk, because many detected pathologies can be successfully treated if detected in the early stages. Therefore, women should definitely undergo a smear for oncocytology once a year:

• Over 30 years old;
• In whose families there were cases of cancer;
• Those who are currently or have previously been diagnosed with human papillomavirus (HPV) of high carcinogenic risk;
• In whom, during a colposcopic examination of the cervix, changes in the epithelium were detected;
• With cervical erosion.

Why is the procedure performed?

Oncocytology of the cervix is ​​a study that helps determine the disease at all stages, since cervical cancer is currently quite common. The problem is that cervical cancer does not show any symptoms, but at the same time it behaves aggressively and quickly grows into an inoperable tumor that can no longer be treated.

In our country, a number of preventive measures are being taken to reduce the risk of developing this cancer.

For this purpose, all women are recommended to visit the gynecological office at least once a year, even if there are no complaints. The specialist conducts an examination and takes swabs for laboratory tests. If the diagnosis shows that a bacterial, viral or protozoal infection is present in a woman’s body, then a smear is prescribed for oncocytology.

This study also helps determine:

• beginning proliferation and metaplasia;
• signs of pathogenic microflora;
• development of dysplasia;
• the presence of inflammatory processes.

Oncocytology cannot be classified as a technique that only diagnoses cancer processes in cells; it also helps a specialist identify other pathologies of the female reproductive system.

What is oncocytology?

Oncocytological examination is carried out by microscopic examination of cellular material. Biomaterial is taken from the cervix (endocervix) and cervical canal (exocervix). The main advantage of this type of analysis over, for example, flora smear analysis, which can reveal the presence of pathological microorganisms, but does not provide information about morphological changes, is the ability to detect cancer in the early stages. This fact becomes even more relevant due to the fact that, according to statistics, among all detected cancers in women, cervical cancer is in third place. These are huge numbers.

Every year, thousands of women are diagnosed with this diagnosis. The disconcerting fact is that often women come to the clinic already in the later stages of the disease, since in the initial stages it is asymptomatic. Gynecologists around the world urge women to periodically visit a doctor for a preventive examination.

Types of oncocytology

Currently, oncocytology results can be obtained using several methods, which are chosen by the specialist conducting the study.

They are as follows:

1. According to the Leishman method . This option is the most common method used for taking a smear for oncocytology. It is applied in all state budgetary healthcare institutions. The method involves staining the taken biomaterial on medical glass by adding certain drugs to the smear. Next, the resulting changes are examined under a microscope, and the result is determined.
2. Using the Papanicolaou method . This option is quite expensive diagnostics, so it is carried out only in private medical institutions. Just like the Leishman technique, it is carried out using the staining method, but the chemical composition of the staining liquid is more complex and precise.
3. Liquid oncocytology of the cervix is ​​a study that has proven itself in modern diagnostics. It is the latest method, which is used in a small number of medical institutions, due to the high costs of equipment and consumables. In this test, material taken from the patient is injected into a special liquid, where the cells form and concentrate, creating a thin coating. The resulting epithelium does not dry out and is examined microscopically in the laboratory in a wet state, which makes it possible to achieve a more accurate oncocytology result, since excess cells not involved in the study are filtered out.

Currently, there are charitable programs for diagnosing cancer of the female reproductive system, which have become widespread due to their private diagnosis, which reduces the time to obtain results.

Types of research

There are two main types of diagnostics:

• Simple cytology
• Liquid

Currently, cytological analysis is taken by several screening methods to study the epithelium for oncocytology. Free public clinics use the Leishman method. The Papanicolaou method or PAP test, which is widespread in antenatal clinics and private clinics, is considered more reliable.

What is liquid-based cytology? The difference between these two analysis options lies in the use of different pigmentation mechanisms of the biomaterial.

Liquid oncocytology is the third type, which is the most modern method. Unfortunately, not all clinics can provide such a service, although a liquid smear for oncocytology gives the most accurate results.

If with the first two traditional options for preparation and staining, epithelial cells are smeared on the glass, which does not exclude the ingress of mucus and blood elements. This, in turn, can make it difficult to see cancerous and abnormal cells.

Liquid-based cytology is the newest technique for performing cytology analysis. And although the collection of material from the cervix is ​​the same for both traditional and liquid, for liquid, the collected cells are sent for research in a container with a fixative.

Oncocytology analysis is a microscopic examination of the cellular structures of the epithelial layer of the cervix and cervical canal to detect cancer. Cytological analysis can also identify benign neoplasms, inflammation and infections of the genitourinary system.

With the first two methods, smear analysis involves applying the material to a special glass, after which it is transferred to a laboratory for study. During the analysis, the shape, size and composition of cellular structures are assessed.

The laboratory technician, having examined the smear, records the results and enters the data into the form. The main difference between Leishman and Papanicolaou cytological studies is the complexity of the staining mechanism of the material sample.

Liquid cytology is the most informative and accurate way to study epithelial cells of the uterus and cervical canal for atypicality. To study this method, the material is placed in a special liquid medium.

Subsequently, using a centrifuge, the sample is purified to combine the epithelial structures in one place. After concentration, the cells form an even layer, which allows one to obtain more accurate results than with conventional cytological analysis of smears, when the taken epithelium is applied to glass.

They differ in the technique used and the use of special equipment.

Simple

This type involves applying biomaterial to glass. In this case, a smear is taken only from a certain area. The disadvantage of the method is that it can show the presence or absence of the disease, but it is not always possible to draw a conclusion about the quantitative characteristics of the virus.

The specificity of the study is that the doctor takes the material and makes a “smear-imprint”. To do this, touch the entire surface of the slide with a brush. It is then dried, placed in packaging and sent to the laboratory.

Liquid

It differs from the previous version in that the taken material is completely immersed in a container with a special composition. At the same time, the morphological and biological properties of the cell are preserved. You can store such material for any amount of time.

The liquid medium in which the taken material is placed protects the cells from bacteria, premature drying and damage. This material remains resistant to temperature changes. A kind of preservation occurs inside the liquid, so the biomaterial turns into an even layer of washed cells.

There are several types of screening with different markers to detect cervical cancer in a woman. Sometimes, if possible, the doctor resorts to several types of tests with different tumor markers to clarify any doubts. Let's look at what types of oncocytology there are and how many days they are done:

1. Leishman method. Used in public and many private clinics. The essence of the procedure is that the taken biomaterial is smeared on medical glass. In the laboratory, the sample taken is stained, which makes it possible to carefully examine the cells under a microscope. Based on laboratory data, a conclusion is issued.
2. Papanicolaou method (PAP test). The research principle of the previous method and the Papanicolaou method are similar. But the Papanicolaou method differs in the technique of staining cells and their examination. Experts consider this method more informative. The result can be obtained in approximately 14 days. But this type has certain disadvantages. In 20% of conclusions, analyzes have errors and inaccuracies. The reason for this may be the uneven distribution of the taken material on the glass, the presence of peripheral blood elements. Rapid drying of the biomaterial can also distort the result.
3. Liquid cytology is considered a more effective study compared to the previous two. With this method, the smear is immersed in a special liquid (in vitro), which increases the shelf life of the taken biomaterial. Conclusions with liquid cytology are more accurate. The analysis takes about ten days.

The essence of these tests is to check the condition of the so-called squamous epithelial cells. Flat cells cover the surface of the cervix. In pregnant women, squamous epithelial cells are of an intermediate or superficial type.

They can be located in layers, fragments, or clusters in a smear. This is within normal limits, without anaplasia. The absence of these cells in the biomaterial or an increase in their number above the norm allows us to talk about any deviations.

When squamous epithelial scales are detected, they are guided by their number. Single scales of squamous epithelium may be a normal variant. A cytogram must be performed by a cytologist or an experienced laboratory assistant.

The type of analysis for onccytology can be of two forms:

• simple oncocytology;
• liquid oncocytology.

When performing liquid oncocytology, the taken material is not smeared on glass, as during simple oncocytology, but is lowered onto a special brush into a bottle with a special medium. The analysis is preserved inside the liquid, turning into an even layer of washed cells.

This method of taking analysis is innovative; it is not used in all clinics. Liquid oncocytology allows the cytologist to obtain the most reliable result.

Indications for the procedure

Oncocytology of the cervix is ​​a screening study that helps identify oncological processes in the area of ​​the female internal genital organs. This study is carried out for all women upon reaching the age of 18 and at the beginning of sexual activity.

If the girl has not yet reached the age of majority, but the girl has already begun her regular sexual life, then she also needs to undergo an oncocytology test, since she is at risk for the spread of the disease.

When visiting a antenatal clinic, this smear is taken as planned if the woman did not have oncocytology results in the previous year. It is also necessary to take a smear for oncocytology if a woman comes to the gynecologist for registration due to pregnancy.

Indications for mandatory analysis:

1. The presence of erosive changes on the cervix.
2. Detection of human papillomavirus infection in the body.
3. Heredity for cancer of the genitourinary organs.
4. A woman complains of irregularities in the menstrual cycle on an ongoing basis.
5. Detection from other studies of chlamydial, herpes or immunodeficiency infections.
6. Taking oral contraceptives on a regular basis for a long period of time.
7. Change of sexual partners.
8. Smoking.

Question: How to prepare for a smear for cytology?

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How to prepare for a smear for oncocytology?

In order for the result of a cytology smear to be informative, it is necessary to prepare for this study. Preparing for a smear test for cytology involves following the following rules:

• For 1–2 days before the scheduled date of smear collection, you must abstain from any sexual intercourse, even using a condom;
• Within 1 - 2 days before the scheduled date of the smear test, you must stop douching;
• For two days before taking a smear, you must stop using any medications introduced into the vagina, for example, suppositories, tampons, creams, ointments, sprays, etc.;
• For two days before taking a smear, you should refrain from using any vaginal products, for example, moisturizing ointments, sprays, etc.;
• For two days before taking a smear, you should wash only with warm water and not use soap or other intimate hygiene products;
• For two days before taking a smear, it is recommended to take only a shower and refrain from bathing.

In addition, women need to remember that a Pap smear is taken before a gynecological examination or colposcopy. If an examination or colposcopy was performed, a smear for cytology can be taken after two days.

It is best to take a smear for cytology a few days after the end of the next menstruation. During menstrual bleeding, a smear for cytology cannot be taken, since in this case the accuracy of its results will be low.

