Facts about Cervical Samples
- Women between 23-65 years offered cervical cancer screening
- The study consists in a cell sample from the cervix taken by gynecological examination
- The study offered every 3 or 5 years, depending on the woman’s age
- The sample may show normal cells or cell changes
- By cellular changes or suspected cell changes will necessitate a closer examination of the gynecologist
- Cell changes does not mean cancer. Cell changes may be harmless and disappear on their own, but they can also be precursors to cancer of the cervix
- Severe degree of cell changes can be removed by a cone biopsy
In South Africa, women between 23 and 65 cervical cancer screening. From 23 to 49 years it happens every 3 years and then every 5 years. The lesion is a response to the presence of one or more viruses from the family HPV – Human Papilloma Virus. The virus is sexually transmitted, and cell change can not occur without the virus.
Over 15,000 South African women being diagnosed each year pre-cancerous or other abnormal cells in the cervix. Cell changes are not cancer, and the majority of women who are diagnosed with precancerous cervical cancer are fully healed. The treatment is relatively simple, rarely causes complications and has no long-term sequelae.
Cell changes are not cancerous
Cell changes in the cervix surface is not cancer, but can be precancerous. In many cases there will not develop cancer, even if you do not treat. Suspected cell changes requires examination and treatment as a precaution, since one can not predict which precursors will actually develop into cancer.
In South Africa demonstrated about 15.000 abnormal cell samples per year, and exported about 5000 cone operations. Annually there are around 350 cases of cervical cancer in South Africa.
The cell sample
The cell sample is taken with a gynecological examination. The doctor scraping some cells from the cervix surface with a small brush. There may be a little stinging pain and general discomfort associated with the sample and little bleeding afterwards. Both are harmless and stop by itself. The material with the udhentede cells is either spread on a glass plate (one smearundersøgelse) or is collected in a container of liquid. The sample is sent to a laboratory of pathology in which the cells are analyzed by microscopy and it is assessed whether the cells are normal or not.
Response of the sample
Examination of a cell sample may give different answers:
In about 90 cases out of 100 the sample shows that the cells from the cervix are normal. There is still recommended Pap smears every 3 or 5 years depending on the age and what previous tests have shown. If it is to follow up on earlier cell changes, it may therefore be necessary to control before.
Some women get the answer to the smear is not good enough. This may mean that there is enough cells in the sample itself, or that it is for some other reason is not possible to assess whether the sample shows signs of disease. The exam must be taken again. That is partly difficult to assess a sample containing blood. This makes it necessary to study outside the menstrual period. Older women often have thin mucus membranes. For this reason it may be difficult to address a satisfactory sample from the cervix.
ASC-US: Atypical squamous cells of unknown significance.
ASC-H: Atypical squamous cells – HSIL suspected (see below)
Is the answer to one of the above, it may be appropriate to examine the cervix more with a special telescope and tissue samples (see below). This is particularly the case if the sample is examined for the presence of high-risk HPV.
However, there are several types of abnormalities (atypical) cells. Atypical cells are cells with an unusual appearance, and these changes may also result from an inflammation caused by virus, fungus, bacteria or other microorganisms. These inflammations can generally be treated with medication.
Precancerous cervical lesions is also called cell changes. Here the answer may be:
- LSIL (low-grade squamous intraepithelial lesions): Slight degree of cell changes
- HSIL (high grade squamous intraepithelial lesions): severe cell changes
- CIS (Carcinoma in situ): said cell changes, however, do not grow in the deeper layers – and thus not cancer
This is based on precursors which are more likely to develop into cancer, but on average, half disappear on its own without treatment. Only when the cell changes spread to the deeper parts of the cervix, it is calledcervical cancer.
Of the cell changes that do not disappear, only a few people, however, develop into cervical cancer. It is in advance not possible to know which cell changes that will develop. Therefore, all cell changes either checked or investigated further – depending on the degree of cell changes.
Are cell sample normal, you will usually be recommended a new study three years later. If there are control after previous cell changes, the sample must often be repeated within ½-1 year.
If the case of atypical cells, your own doctor either choose to take a new test after three months or refer you to a gynecologist. Are there actual cell changes – LSIL, HSIL or CIS refer your doctor for a gynecologist for further investigation.
To assess cell change the scale must take more tissue for examination, and the cervix to be examined thoroughly.