In addition, you cannot take a smear for cytology against the background of an inflammatory process of any nature. You must first undergo a course of treatment and stop the inflammatory process, and only after that take a smear.

Oncocytology is a modern diagnosis of tissues of the cervix and cervical canal, reflecting the appearance of cancerous growths (onco-cancer, cyto-cell). Another name for the analysis is called a cell atypicality study. The technique is necessary for women, since cervical cancer is difficult to diagnose. The type of oncology ranks third in the list of deaths among the female half of humanity. Therefore, it is important to identify the oncological process at the initial stages.

Research methods

Conducting a study for oncocytology of the cervix is ​​carried out as a standard procedure, taking place on the gynecological chair. When visiting a gynecologist, a woman takes the usual position for an examination on a chair. A female doctor uses a gynecological speculum to collect biomaterial from the epithelium in the area of ​​the cervical canal.

This scraping occurs with a gynecological spatula or a special brush for taking smears. The doctor inserts the instrument into the patient’s vagina and, with a light touch, takes a scraping for examination.

The taken material is ground into a thin layer onto a special glass slide. Depending on the research technique chosen by the doctor, the glass is stained with preparations or placed in a special liquid and examined under a microscope. You can find out the result of a laboratory diagnostic test in 2 weeks.

Description of the procedure for taking biomaterial

During a cytological examination, tissue samples taken from the cervical canal or vagina are examined under a microscope to determine the typicality of the cells. This diagnostic method began to be used 50 years ago.

And until now it can safely be considered one of the most inexpensive and effective. The interpretation of the Pap test given by the attending physician will tell you about the absence or presence of abnormalities. Seeing the results, the cytological picture becomes clear to him.

Cytology - what is it in gynecology? This is one of the non-invasive diagnostic methods. That is, in the process of taking a smear, the skin and mucous membranes are not broken, no substances are introduced into the body, and instruments are not used to penetrate inside through natural routes. This is how a smear for cytology differs, for example, from histology.

To get more accurate results, you need to carefully prepare for the process and follow all the rules. An important factor is decoding. It is advisable that it be carried out by a gynecologist observing the woman.

The technique of taking a smear for cytology is completely simple. A smear is taken during a routine examination in a gynecological chair. The doctor must first insert a speculum into the vagina. Having examined the mucous membrane of the cervix, vagina, and entrance to the cervical canal visually, he uses a sterile special brush to make a slight movement to take scrapings - epithelial cells from areas such as the surface of the cervix, cervical canal, and urethra.

The collected biological material should be applied to a glass slide, distributed evenly and dried, sent to the laboratory for further research using a microscope and specific staining substances.

What laboratory specialists evaluate:

• Structure and size of seized cells
• What is their number per unit of a certain area?
• How are they located relative to each other?
• What shape is the epithelium
• Are there any pathological changes?

The results of the study can be found out quite quickly.

The cost of the analysis is moderately low, and it makes it possible to reliably verify whether everything is in order with the patient’s cervix.

• If the correct structure of the cells is beyond doubt, then everything is normal.
• If minor distortions are present, then we may be talking about mild dysplasia.
• Atypical changes in single cells indicate moderate to severe dysplasia.
• If the nuclei, chromosomes, and cytoplasm are changed, then cancer is suspected.
• When there are a lot of pathologically altered cells, then the accuracy of the results indicating cancer is beyond doubt.

Oncocytological examination is carried out by microscopic examination of cellular material. Biomaterial is taken from the cervix (endocervix) and cervical canal (exocervix). The main advantage of this type of analysis over, for example, flora smear analysis, which can reveal the presence of pathological microorganisms, but does not provide information about morphological changes, is the ability to detect cancer in the early stages.

Every year, thousands of women are diagnosed with this diagnosis. The disconcerting fact is that often women come to the clinic already in the later stages of the disease, since in the initial stages it is asymptomatic. Gynecologists around the world urge women to periodically visit a doctor for a preventive examination.

A timely analysis will reveal precancerous conditions of the cervix, namely:

1. keratinization of the upper part of the mucous membrane of the cervix, medically called leukoplakia;
2. Atrophy of the mucous membrane of the cervix, called erythroplakia;
3. Benign neoplasms (polyps) in the cervix;
4. Physiological changes on the surface of the cervix.

It should be noted that in some cases, for example with cervical dysplasia, a cytological examination may be insufficient, since the deep layers are not captured with this type of examination.

In such cases, they resort to research methods such as biopsy (taking a tissue sample) and histology (PGI). Patients often confuse the meaning of histology and cytology. The difference is that in oncocytology, cells are examined, while in oncohistology, tissues taken for analysis by biopsy are studied under a microscope.

Often women are scared by the name of the procedure. But it should be noted that taking tissue for analysis does not cause the woman any discomfort, much less pain. It will take a maximum of ten minutes to complete. Even with moderately severe inflammatory processes, tests are required.

Before you take a smear for oncocytology (oncocytology) of the cervix, you need to know certain rules and restrictions:

• Refrain from sexual activity two days before the procedure;
• If a woman has menstrual bleeding on the day of the test, she must inform her doctor. Taking a test during menstruation may lead to erroneous data in laboratory tests;
• A few days before oncocytology, it is not recommended to use tampons;
• Douching is also contraindicated before the test;
• It is not recommended to use vaginal creams several days before the smear test, as this may distort the results;
• If there is inflammation in a woman’s reproductive and genital organs, it is necessary to eliminate them. After the treatment prescribed by the gynecologist, it is necessary to take a control epithelial smear to make sure that there is no inflammation;

The technique for taking biomaterial for research is simple: the woman sits on a gynecological chair. To take a small scraping from the epithelium of the cervical canal, the doctor uses a special cervical brush or gynecological spatula.

First, the doctor inserts a speculum. Next, using a spatula, the surface layer of the vulva, vagina and ectocervix (cervical canal) is scraped off. The taken material, depending on the type of analysis, is applied to laboratory glass or placed in a special solution, which is prepared in advance. Let's look at how these procedures differ further.

It should be noted that after taking the test, slight spotting of blood is possible, which does not pose any danger and will disappear in a couple of days.

When and how often do you need to take a smear for oncocytology?

If there are no risk factors, then young women under 30 years of age should undergo a smear for oncocytology once a calendar year along with a visit to the gynecologist for a preventive examination. Older women need to undergo this procedure once every six months.

If the oncocytology answers reveal unsatisfactory results, if pathological changes have appeared, then the doctor prescribes treatment and draws up an analysis schedule to monitor the process of cell development.

If there are risk factors, women should be tested for oncocytology according to the recommendations of a gynecologist. Their frequency depends on the burden of these factors.

Main factors:

• smoking;
• immunodeficiency infection;
• genitourinary infections;
• deficiency of vitamins A and C.

Taking a smear during pregnancy

At the slightest suspicion of the presence of infections and fungi harmful to the fetus, cytology is often used. The inflammatory type of smear makes it possible to diagnose pathological processes if a woman complains of burning and itching of the external genitalia, changes in the color and smell of discharge.

To analyze the state of the vaginal microflora in pregnant women, cytology smears are done at least three times. If necessary, your doctor may order additional PAP tests.

A Pap test for pregnant women is performed using conventional technology.

Oncocytology for older women

The onset of menopause is not a sign that cancer in the cervix will not occur in women in this category. Reducing the production of female hormones reduces the risk of dyshormonal disorders, which allows women 50 years of age and older to be classified as a low-risk group.

But at the same time, against the background of other diseases of the body, the risk of pathological processes in internal organs increases.

For these reasons, there are 2 options for obtaining analysis:

1. If the patient does not have pathologies of other internal organs, if she has had a smear for oncocytology once a year over the past 3 years and no abnormalities in the structure of the cells were found, then a woman who has entered menopause can now take the test once at 2 years old.
2. If a woman does not visit a gynecologist regularly, if previous results revealed pathological processes of inflammation, then it is necessary to carry out oncocytology sampling every year until no changes are detected and confirm the result with positive tests for 3 years.

Oncocytology and inflammatory process

Since the task of the cytologist is not to establish the cause of the inflammatory process, attention is often paid to this, and all possible causes of pathological changes are identified. Inflammation can be projected by a wide variety of pathogenic microflora - because of this, doctors distinguish between specific and nonspecific.

The inflammation itself can be:

1. Spicy . Lasts up to 10 days and a large number of neutrophilic leukocytes are present in the smear.
2. Subacute and chronic type of inflammation. In this case, in addition to leukocytes, the smear will contain lymphocytes and histiocytes.

In the case of diagnosing an inflammatory process, it is important to identify which microorganisms and pathogenic microflora provoke inflammation. Most often, it provokes inflammation:

1. Koch's tubercle bacillus - the smear itself will reveal curdled masses, as well as Pirogov-Langerhans cells.
2. Trichomonas , when the cells of the inflammatory process themselves, namely the Trichomonas themselves, are diagnosed in a smear.
3. Fungi from the genus Candida , in which thrush most often manifests itself.
4. Gonococci and chlamydia , which provoke gonorrhea and urethritis, inflammation of the pelvic organs.
5. Herpes viral cells can also be detected in biological material .

This is not a complete list of pathogenic microorganisms that can provoke inflammation - there are about 40 species of bacterial and viral pathogens.

Video: how to take a smear for oncocytology?

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Oncocytology for pregnant women

During pregnancy, female hormones undergo significant changes, which affects the functioning of the woman’s body, and therefore problems may arise in the functioning of the endocrine system.

These factors can become concomitant for the development of cell pathology. Therefore, when registering a pregnant woman at the antenatal clinic, the gynecologist must take a smear for oncocytology to identify incipient oncological pathologies.

This procedure is possible only after confirmation by examination and other tests that the woman and fetus are healthy, and there are no other inflammatory processes in her body. If such changes are noticed, the specialist first prescribes a course of treatment, and then only an oncocytology analysis is performed.

Oncocytology of the cervix is ​​a study that, if biomaterial is correctly taken from a pregnant woman, will not harm either the woman or the fetus, it does not affect the course of pregnancy in any way. Sometimes, after taking a test, bloody discharge may occur, but you should not be afraid of this, you need to be prepared for such a change. During the day, this discharge may cause discomfort.

If there is a need to repeat the oncocytology test, then the next test is taken during the 2nd and 3rd trimester of pregnancy.

Clinical picture

The disease is characterized by an asymptomatic course. In such cases, detection of cervical cancer is possible through general and special tests, as well as smears.

With cervical cancer, manifestations most often occur in advanced stages of the disease. That is why the timely determination of pathology, including the necessary examination, comes to the fore.

Symptoms of cervical cancer include:

• loss of strength and constant fatigue;
• low-grade fever;
• leucorrhoea with light inclusions;
• thin or bloody discharge with an unpleasant odor;
• contact discharge;
• intermenstrual bleeding;
• pain in the lower abdomen, lower back, sacrum;
• dysfunction of the intestines and bladder;
• fistula formation;
• swelling.

The appearance of a characteristic clinical picture is associated with the spread of the pathological process to surrounding organs and tissues. To determine violations of the internal organs, it is necessary to undergo an examination, including general tests and smears.

Oncocytology during inflammation

A smear for oncocytology is sometimes performed during the inflammatory process that is present in the cervix. This happens if the woman has not properly prepared for the procedure, she has chronic inflammation, which she tried to treat, but without success, or there is resistance to therapy.

Carrying out analysis during the inflammatory process is not recommended, because during this period leukocyte cells and debris from dead cells make it difficult to determine whether there are cells affected by cancer pathology.

Pathogenic microflora that cause infectious inflammation (Trichomonas, fungi, chlamydia or gardnerella), in the normal state in the microscope lens, differ in appearance from cancer cells, and during a long-term acute state of infection they are modified and similarities with oncological ones are observed, which misleads the specialist who deals with research.

As a result, this may result in a false positive response.

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This procedure, which does not take much time, can protect women from many diseases, including identifying cervical cancer in the early stages.

A timely analysis will reveal precancerous conditions of the cervix, namely:

1. keratinization of the upper part of the mucous membrane of the cervix, medically called leukoplakia;
2. Atrophy of the mucous membrane of the cervix, called erythroplakia;
3. Benign neoplasms (polyps) in the cervix;
4. Physiological changes on the surface of the cervix.

It should be noted that in some cases, for example with cervical dysplasia, a cytological examination may be insufficient, since the deep layers are not captured with this type of examination. In such cases, they resort to research methods such as biopsy (taking a tissue sample) and histology (PGI). Patients often confuse the meaning of histology and cytology. The difference is that in oncocytology, cells are examined, while in oncohistology, tissues taken for analysis by biopsy are studied under a microscope.

Preparation for the procedure

There is no specialized training for taking an oncocytology test, but there are recommendations that should be followed to obtain an accurate result.

For example:

1. You can take a smear on any day, but excluding menstruation days. The preferred period of the menstrual cycle is the first week after menstruation.
2. If an inflammatory process is observed in the genitourinary area, then before collecting biomaterial the inflammation should be cured so that the answers to oncocytology do not result in a false positive result.
3. During the previous two days, no other tests can be taken from the cervical area. This can be traumatic to the sensitive tissue in this area.
4. You cannot conduct an ultrasound examination with a transvaginal sensor 1 day before the planned procedure.
5. Sexual intercourse should be avoided for 3 days to prevent foreign cells from entering the collected material for analysis (sperm, condom lubricant, partner bacteria).
6. Vaginal suppositories and creams should not be used for 3 days before the test, as medical residues from these products may affect the test result.

Preparation and procedure for taking tests

Biomaterial is collected for analysis using a special brush or spatula.
The procedure itself is simple, taking 5-10 minutes. One type of smear is not enough for this. It is necessary to examine not only the vagina, but also the upper layer of the cervical canal. A competent doctor will never use the same glass for both samples during an examination. An important step before taking a smear is preparation. For a couple of days, the use of any intimate cosmetics, ointments, candles, tampons is excluded. It is also necessary to abstain from sexual intercourse for 2-3 days before taking tests. Douching and other gynecological procedures are also prohibited. According to doctors, the best time to submit the material is before and after menstruation. It is also not recommended to take a bath, only shower during the preparation period.

An experienced doctor knows that a woman's smear is different at the beginning, middle and end of the menstrual cycle. Women will also have other indicators during pregnancy. Therefore, when conducting the study, the following factors are taken into account:

1. Age;
2. Gestational age, cycle time;
3. Having an IUD or taking contraceptives;
4. Treatment of other diseases.

The doctor often prescribes a repeat examination to obtain more accurate indicators.

We hasten to say that the procedure for collecting cells for oncocytology is absolutely painless and will not cause injury to the patient.

How is an oncocytology test taken?

Oncocytology of the cervix is ​​a study whose mechanism has been worked out over time, so taking this test does not cause difficulties. During oncocytology, the patient sits on a gynecological chair in a standard position, as for an examination by a gynecologist.

A gynecological speculum is installed in the vagina, which displays the cervix and visualizes the cervical canal. Using a special brush, the doctor carefully makes a scrolling movement in both directions along the area of ​​the cervical canal so that the biological material is attached to the bristles of the brush.

Oncocytology of the cervix is ​​performed by an experienced specialist.

Then this brush is passed along a special glass slide in the opposite direction, making unwinding movements so that all the cells fixed in the hairs of the brush fall on the glass. Much attention is paid to these actions, since thanks to them, the specialist sees the full picture of the analysis.

How to determine cancer using a blood test

Today there are special systems that help detect tumor markers, substances produced by malignant tumors. That is, when taking blood and analyzing biomaterial, the doctor can use some blood indicators to tell whether there is cancer or not.

It all depends on the number and type of tumor marker. There are a lot of tumor markers, more than 200, but most often the most important are about 30. As a rule, the indicators of tumor markers increase with the progression of the stage of the cancer.

What tumor markers change in cancer? This is CEA - carcinoembryonic antigen. This is NSE - when the human nervous system, as well as the skin and lungs, are exposed to damaging effects.

How long does it take to prepare a smear for oncocytology?

The timing for issuing smear results for oncocytology varies: the study lasts from 3 to 14 working days. This depends on the chosen analysis technique and the clinical diagnostic center for conducting the study.

In private gynecological medical institutions, obtaining the result takes up to 5 days.

And in public clinics – up to 10 working days. But if the choice fell on determining oncocytology of the cervix using the liquid cytology method, then it will be possible to get the result only after 2 weeks.

Interpretation of results

Sometimes, when deciphering a study, in the laboratory technician’s conclusion you can find only two words: positive, negative. This implies the presence or absence of potentially malignant elements. Today, such interpretation of a smear for oncocytology is incorrect. A more accurate and detailed description of the lesions is required.

Decoding according to the degree of dysplasia has become widespread in the country. The smear is graded according to the following grades:

• CIN 1, mild dysplasia – the normal structure of the epithelium is preserved, altered foci are present;
• CIN 2, moderate dysplasia – cell degeneration occupies half of the layer;
• CIN 3, severe dysplasia - pathological transformation of elements is observed in most of the epithelium.

To simplify the interpretation of oncocytological smears, depending on the chosen technique, special classifications have been compiled. According to the results of the Pap test, decoding consists in determining the appropriate class. Another gradation recommended by WHO is widely used abroad - the Bethesda method. Modern laboratories, when interpreting a cervical smear, use the latest classification. The practitioner must know the group ratios in order to explain the results to the patient.

The deciphered smear of groups 1 and 2 is considered normal or has minor deviations. The second type requires additional examination and clarification of the diagnosis. The remaining classes require additional colposcopic and histological examination. After receiving a full package of tests and deciphering the biopsy, the doctor will determine further treatment tactics.

When is it possible to get erroneous results?

As with all other studies, the results of cervical oncocytology can be erroneous.

This can happen for several possible reasons:

1. the mucous epithelium of the cervical tissue can be modified, this occurs due to age-related changes at 18-20 years old, since large hormonal changes occur in the girl’s body that affect all organs;
2. the biomaterial was taken from the patient during menstruation, which led to the fact that the coloring composition of the drug came out prevailing in the endometrium of the blood, and the results were distorted;
3. contamination of biomaterial for research, for example, with vaginal gel, lubricant, medicated suppositories, sperm;
4. previous bimanual examination of the vagina, which contributed to the introduction of external bacteria;
5. the rules and standards for collecting material for analysis were ignored by the doctor;
6. an error in the laboratory when staining biomaterial with a special preparation.

Reasons and factors

A malignant tumor develops due to the presence of common background and precancerous pathologies that cause changes in the structure of the epithelium.

The cervix connects the body of the muscular organ and the vagina through a special canal called the cervical canal. The cervical canal contains mucus that prevents the spread of pathogenic microorganisms from the vagina.

The cervix consists of a vaginal and supravaginal part. During a gynecological examination, only a small part of it is visualized, which is called the vaginal part. The epithelium of this area contains flat and multilayered cells.

Cervical cancer often develops in the transition or transformation zone separating two different types of epithelium.

Under the influence of pathological factors, changes can occur in the cellular structure. Normally, a healthy cell is round in shape and contains one large nucleus.

With the development of precancerous pathologies, cellular elements can take on any shape and increase the number of nuclei. Such atypical cells are not yet called precancerous.

In modern gynecology, it is believed that the main cause of cervical cancer is HPV, which is sexually transmitted. After its penetration into the body, the virus penetrates directly into the DNA structure, changing cells.

Over time, dysplasia develops, which can be diagnosed using cytological examination. If appropriate therapy is not carried out at this stage, the precancerous pathology will develop into cancer.

Only certain types of HPV, which, according to tests, are considered highly oncogenic, can cause precancerous diseases and cervical cancer. Strains with low and medium oncogenicity promote the formation of papillomas and condylomas.

Among the factors for the development of cervical cancer, scientists identify:

• use of oral contraceptives as protection;
• ignoring barrier methods of contraception;
• the presence of several infections, for example, HIV and HPV;
• smoking;
• sexual relations with multiple partners;
• childbirth at a young age;
• multiple pregnancies and subsequent births;
• damage to the epithelium during abortion, curettage;
• age after forty years;
• the beginning of intimate life before the age of eighteen;
• violation by a partner of the rules of genital hygiene;
• hereditary factor.

For the development of cervical cancer, a combination of several unfavorable factors is often necessary.

Analysis transcript

When receiving oncocytology answers, a “positive” or “negative” result of the study is indicated. If the answer is “positive,” you should not think that the woman has cancer cells or that they will become so in the near future.

It is possible that there is some kind of inflammatory or infectious process in the cervix. Therefore, the decoding of the result indicates the degree number, which plays a big role when the specialist prescribes a treatment plan.