During a regular gynecological examination making gynecologist one ‘colposcopy’. It is a study in which the gynecologist examines the cervix through the vagina mucosa by means of a special telescope. A colposcopy examination takes only a few minutes. The discomfort is as regular gynecological examination.
In this investigation will gynecologist take small tissue samples from the cervix and curettage of the cervical canal. The samples are subsequently examined under a microscope by a pathologist. Tissue samples are also called biopsies, while scraping out called cervical curettage. Sampling can provide ease pain, and you can ask for local anesthesia. Some women feel, however, virtually nothing. After these studies can bleed a little, and it is recommended to use napkins, take it easy and to abstain from intercourse in the next few days.
If bleeding in connection with the sampling, the physician may lay up one Meche (a long gauze pad) in the vagina. You remove yourself mechen after some hours by pulling it out gently. In rare cases it may bleed more than menstruation, and then you must ask your doctor.
Answers to the surveys
The answer to the investigations come after about 2 weeks and tells whether there are cell changes, and how severe they are.
The answer may be:
- no cell changes
- mild dysplasia
- moderate cell changes
- severe cell changes
- cervical cancer and carcinoma in situ
By facilitating cell changes may be enough to bide their time and take a new examination after three to six months. Often disappear these cell changes by itself.
Moderate cell changes will in most cases disappear by itself, and even severe cell changes may disappear. One can not predict in which cases there is a risk of deterioration, and in which cases the changes disappear. At moderate or severe cell changes and carcinoma in situ will gynecologist therefore advise you to get the diseased tissue removed in an efficient manner.
There are two purposes for the treatment:
- to remove the diseased tissue
- to ensure that there is no harder cell changes elsewhere in the cervix
Today fortages treatment of cell changes at a taper of operation in which the outermost part of the cervix is removed. It is a minor procedure that only takes a few minutes. It is performed as an outpatient under local anesthesia, but can also be done under general anesthesia. Most can sense when the local anesthetic is injected into the cervix, but the engagement is not labeled. You can go home an hour after, if you’re comfortable and do not bleed. You could have made a cone biopsy several times.
With certainty to determine that all of the abnormal cells have been removed, is sent the removed tissue for microscopic examination. If the lesion sits in the middle of the removed tissue is healthy cells from the lesion and the remaining portion of the cervix. The recommended additional pap smear after 6-12 months. Is this normal, you go mostly back to normal controls every 3 years.
If there are cell changes to the edge of the removed tissue, it is not certain that all diseased cells have been removed. In these cases, a check after the tissue has healed, typically after a few months.
After frusto-section, there may be little bleeding or brownish, and aqueous discharge for up to a few weeks. The opportunities to get pregnant or carry a pregnancy is not reduced after a cone biopsy.
Three to six weeks after the operation is wound on the cervix completely healed. New mucosa covers the area in which the cone was removed. Even the most severe forms of precursors to cervical cancer, is the vast majority of women cured, but it is necessary to go to the annual smearkontrol the first five to 10 years, then every three years.
Pregnancy, cell changes and conic
Usually does not take cell samples during pregnancy. If you are pregnant and have not had cell changes before, one can therefore shoot sample after pregnancy. If you already have cell changes, it will in most cases just follow them in pregnancy, but do not take tissue samples or low-conic.
I suspect serious cell changes, it is possible to take tissue samples from the cervix during pregnancy and also make a conic. But even serious of cellular changes will in most cases only be followed with ‘colposcopy’ about every 3 months.
There are studies showing that more conic may increase the risk of giving birth prematurely. The risk increases with the size of the removed tissue. The risk of premature birth is still very low. There is no increased risk after one conic. You must have made additional conic, your gynecologist to discuss this with you. It is possible to assess cervical length and also due to the pregnancy in order, whether to develop signs of premature birth.
Causes of cell changes
Cell changes in the cervix caused by infection with an HPV virus (Human Papilloma Virus). About 2 of 3 younger sexually active women will have an HPV infection. The infection provides no symptoms and can not be felt. In connection with the infection may develop mild dysplasia of the cervix. In most cases fought the infection of the body and the lesion disappears. In some cases develop a chronic infection, and in these cases there is a risk that the eventual development of progressive cell changes and, at worst, cancer of the cervix. One can not treat HPV infection, but it can in part be prevented by vaccination, Widely routine in South Africa.