Analysis results

Oncocytology results
As stated earlier, a complete picture requires two tests - an oncocytology smear (oncocytology smear) from the vagina and the cervical epithelium. There must be enough biomaterial, otherwise the doctor will require a repeat test.

It takes 2-3 days to get results, sometimes about an hour. The transcript of the cytogram indicates the full name. patient, date and type of analysis, description of samples.

Here are some possible conclusions:

The endocervix is ​​a zone of transformation of cells of the vagina and uterine cavity or squamous and cylindrical epithelium. The cytological report indicates that the endocervical cells are unchanged. If such a statement is absent, then the smear was not taken from the transformation zone.

Exocervix - cells of stratified squamous epithelium (MSE) of the vaginal part of the cervix. When concluding, the cycle period is taken into account.

If cancer cells are not detected, but other inflammatory processes caused by specific and nonspecific causes are present, then which ones are indicated.

Nonspecific are acute and chronic.

Acute are characterized by a large number of neutrophilic leukocytes in the smear.

Chronic inflammation in cytology is manifested in the presence of leukocytes, histiocytes, lymphocytes and macrophages.

As for specific diseases, they are generated by specific pathogens. There are about forty of them in total. Let's list some of them:

• Herpes . Timely detection is especially important when planning pregnancy. If the tests are positive, a cesarean section is prescribed to prevent the infection from passing on to the baby;
• Chlamydia . This infection is dangerous if left untreated. Its consequences lead to infertility, heart and joint disease;
• Candidiasis or thrush . It gets especially worse in pregnant women. It is dangerous because, if left untreated, it can be transmitted to the baby through the birth canal in the form of mucosal infections;
• Trichomoniasis . In 90% of cases, spread occurs through sexual contact. If not treated in a timely manner, it can lead to inflammation of the reproductive organs, the appearance of neoplasms in the cervix, miscarriage or premature birth.

When describing the cytogram, you can read the following: mild leukocyte infiltration or the reaction of epithelial elements is moderately expressed. Don't be afraid of such complex terms. They indicate the presence of mild inflammation, which will subside after a course of treatment prescribed by a doctor.

Do you want to know the cost of cancer treatment abroad?

* Having received data about the patient’s disease, the clinic representative will be able to calculate the exact price for treatment.

HPV – human papillomavirus – requires special attention. It can be detected only after its activation and by the presence of indirect signs - koilocytes, multinucleated cells, dyskeratocytes. The presence of HPV determines a precancerous condition.

If malignant cells are detected in the oncocytogram, the abbreviations ASC (atypical squamous cells) or AGS (atypical glandular cells) are indicated, and the level of dysplasia and other data are indicated.

Dysplasia is a change in the epithelial cells of the cervix with their gradual replacement by abnormal ones. Doctors distinguish three stages of the disease:

CIN I – mild degree . The changes are barely noticeable. The percentage of damage is up to a third of the entire epithelium.

CIN II – moderate severity . The changes are noticeable. Two thirds of the layer are affected. In 5% of patients this degree develops into cancer.

CIN III - severe degree . Urgent further examination and treatment is required. The risk of developing cancer is up to 12%.

A more dangerous diagnosis is anaplasia. This is the destruction of the cellular system to an undefined state, which is a sign of advanced cancer. Doctors also call this process oncocintic differentiation, i.e. cell transformation.

In the cytological report form, the norm is indicated by the abbreviation CBO - “cytogram without features.”

If the analysis shows the presence of cancer cells, do not get upset ahead of time. To confirm or reject the disease, you will be prescribed a colposcopy or biopsy. Modern medicine is able to recognize the most serious diseases at an early stage. We encourage you to use all diagnostic methods. Take care of your health.

Negative results

If you receive a negative result, you should not panic. Cancer cells can be detected at different stages of their development. It is necessary to consult an oncologist who will prescribe a course of medications depending on the morphological and pathological affiliation of the cells.

It is worth carrying out treatment as early as possible to shorten the development time of cancer cells and prevent metastasis to other organs of the patient.

Positive results: types of pathologies

If the research data obtained corresponds to the norms, then no abnormalities were identified and the woman is healthy. In case of positive results, pathology develops.

Finding abnormal cells does not always indicate the presence of cancer. Dangerous infectious diseases are often detected during a Pap test.

1. Human papillomavirus infection - the formation of genital warts in the vagina and on the cervix. This virus is very dangerous for women's health.

2. Chlamydia is the most common sexually transmitted infection. Basically, this disease occurs without pronounced symptoms. In addition, it is difficult to diagnose in the laboratory. This makes treatment difficult, and its absence can lead to serious complications.

3. Trichomoniasis is a popular sexually transmitted disease. The main symptoms of the disease: itching, yellow-green discharge, discomfort when urinating and during sexual intercourse.

4. Gonorrhea is an infectious disease of the genitourinary system. The chronic form of the disease is often the cause of infertility in women.

5. A yeast infection is an overgrowth of fungus that lives in the vagina. For some reason, its reproduction gets out of control and inflammation occurs.

If the smear test is positive due to the presence of infection, the identified diseases should be treated. Very often it is difficult to determine cancer precisely because of viruses.

Depending on the pathology, sometimes it is necessary to take a second smear for cytology, which shows the dynamics of changes in the structure of cells over a certain period.

Where to take the study?

The oncocytology procedure is carried out during a planned visit to the antenatal clinic by a gynecologist. For early prevention of cancer processes in the cervix, this study is carried out free of charge, but the result of such an analysis may be obtained in 2 weeks.

If the patient wants to know the results earlier, then she should contact a private gynecological office. It includes a period of up to 5 days for receiving answers, and the cost of the study will be from 350 to 1000 rubles.

Article design: Oleg Lozinsky

Diagnostic price

The test is carried out in almost all clinics. In municipal and federal ones, you can undergo diagnostics free of charge with a medical policy. To do this, you will first have to make an appointment with a gynecologist.

In private clinics, a standard (simple) test is cheaper than a liquid test. The difference is almost double. Please note that the price lists usually include the cost of the analysis itself, without consulting a gynecologist.

Oncocytology allows you to identify cancer cells even at the very beginning of the disease. If the result is positive, a more thorough approach to examining the body is required.

Research results

The cytogram is considered normal if no atypical cells were found in the test results. A positive result does not indicate with 100% accuracy a precancerous or cancerous condition.

Out of 100 smears taken, about 50 are considered uninformative because the conditions for preparing for the procedure were violated or the laboratory received an insufficient amount of material. In this case, oncocytology is performed again.

The reasons for obtaining an unreliable result include infection of a woman with the following sexually transmitted infections:

• gonococci;
• chlamydia.

The papilloma virus also causes changes in the structure of the epithelium and the formation of benign elevations on its surface - genital warts. For this reason, women suffering from HPV should undergo oncocytology 2 times a year.

A breakdown of the results by class is presented in the table

The diagnosis is made definitively only after a comprehensive diagnosis. A few months after treatment, tests are repeated.

If the cytogram is positive, women are prescribed:

1. Colposcopy. The study allows you to study in detail the condition of the cervix and vaginal mucous membranes.
2. Biopsy. The study is prescribed only if malignant cellular structures are detected.
3. Histological analysis.

Reasons for development

HPV (human papillomavirus) plays a major role in the formation of cervical cancer. The virus is capable of introducing its genes into the DNA of epithelial cells, which can lead to cell degeneration.

Cells can actively divide, ceasing to mature and losing the ability to perform functions. This leads to the appearance of a cancerous tumor at the site of one mutated cell. Over time, it grows into nearby organs and metastasizes to other parts of the body, leading to consequences for the body.

In addition to HPV, there are many factors that cause the formation of malignant tumors on the cervix, including:

1. Early onset of sexual activity. The risk group includes those who had sexual intercourse before the age of sixteen. This is due to the fact that the epithelium of the cervix may contain immature cells that can easily degenerate.
2. Large number of sexual partners. Research shows that women who have had more than ten partners in their lifetime have a twofold increased risk of cervical cancer;
3. Infections that can be sexually transmitted.
4. HIV infection. Viral venereal and bacterial pathologies can cause cell mutations.
5. Excessive dieting and poor nutrition. Lack of vitamins and antioxidants in food can increase the likelihood of mutation.
6. Smoking. Carcinogenic substances contained in tobacco smoke contribute to the degeneration of healthy cells into malignant ones.

Purpose of the study

Many patients, when examined in a gynecological office, hearing that they have had a smear taken for flora and cytology, think about why this is and what it will show. The procedure is mandatory during routine examination of women, as well as in cases of genetic predisposition to cancer. For clarity in understanding what it is and what research shows, let’s consider the pathologies detected by cytology. These include:

1. Cervical cancer is a malignant neoplasm that develops in the cervix. Pathology is represented by 2 main types: squamous cell carcinoma and adenocarcinoma. Analyzes make it possible to identify atypical cells in the early stages of development and take measures to treat oncology.
2. Human papillomavirus infection (PVI) is a group of diseases that affect the epithelium of the genital organs as a result of infection with the human papillomavirus (HPV). It is characterized by the formation of various growths on the mucous membrane, for example, warts. If left untreated, infection can lead to cancer. Cytological analysis allows you to detect altered cells in the early stages.
3. Cervical polyps are benign neoplasms localized in the cervical canal.
4. Leukoplakia (hyperkeratosis) is a pathological change in the epithelium covering the mucous membrane of the cervix.
5. Erythroplakia is an atrophic lesion of the upper layer of the mucous membrane of the cervix.
6. Dysplasia is structural changes in the epithelial cells covering the uterus. The disease is classified as a precancerous condition.
7. Inflammation. The cytology option makes it possible to detect cellular changes when a harmful pathogen penetrates the reproductive system.

If any changes are detected in the biological material, additional examinations are prescribed to help verify the diagnosis. For example, if there is blood in the urine, a cytological examination of the urine is performed, which allows one to confirm or exclude pathologies of the urinary system. Also, if necessary, MRI (magnetic resonance imaging), CT (computed tomography), and ultrasound are prescribed.

Symptoms

Early symptoms of cervical cancer:

• The appearance of discharge

They are usually watery in nature, have the color of “meat slop”, and have a specific odor. Such discharge occurs if the tumor grows to a large size and gradually disintegrates.

• Bleeding not associated with the menstrual cycle
• Contact bleeding (during intercourse), pain during intercourse
• Bleeding in postmenopause

Late symptoms

• Pain of a gnawing and pulling nature, occurring in the lower abdomen, in the lower back and sacrum, in the rectum area.
• Frequent urination

Neglected cases

• Signs of tumor intoxication: sudden weight loss, loss of appetite, constant fever, loss of strength, anemia
• Disorders of urination and defecation: blood in the urine, blood in the stool, constipation.
• Leakage of urine or feces from the vagina (when the tumor grows into the wall of the bladder and intestines with the formation of fistulas)
• Swelling of the legs, shortness of breath

Cervical cancer test

Today, the Papanicolaou test or PAP test is an internationally recognized analysis for the early diagnosis of cervical cancer.

This analysis is taken from the cervical mucosa with a spatula or a Wallach brush. Then the collected material is sent to the laboratory in a special container. In the laboratory, samples are applied to glass slides and cytological examination is carried out according to the characteristics of the cells. The result is determined after seven days.

An analysis for cervical cancer cells is usually taken no earlier than the 5th day after the start of the cycle and no later than five days before the start of menstruation itself. A few days before visiting the gynecologist, it is recommended to refrain from douching and sexual intercourse.

To diagnose cervical cancer, several more tests are performed:

Cytology for atypical cells. This test for cervical cancer involves taking a sample of the contents from the cervical canal and using a microscope to determine the presence of malignant cells in it.

Thin Prep method or liquid cytology. Consists in the production of a special thin-layer cytological preparation.

HPV double gene trap test. Thanks to it, it is not the tumor itself that is diagnosed, but the degree of HPV infection and the degree of risk of cancer formation.

What tests for uterine cancer are the most objective today?

The main condition for the development of cervical cancer in a woman is considered to be the presence of high-risk HPV. First of all, this is a virus of types 16 and 18. Therefore, when the cervix appears, patients need to be tested for HPV.

Tumor markers

Tumor markers are special substances in a woman’s blood that can indicate the development of cancer in the body. Each cancer has its own special markers, which depend on the cells in which the cancer develops. If there is cervical cancer in the body, the level of the SCC tumor marker in the blood increases.

The more SCC found, the more advanced the cancer is and the more difficult it will be to cure. During the treatment itself, it is necessary to constantly monitor changes in the amount of the SCC tumor marker, because its decrease may indicate successful treatment. If, after therapy, the level of tumor marker in the blood increases again, then we can say that the disease recurs.

However, an increase in this tumor marker cannot accurately indicate cervical cancer. The SCC level may increase with cancer of the external genitalia and lungs. But, if the diagnosis has already been confirmed, then it is simply necessary to monitor and monitor the level of the marker during the treatment process. This can help predict the further development of the disease and influence the course of treatment.

Liquid cytology

A smear for liquid bone cytology is a simple but fairly accurate analysis that helps evaluate the cells and tissues of the cervix and determine the presence of any pathologies. The test itself is safe and painless. The main purpose of this procedure is to identify cells that may mutate over time and become cancerous. The effectiveness of treatment depends on timely identified pathologies and changes in tissues and cells.

The analysis procedure itself is very simple. First, the gynecologist must thoroughly clean the cervix, then use a special brush to collect biomaterial for analysis and place it on medical glass. For a woman, this is where the procedure ends. Then she simply waits for the result of the analysis.

The collected material is examined under a microscope in the laboratory. The answers from the research are usually ready within a week. Using liquid-based cytology analysis, the size of the cells is studied, as well as the order in which they are arranged. Such a study helps to identify the development of cervical cancer in the initial stages, which allows us to develop the correct course of treatment. For preventive purposes, it is recommended that all women carry out such an analysis at least once a year.

A cytology smear helps in choosing the most effective method of treating various gynecological cancers. Using this analysis, it is possible to identify malignant cells at an early stage of the disease, which provoke the rapid development of the disease.

This analysis is prescribed if:

1. The girl is planning a pregnancy.
2. The menstrual cycle is disrupted.
3. A diagnosis of infertility was made.
4. A woman has not one sexual partner, but several.
5. For genital herpes, genital warts, etc.
6. The woman had been taking contraceptives for a long time.
7. Unreasonable discharge from the external genitalia.
8. There are suspicions of oncology.

Liquid cytology allows you to timely diagnose the presence of human papillomavirus in the body and identify pathologies in the cervix.

The result of the analysis is:

• “normal”, which indicates the absence of any pathologies and cancer cells in the cervix;
• “pathological” when cells that can trigger the development of cancer were found in a biological sample.

Positive aspects of liquid cytology analysis:

1. Fast material collection process.
2. The material has a fairly long shelf life (thanks to a special stabilizing solution, the cells do not dry out, and the biological sample is transferred to the laboratory for research in comfortable conditions).
3. Possibility of preparing a monolayer smear.

However, this new cancer diagnostic technique has one significant drawback. Using a smear for cytology, it is not possible to identify inflammatory processes, since during the filtration of biological material all leukocytes and other impurities are removed from it. Therefore, if there is a suspicion of inflammatory diseases, then it is also necessary to take a smear for oncocytology.

Colposcopy

There are other popular tests for uterine cancer. One of them is colposcopy. During this method, the gynecologist examines the uterus using a device that has the properties of a magnifying glass. A colposcope allows the gynecologist to examine the uterus and identify areas of tissue that have undergone changes. Such areas may indicate the presence of cancer or.

Cervical biopsy

The essence of a biopsy is that a piece is “plucked off” from pathological areas of the cervix identified during colposcopy for further examination under a microscope. This cancer test allows you to determine whether the cells are cancerous. Obtaining such information is necessary to create an effective course of treatment.

Diagnostic procedures

• Vaginal examination using a speculum. With it, the gynecologist must assess the condition of the cervix, fornix and vaginal wall. In 95% of patients, cervical cancer can be detected during a routine examination. A lumpy formation covered with folds may be visible on the neck, which bleeds. Ulcers and a plaque of dead cells are often present. In some cases, changes extend to the vaginal vaults. If the malignant formation is located deep in the canal or does not grow outward, but grows into the thickness of the uterine wall, then the symptoms may be less pronounced.
• Two-handed gynecological examination. During this examination, the doctor probes the uterus through the vagina with one hand, and the anterior wall of the abdomen with the other. With oncology, the uterus increases in size, becomes more painful and dense. With metastases, it may not move well to the sides.
• Oncocytology smear (Pap test). It involves taking a smear of the surface cells of the glandular epithelium. If the cells have degenerated on the mucous membrane, then this fact will be noticeable when studied under a microscope. In such cells, the structure of the cytoplasm may change and the nuclei may enlarge. If the result is positive, no conclusions are drawn about the presence of cancer, but only additional examinations are carried out. If atypical cells are detected, the specialist recommends testing to detect human papillomavirus (HPV) DNA.
• Colposcopy. This diagnosis is carried out when the results of other studies are not very good (in the presence of atypical cells or signs of human papillomavirus). Upon examination, a specialist may notice even minor changes and the slightest neoplasms.
• Biopsy. During this procedure, a tissue sample is taken for thorough examination under a microscope. The material is taken using special instruments from places where signs of the disease are found. To make the procedure painless, the areas are treated with painkillers.
• Palpation of lymph nodes. The specialist should check the lymph nodes by touch, determining their size and density. This is done to detect metastases.
• Additional research. The attending physician may prescribe a number of additional studies, such as: x-rays, ultrasound of the pelvic organs, computed tomography and magnetic resonance imaging. If the neoplasm is confirmed, then cystoscopy, excretory urography, radioisotope renography and sigmoidoscopy can be used to determine its size and search for metastases.

FAQ

Is the appearance of genital warts a risk factor or a symptom of cervical cancer?

Genital warts (genital warts) are caused by non-oncogenic types of the virus. Although they can cause discomfort and aesthetic inconvenience, this has nothing to do with cervical cancer.

A smear for oncocytology revealed mild CIN1 dysplasia and an inflammatory process. Is it necessary to do conization of the cervix?

Mild dysplasia in most cases goes away on its own and requires only monitoring twice a year. In addition, an inflammatory process (cervicitis) could affect the assessment of smear results. Therefore, it is first necessary to find out the cause of the inflammation, treat it, and then repeat the cytological examination.

How long do people live with stage 2 cervical cancer?

The second stage is characterized by local spread of the tumor. With radical surgery followed by radiation therapy and regular follow-up, 75% of women survive the five-year mark. In oncology, patients who have lived 5 years without relapse are conditionally considered recovered.

What initial stage treatment can be carried out if there is a desire to have children in the future?

The question of the method of treatment is decided primarily by the attending physician: a gynecological oncologist. In addition to the stage, the type of tumor, the woman’s age and concomitant diseases play a role. Under favorable circumstances, organ-preserving surgery can be performed: removal of only the cervix. Pregnancy after this intervention is possible.

What is cervical cytology: advantages and disadvantages

A Pap smear (another name for cervical cytology) is the most common test for detecting cancer in its earliest stages. Thanks to such a simple study, specialists detect cellular changes long before the first symptoms of the disease appear.

Statistically, it takes several years from the deformation of the cell nucleus to the development of cancer. Therefore, the risk of cancer in women who visit a gynecologist at least once a year is minimized.

Advantages of the PAP test compared to tissue biopsy:

• Ease of sample collection;
• Almost complete absence of pain in the patient;
• No risk of serious complications after the procedure itself;
• Low cost.

The only disadvantage is that in some cases, tissue biopsy shows more accurate and advanced results than cytology.

Indications for a Pap test

A cytological examination is carried out for all women aged 18 to 30 years once a year. For patients aged 30 to 65 years, a Pap test is performed every 3-4 years. For women over 65 years of age, the analysis may not be performed, but only if previous tests did not reveal any pathologies.

Other indications for a Pap test (sometimes even annually) are:

• Constant change of sexual partners;
• HPV infection, history of STDs;
• Beginning of sexual activity at a very early age;
• Weakened immune system (for example, after chemotherapy or radiotherapy);
• Smoking;
• A family history of cancer.

If a woman has ignored visits to the gynecologist for many years, then a smear test can be performed already during pregnancy. This poses a certain threat to pregnancy, so it is worth taking all standard tests 2-3 months before the planned conception.

How to prepare for a Pap test?

Obtaining the most accurate results of a smear from the cervical canal depends not only on the specialist who collects the material, the laboratory assistant, but also on the patient herself. It is worth scheduling the analysis for the middle of the cycle (no earlier than 14-16 days after the end of menstruation).

Sexual intercourse is prohibited for 24 hours before the test , since natural and artificial lubrication and sperm can make it difficult to collect a “clean” sample. Douching and excessive washing are also prohibited.

Other important recommendations for preparing for cytological examination of cervical smears:

In the morning, before going to the doctor.

Wash only the external genitalia (avoid bathing while sitting or lying down).

If an intrauterine device or vaginal ring was placed.

Then it is necessary to additionally visit a doctor 1.5-2 weeks before the examination to decide on the possibility of taking a smear.

4 days before visiting the gynecological office.

Avoid using any vaginal medications (suppositories, ointments).

If a young girl is about to undergo a PAP test for the first time, she should visit a gynecologist in advance to receive a detailed oral consultation. This will allow you to mentally prepare for the procedure. The calmer the patient is, the faster and more painlessly the material will be collected.

How is a cytological examination performed?

A Pap smear is often performed during a gynecological examination in a chair. This is a simple and quick test. After spreading the vaginal walls using a speculum, the gynecologist will insert a special brush into the os of the cervix.

After three forward movements, the specialist will remove the brush and move the material onto a glass slide or into a container with a special liquid.

Important! During the first 24 hours after the test, a woman may notice blood spots on her underwear. This unpleasant symptom is a variant of the norm. But if bloody spots appear even three days after the test, you need to contact your gynecologist again.

Women having a smear test at private clinics may be asked to have the procedure performed on a couch. For greater psychological comfort, the lower part of the body is covered with an opaque paper sheet.

Another advantage of having a smear in a private clinic is the individual selection of the size of the spatula or brush used. For example, during menopause, the vaginal walls narrow, and there is practically no lubrication in the cervical canal, and using a standard-sized brush can make the procedure painful.

What happens to the material after collection?

After collection, the samples are transferred to the laboratory, where the material is cleaned and examined under a microscope. Many regional public hospitals still use traditional cervical oncocytology.

The samples are placed on a special glass, after which they are cleaned in a centrifuge, stained with a special reagent and examined under a microscope. The disadvantage of the traditional method is the large percentage of false negative and false positive results.

Deciphering a cytological examination of material taken from the cervix using the traditional method can be difficult due to insufficiently thorough cleaning of the slide (according to the standard, new slides must be used, but in government laboratories the slides are reused several dozen times).

Also, the slide is susceptible to contamination by foreign cells during transportation to the laboratory.

Liquid cytology of the cervix is ​​widely performed in private clinics. After collecting the material, the doctor moves the brush into a container with a special preservative liquid. The risk of sample contamination during transportation is reduced to a tenth of a percent.

The work with the sample itself is not carried out manually, but in special machines that separate blood and artificial particles from cells from the cervix, and also form a cytospecimen ready for evaluation. The laboratory assistant will only have to draw a conclusion about the quality of the cells.

How to decipher the results?

The results sheet (especially if the analysis was done in a state laboratory) may only contain a few English letters. Private clinics usually add a short summary in Russian.

Since several days may pass between receiving the results and going to the doctor, women try to decipher the coding on their own.

In traditional cytology, the column “quality of material” is added to the results sheet. A “satisfactory” rating means that there were enough differentiated (purified) cells to evaluate their structure.

The note “unsatisfactory” indicates that the sample is highly contaminated. In this case, the patient will have to undergo the procedure again (but not earlier than in a month).

Interesting to know! Liquid-based cytology allows multiple specimens to be obtained from a single smear, so the “unsatisfactory” note occurs in less than 1% of cases.

Until 2001, a five-step assessment of the condition of cervical epithelial cells was widely used. Such a system only described the degree of change, but did not provide any information about cell morphology. In 1988, the classification was radically changed, and only in 2001 was it recognized at the global level.

Decoding the result of a cytological smear according to the modern Bethesda system.

ResultDecryption

Pap-test results, further tactics

According to the results obtained from the cytological examination, the doctor must determine further tactics of treatment, examination, and observation:

• Type 1 smear – women who are absolutely healthy from a gynecological point of view. They require annual medical examination and are not subject to special registration or continued in-depth examination.
• Type 2 smear – patients with an inflammatory process. Such patients are prescribed examinations to detect sexually transmitted infections. If an infectious agent is detected, it is given appropriate treatment. Observation of this group of patients is carried out in the same way as patients with the first type of smear.
• Type 3 smear - an immediate repeat cytological examination is required; for diagnostic purposes, a targeted biopsy and colposcopy are performed.
• 4th type of smear - a complete gynecological examination is required, including colposcopy, separate diagnostic curettage, and ultrasound methods in order to determine further tactics for treating the oncological process or severe form of grade 3 dysplasia.
• 5th type of smear – in clinical significance it corresponds to cancer and requires compliance with all oncological examination and treatment protocols.

Regular preventive gynecological examinations are a guarantee of timely detection of cervical pathology.

Determination methods

The absence of specific symptoms can significantly complicate the definition of the disease. Doctors call the similarity of signs of cancer and other gynecological diseases one of the main factors in late diagnosis of the disease.

To identify pathology, the patient must undergo a full examination, including various tests.

• General gynecological examination. For cervical cancer, determining the disease begins with a gynecological examination and medical history. During a bimanual examination and examination with a vaginal speculum, the doctor can visualize changes, including the structure and color of the mucous membrane. In addition, cancer processes are often accompanied by characteristic growths of epithelial tissue. A general examination is especially important for invasive cancer. With endophytic growth of cancerous elements, the neck has a denser consistency and may be larger in size. An exophytic type of cancer pathology during a gynecological examination looks like the formation of a tuberous structure.
• Lab tests. To determine cancerous structures, a screening test is used, called an oncocytology smear. Unlike a general smear, this analysis shows the presence of cancer cells, as well as the inflammatory process. It is advisable to perform a cytological examination or smear for oncocytology in the middle of the cycle. Before collecting biological material, suppositories and spermicides should not be used. A smear for oncocytology is taken with a special brush during a gynecological examination. To identify cancer cells, a cytology smear is examined under a microscope.

Many women are interested in whether it is possible to detect cervical cancer using a general blood test. In fact, cancer cells cause changes throughout the body that can be seen in a complete blood count. A general blood test in medicine is called a basic blood test. However, in order to determine the type of oncology, a general blood test is considered uninformative. In such cases, it is necessary to perform a biochemical blood test showing the presence of cancer cells in a specific organ.

A general blood test with the spread of cancer cells indicates an increase in ESR and the number of leukocytes, a decrease in hemoglobin levels and the appearance of myeloblasts.

Tumor markers are a specific type of protein that appears as cancer spreads. Normally, these proteins are absent in a blood test or are contained in small quantities. Each organ has its own tumor markers, diagnosed in a blood test. For example, a blood test to measure CA 125 and SCCA levels may be used to detect cervical cancer. Such blood tests are not always reliable and are used mainly to evaluate the therapy performed. They are not suitable for primary diagnosis, since cancer cells do not always produce specific proteins.

When determining cervical cancer, an HPV test is prescribed. Of particular importance is the identification of highly oncogenic strains of the virus that can contribute to the formation of cancer.

• Colposcopy. The study is necessary for oncological suspicion and is carried out according to the results of a diagnosis called a cytological smear. The procedure is a diagnosis carried out using a colposcope - a device with a magnifying and lighting system. Often, extended colposcopy is used using special reagents applied to the cervix to determine the clinical picture.

• Hysteroscopy. The manipulation is carried out using a device called a hysteroscope. This device is inserted into the vagina to detect diseases and treat them.

• Biopsy. The study is indicated if a cytology smear and colposcopy show conflicting results. Sometimes a cytological smear to determine cancer may not reveal pathology. The biopsy procedure involves removing tissue for further examination in the laboratory. Such an examination can be carried out in the following ways:

1. colposcopic;
2. wedge-shaped;
3. curettage.

Wedge biopsy has several varieties:

• Ultrasound. The examination is carried out abdominally and transvaginally. With this type of examination, you can evaluate the appearance of the cervix and its structure. With cancer, the cervical part has an irregular shape and position, as well as a blurred outline.

The following instrumental types of research are used to detect metastases:

Timely diagnosis, including a cytological smear, ensures the prescription of adequate therapy and significantly increases the patient’s chances of a complete recovery.

Types of cancer

Tumors of the cervix can consist of different tissues, form in different parts of the organ, and have different malignancies.

• Pre-invasive cancer
• Squamous cell carcinoma
• Glandular cancer (adenocarcinoma)
• Other types of cancer (including undifferentiated)

Preinvasive cancer (in situ, grade 3 dysplasia, CIN 3)

Cancer “in situ” or cancer in situ are different names for the same pathology. In this case, the cells covering the neck show signs of malignancy. But they do not grow deep into the stroma. Accordingly, there are no metastases. Since there are no symptoms of cervical cancer at this stage, it can only be detected with regular examination by a doctor. Over time, in situ cancer turns into microinvasive and then metastatic cancer.

Microinvasive cancer

Experts often distinguish a special form of cervical tumors – microinvasive cancer, corresponding to stage Ia. This is no longer cancer in situ, since tumor cells have penetrated the stroma. But this invasion does not exceed 5 mm, and the size of the tumor itself is 1 cm or less. In this case, the cancer is usually mildly aggressive, does not metastasize, and is quite treatable.

Invasive CC

If the tumor penetrates deep into the tissue, it is called invasive. It is during this period that the first symptoms of cervical cancer appear. This cancer is easier to notice when examined by a gynecologist, and it also has the characteristic features of smears and colposcopy. In cases of advanced cancer, clear signs may appear.

Based on their shape, cervical tumors are divided into three groups:

• With exophytic growth

This type of cancer grows inside the cervical canal, as if into the lumen of the cervix. It can be detected during examination on the gynecological chair: it often hangs outward from the cervix in the form of a cauliflower-shaped polyp. Such tumors are considered less aggressive, metastasize later and have a better prognosis.

• With endophytic growth

These tumors grow deep into the cervix. From the outside they look small, but deep in the tissue they form ulcerations and decay. In such cases, the disease is more aggressive, the prognosis is less favorable

• Mixed

Symptoms of the disease

In the early stages of development of cervical cancer, specific symptoms do not appear. The woman does not notice pronounced changes and strange sensations.

The first symptoms occur when the tumor reaches a large size, affecting nearby organs.

It is important to undergo an annual examination with a gynecologist to detect cancer in the early stages, when there is a high chance of defeating it.

Symptoms of cervical cancer may include:

• Bleeding from the vagina (after menopause, after a gynecological examination or sexual intercourse, between menstruation).
• Changed nature of menstruation (change in bleeding pattern or lengthening of the menstrual period).
• Changes in vaginal discharge (blood discharge, increased amount of leucorrhoea, foul-smelling discharge).
• Pain during sexual intercourse.
• Pain in the back and lower abdomen.
• Dramatic weight loss.
• Swelling of the legs.
• Impaired urination and bowel movements.
• Reduced performance and weakness.

The listed signs are not specific for cervical tumors. They can appear with other pathologies of the genital organs.

What does the analysis of histology and cytology show in cancer?

Cytological analysis of a smear usually takes from 1 to 5 days.

It is important to remember that the oncological process does not occur in a few days. Quite a long time passes from the first pathological changes to malignant degeneration.

Therefore, timely detection of atypical cells in a woman’s body makes it possible to prevent the development of cervical cancer. For these purposes, an accessible and simple method for the early diagnosis of malignant cells was introduced everywhere - a cytological examination of a smear.

Various methods and systems are used today to diagnose cancer. When cancer symptoms are detected, a biochemical blood test, urinalysis, histology and cytology, and MRI can be performed.

For example, biochemical blood parameters - an increase or decrease in the number of leukocytes, erythrocytes - a sign of oncology, a decrease in hemoglobin levels, an extreme platelet shift, a permanent increase in the erythrocyte sedimentation rate - all this indicates certain tumor effects on the body.

With cancer, the color of urine changes, it becomes red and cloudy due to the increased number of leukocytes and red blood cells in it. Ketone bodies, proteins, sugars, as well as all kinds of bacterial agents are recorded. In addition, there may also be tumor markers in the urine that are visible to the doctor.

When analyzing for cancer, histology and cytology reveal whether the sample taken corresponds to the generally known norm, or if there are deviations from normal values.

The analysis can reveal the presence of atypical cells and their degeneration into malignant ones. Cytology is usually prescribed as an auxiliary method to other medical techniques used in the diagnosis of cancer.

Viedorolik Elena Malysheva: What do the tests say? How to recognize cancer?

In order to prevent and prevent the development of dangerous diseases, cytology of a smear from the cervical canal is done for every woman. This analysis allows us to identify abnormalities in the cellular structure of the cervix that cause the development of cancer.

To avoid possible pathologies, all women should regularly visit a gynecologist. If changes occur, they are recorded at an early stage, when the disease is treatable and full recovery is still possible.

In addition to cellular pathologies, a cytology smear allows you to evaluate the mucous membrane and determine the presence of harmful microorganisms in the vagina. The PAP test does not determine the exact data of these parameters, so in such cases it is necessary to use additional methods of analysis.

Symptoms required to prescribe these tests

The first symptoms to look out for are:

1. Bloody discharge that appears after intimacy or for no reason in the middle of the menstrual cycle. Their abundance can vary: from slightly smearing to heavy, similar to menstrual ones.
2. Pain when urinating, blood in the urine.
3. Lower abdominal pain. This is usually a symptom of one of the last stages of cervical cancer.
4. Bloody and painful discharge after sexual intercourse.

Any of the listed symptoms may signal the development of cervical cancer. Therefore, if at least one of them appears, you need to contact a gynecologist!

Frequency of analysis

As mentioned above, female oncology is often initially asymptomatic. Therefore, it is necessary to carry out preventive measures at regular intervals. Experts give the following recommendations:

1. Women under the age of 30 are recommended to have a smear for oncocytology at least once a year. If the results are unsatisfactory or there are pathogenic elements, then the frequency of the procedure is regulated by the gynecologist.
2. Upon reaching 30 years of age and older, women should be tested every six months, as the risk of cervical cancer increases significantly.

Some factors in a woman’s life should also be taken into account. For those at risk, the frequency of testing is also more frequent. Risk factors include:

• smoking;
• immunodeficiency condition, aggravated during bad weather;
• avitaminosis;
• infectious processes in the genital area.

How is the research conducted?

Oncocytology is not accompanied by pain and for this reason does not require the administration of painkillers before taking a smear. After the study, there is no damage to the epithelium or changes in its structure.

A smear is taken by a gynecologist. First, the specialist inserts a dilating speculum into the vagina, then, using a spatula, removes epithelial cells from the cervix. If necessary, the doctor collects samples of material from the cervical canal.

After the procedure, bleeding from the vagina may occur. After a few days, the bleeding goes away on its own without treatment.

The collected biological material is placed on a sterile piece of glass or in a liquid medium. Epithelial cells are treated with fixing compounds and staining solutions. The conclusion is issued by a morphologist who studies the material under a microscope.

Based on the results of this conclusion, the gynecologist draws up an appropriate treatment regimen.

Useful video

Watch this video about the treatment of cervical cancer:

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How quickly it develops

Cancer develops over many years—at least five to seven. It is believed that the disease goes through all stages - dysplasia, precancer, and only then cancer appears.

There is a pattern - the earlier a malignant tumor is detected, the greater the likelihood of a complete cure. If CC is detected at the stage of carcinoma in situ and radical treatment is carried out, in 95% of cases recovery is observed, the woman is even removed from the dispensary register.

Stages and diagnosis of cervical cancer

Zero stage. At this stage of development, malignant cells are located only on the surface of the cervical canal, without forming a tumor itself and without penetrating deep into other tissues.

1st stage. At this stage, cancer cells grow, forming a tumor that can penetrate deep into the tissue of the cervix. The cancer does not extend beyond the cervix and does not metastasize to the lymph nodes.

The first stage has two substages: 1A and 1B. In substage 1A, the tumor size ranges from three to five millimeters and the depth is less than seven millimeters. In substage 1B, cancer cells penetrate five millimeters into the connective tissue of the organ. The diameter of the tumor ranges from seven millimeters to four centimeters.

At this stage, cancer can be diagnosed by oncocytology analysis - a microscopic examination of cytology taken from the cervical canal. If atypical cells are detected in the analysis, a study is carried out using a colposcope - a device that allows for a detailed examination and display of the image on the monitor screen.

2nd stage. In the second stage, the neoplasm can grow into the body of the uterus and extend beyond its limits. The tumor does not spread along the walls of the pelvis and lower parts of the vagina. It is divided into two substages: 2A and 2B. In substage 2A, the malignant tumor has a diameter of about four to six centimeters and is clearly visible during examination.

The tumor can affect both the cervix itself and the upper part of the vagina. The cancer process does not spread to the lymph nodes, and metastases do not form in distant organs. At stage 2B, the tumor spreads to the periuterine space without affecting nearby organs.

To diagnose the second stage, studies are prescribed using a colposcope and ultrasound of the pelvic organs. In some cases, a biopsy is performed - taking a tissue sample from the cervix. The procedure is performed during colposcopy or separately. Another diagnostic method is wedge biopsy. It is performed using an electrosurgical loop or scalpel to remove material for analysis from deep layers.

3rd stage. At this stage, the malignant neoplasm has already spread along the walls of the pelvis and the lower part of the vagina. The tumor can affect nearby lymph nodes and interfere with urination. It does not affect distant organs. Divided into substages 3A and 3B. In substage 3A, the tumor grows into the lower third of the vagina without affecting the walls of the pelvis. In substage 3B, the tumor can block the ureters and affect the lymph nodes in the pelvis.

Colposcopy, biopsy and computed tomography are used for diagnosis. With the latter method, X-rays are irradiated; with their help, several images are taken, which are compared on the monitor screen, giving a holistic picture of the changes.

Magnetic resonance imaging is a fairly informative research technique. The operation of the tomograph is based on the action of radio waves, which absorb to varying degrees and release different types of tissue.

4th stage. The formation reaches a large size and spreads widely around the cervix. Distant and nearby organs, as well as lymph nodes, are affected. Has substages 4A and 4B. In substage 4A, metastases spread to the bladder and rectum, without affecting the lymph nodes and distant organs. In substage 4B, lymph nodes and distant organs are affected.

For diagnosis, visual examination, intestinal endoscopy, computed tomography or magnetic resonance imaging are used to determine the size of tumors. To identify distant metastases, positron emission tomography is prescribed. Glucose containing a radioactive atom is introduced into the body, which is concentrated in malignant cells of neoplasms and metastases. Such clusters are detected using a special camera.

Types of smears

The resulting cytological preparations are subjected to a special staining method. According to WHO recommendations, the smear should be stained using Papanicolaou - the so-called Pap-test, based on the results of which all cytological smears are divided into five types:

1. Absolutely normal smear, corresponding to the cytologically normal structure of the epithelium.
2. The smear shows cell changes characteristic of an inflammatory reaction.
3. Individual cells with signs atypical for normal cervical epithelium were identified, corresponding to grade 1–3 dysplasia. The patient should repeat the cytological examination, perform colposcopy and biopsy of the suspicious area.
4. A small number of cells with signs of malignancy were detected.
5. The smear contains a fairly large number of malignant cells; the diagnosis of cancer is beyond doubt.

Types of tumors

Cancer (carcinoma) forms from the upper part of the epithelium of the cervix. Adenocarcinoma is much more common and has a more favorable prognosis. The form of malignancy can be determined only after histological examination, for example, after a biopsy or after surgical removal of an organ. Tumor variant influences the prognosis and treatment of cancer.

Squamous cell keratinizing

This form is characterized by the detection of signs of cell keratinization. They look like "cancer pearls". This type of cervical cancer often develops against the background of tissue leukoplakia. Depending on the degree of cell differentiation, cervical cancer is distinguished:

Squamous cell carcinoma of the cervix without keratinization

Cells of squamous cell carcinoma of the cervix without keratinization have a high ability to divide. When examining such tissues using a microscope, keratin “pearls” are not detected. Based on the degree of differentiation, low-, moderate-, and highly differentiated cancers are also distinguished.

Poorly differentiated cancer

This is a type of squamous cell carcinoma. Characterized by the following:

• progresses rapidly;
• more often gives metastases;
• symptoms appear late;
• does not respond well to chemotherapy.

Glandular (adenocarcinoma)

Much less common than squamous cell carcinoma. It is formed from glandular cells and is similar in structure to endometrial cancer. Clinically, it does not have any manifestations for a long time, so it is often detected late. Depending on the histological structure, the following options are distinguished:

• mucinous,
• glandular-papillary,
• endometrioid,
• clear cell,
• serous,
• mesonephric,
• mixed.

Cervical erosion and cancer

Quite often you can hear the diagnosis “cervical erosion”. This is an imprecise term. Most often, it refers to ectopia, a condition that is normal for 25% of young women. With this feature, the columnar epithelium lining the cervical canal replaces the multilayered one. As a result, the transformation zone shifts outward. In most cases, ectopia does not require treatment, has no symptoms, and is certainly not a precancerous condition. The only recommendation: regular monitoring by a gynecologist.

Diagnosis of cervical cancer by blood

The scientist isolated a special antigen for squamous cell carcinoma - SCC, which can be considered a marker of cervical cancer. The level of this antigen depends on the stage of the disease, the involvement of lymph nodes and the total tumor mass. SCC is used to monitor the effectiveness of treatment and early diagnosis of disease relapse. Approximately 4-8 weeks after therapy, the antigen level decreases. If after this there is a rise in the marker, then a relapse can be suspected.

Using the SCC antigen level as a method of primary diagnosis of cervical tumors is unacceptable. There is a high probability of false positive and false negative results. Thus, the marker increases in skin diseases (psoriasis, eczema), liver and kidney diseases, endometrial and vaginal cancer. In addition, not all types of cervical cancer produce high levels of this antigen. Thus, there is no absolutely reliable test for cervical cancer.

Cancer and HPV carriage

CC is one of the diseases that is easier to prevent than to cure. A great achievement in science was the discovery of the viral nature of this oncological process. It is believed that it is infection with the human papillomavirus that causes precancerous changes that ultimately lead to a malignant tumor.

Currently, more than 100 types of HPV have been identified that can live in the human body. But not all of them are a risk factor for the development of cervical cancer. All viruses are conventionally divided into groups of high, medium and low oncogenic potential:

• Low risk: HPV types 6, 11, 42, 43, 44 (causes genital warts, does not increase cancer incidence)
• Intermediate risk: types 31, 33, 35, 51 and 52 (often cause dysplasia, much less often cancer)
• High risk: 16, 18, 39, 45, 50, 53, 55, 56, 58, 59, 64, 68 types (found in 99% of cervical cancer cases)

In most cases, HPV disappears on its own within 1-2 years, without leading to significant changes. And only occasionally does it cause a chronic, long-lasting infection, leading to dysplasia and causing cervical cancer. It is believed that the younger the woman, the faster self-healing occurs. Therefore, in girls, detection of the virus by PCR was considered inappropriate. Typically, an HPV test is performed for changes (leukoplakia, dysplasia) detected by smear and colposcopy, as well as symptoms of cervical cancer.

When and why does a doctor refer a cervical scraping for analysis?

Many diseases of the cervix are practically asymptomatic for a long time. In order to identify them in time, it is necessary to examine a sample of biomaterial. Most often, a smear or a very small piece of tissue is taken for analysis. A referral for analysis can be given by an oncologist or gynecologist, in some cases a venereologist.

Analysis of cervical tissue makes it possible to identify oncological diseases; it is also prescribed if the presence of human papillomavirus or cervical erosion is suspected. Such studies can be not only diagnostic - the doctor can refer the patient for a cervical analysis in order to monitor changes during treatment of the disease, and, if necessary, adjust therapy.

Cytological analysis of cervical scraping

Such an analysis of the cervical smear (study of the structure, cell structures and comparison with normal ones) is the most accurate and at the same time simplest research method for the patient. It makes it possible to detect modified cells, including those affected by malignant processes; it is also used to diagnose dysplasia and detect the presence of human papillomavirus.

It is recommended to undergo this test regularly. At a young age - once every three years, and after 50 - once every five years, but better - annually.

There is no need to be afraid of this procedure - it is simple and painless. The material is collected during a gynecological examination. The analysis can be taken at any period of the cycle, except for menstruation and three days after its end. First, the doctor cleans the cervix of secretions with a cotton swab, and then uses a special brush to take a sample of the material and place it on a glass slide, which is sent to the laboratory.

There are several methods for studying the obtained material.

• The most common is the Papanicolaou cell staining method (PAP test), which allows you to detect cellular changes in the early stages. This is an inexpensive test that has been successfully used for a long time to detect pathological changes in cervical cells.
• A cytological examination of scrapings of the cervix and cervical canal with a description according to the Bethesda terminological system, which is based on the identification of pathological changes in the cell nucleus, provides maximum information and allows timely identification of dysplasia and cancer.
• NovaPrep fluid testing is one of the most advanced and accurate.

In order for the results of the cervical analysis to be accurate, you need to follow simple preparation rules:

• Avoid sexual intercourse for two days before the test.
• For the same period, you should stop taking any antibacterial and antiviral drugs.
• It is also not recommended to use intimate hygiene products, contraceptive and medicinal vaginal ointments, suppositories, balls, gels and sponges.
• You should not douche on the day of the study.

After taking a smear, doctors do not advise having sexual intercourse for another 1-2 weeks; it is also recommended not to use tampons and douching.

The result is designated as CIN 1, 2 or 3 - that is, dysplasia of the first, second or third severity. Carcinoma means detection of carcinoma. If the result of the analysis shows the designation CIN, this almost always means the presence of human papillomavirus, the most common culprit in the development of cervical dysplasia.

Histological analysis of biopsy tissues of the cervix

Sometimes the data obtained from a cervical smear test is not enough. Then a biopsy is prescribed. A biopsy is the removal of a small piece of tissue from the cervix for microscopic examination. Like cytological analysis, this study can be therapeutic and diagnostic. Cervical biopsy is a more accurate method than cytology.

There are several ways to remove a piece of cervical tissue.

Most often, the low-traumatic pinching method is used, when the sample is pinched off with special forceps for biopsy.

• The radio wave method involves the use of a radio wave loop; its advantage is that it is bloodless, although sometimes vaginal discharge may be observed for several days after the procedure.
• Conization - cutting off a cone-shaped piece of tissue - is used both to collect material and to remove the affected area. The choice of method depends on the goals of the study.

The conditions and rules for preparing for a cervical biopsy differ little from the conditions for taking a smear. However, unlike taking a smear, this manipulation is performed under anesthesia. Therefore, you should go to the doctor on an empty stomach, the last meal should take place 10–12 hours before the test.

Sometimes after a biopsy, patients complain of nagging pain in the lower abdomen and spotting. In order for recovery to take place as quickly as possible and all discomfort to pass quickly, the following recommendations must be followed for 1.5–2 months after the biopsy:

• Do not visit the bathhouse or sauna, do not take a bath (only showers are allowed).
• Avoid significant physical activity.
• Do not use tampons, vaginal ointments and suppositories, and do not douche.
• Do not have sexual intercourse.
• Take blood thinning medications, including aspirin, with caution.

The results of the cervical biopsy tests will be available in approximately 12 days. As a rule, they are very accurate and allow us to say with certainty whether there is a pathological change in the tissues or not.

The results of the study are indicated as follows:

• Norm.
• Minor changes.
• Infectious disease, inflammation.
• Cervical dysplasia 1st degree.
• Cervical dysplasia 2 degrees.
• Cervical dysplasia grade 3.
• Koilocytosis (human papillomavirus).
• Invasive cancer.

Laboratory methods are the most important stage in the diagnosis of cervical diseases. Thus, a clinical examination by a gynecologist in 80% of cases does not allow identifying stage 1a of cervical cancer, which means taking preventive measures and increasing the likelihood of a favorable outcome. This once again proves the need to submit biomaterial for cytological and histological studies even at the slightest suspicion of pathology and for preventive purposes.

Keep in mind that if you suspect cervical diseases, in addition to visual, as well as cytological and histological analysis methods, the doctor may prescribe a PCR test to detect sexually transmitted infections, as well as study hormonal and immune status. The latter allows you to assess the state of the patient’s body’s defenses.

A malignant neoplasm in the tissues of the cervix at the initial stage of formation occurs without pronounced symptoms. The disease sometimes stays in the body for a long time and does not manifest itself. The first signs are noticeable at stages 3-4, when the chance of full recovery decreases. Cancer can be detected in its early stages using laboratory and instrumental diagnostic methods. Doctors advise undergoing regular examinations with a gynecologist to detect the disease at stages 1-2.

Features of the cervix

The cervix is ​​the lower part of the uterus. In its center there is a canal called the cervical canal. One end opens into the uterus, and the other into the vagina. Only a third of the entire cervix is ​​visible when examined in a gynecological chair. Most of it is hidden from view. Throughout a woman's life, the cervix constantly changes. There is a special zone in it at the junction of two types of epithelium, which over time moves inside the cervical canal. This transformation zone is the most vulnerable to all unfavorable factors. This is where all precancerous and cancerous changes most often begin.

Prevention of cervical cancer

• Vaccination

Vaccination is considered the main way to prevent cervical cancer. The Gardasil vaccine is developed against 4 types of virus. Two of them (types 16 and 18) cause about 70% of cancers, and types 6 and 11 are associated with the majority of cases of genital warts. The vaccine underwent large-scale clinical trials for 15 years, showing high efficiency and safety.

It is recommended to vaccinate girls aged 11–13 years. Vaccination is also possible for girls under 26 years of age, especially if they have not started sexual activity and have not been infected with the above types of viruses. For full protection, three doses of the drug are required over a 6-month period. The duration of action of the vaccine has not been fully determined, the minimum is 5-8 years.

The Gardasil vaccine is guaranteed to protect a woman from cancer caused by 2 types of the virus. But 30% of cancers are caused by rarer types of HPV or are non-viral in origin. Therefore, all women who receive the vaccine still require regular examination by a gynecologist with a cytological smear.

• Treatment of precancerous diseases

All changes in cervical cells that can turn into cancer are called precancerous conditions. These include dysplasia, extensive leukoplakia and other pathologies. On average, it takes 10-15 years for cancer to develop from precancer. Therefore, timely noticed and treated dysplasia is a good way to avoid a malignant process. Thus, it is important to undergo regular examinations and consult a doctor at the first symptoms of cervical disease.

• Using condoms

Barrier methods of contraception significantly reduce the risk of HPV transmission, although they do not completely protect against it.