Smear examination for oncocytology interpretation. Smear for oncocytology - what it is, when to take it, explanation. Cytological analysis in gynecology
It is especially important for a woman to carefully monitor her health, and for this she should be regularly examined by. Often, if you suspect a disease, you have to undergo a cytological examination, that is, take a smear for cytology.
This procedure involves taking tissue for analysis. In the laboratory, using various dyes and fixatives, the sample will be examined for five possible changes. As a result, after a cytology smear, or so-called PAP test, it will be possible to talk about whether women are developing cervical cancer.
This procedure is carried out in any free institution. The price of tests in paid clinics varies. For example, in Moscow the cost can range from 300 rubles to a thousand.
Women undergo a cytological examination (cytology smear) if they suspect a gynecological disease
What can be seen in a smear?
Regular smear analysis for cytology will allow you to notice pathological changes in the female microflora at the earliest possible time. If the laboratory sees that the standard indicators have changed, the doctor will be able to begin treatment of the patient in a timely manner.
In general, such research provides two possible answers. Or the analysis is positive, which means that some kind of inflammatory process has begun in the uterus, which led to pathological cells entering the sample. Or the results may be negative, that is, no noticeable changes have occurred, the cervix is completely healthy.
Doctors recommend that all women undergo a cytological test approximately once every 1-2 years. This is a kind of prevention of cancer, since a smear will detect them at a very early stage. Rapid diagnosis is the key to possible successful cancer treatment.
Regular examinations are the key to good health for women
When should you get tested?
To be confident in your health, you need to take a smear for flora and cytology regularly, but not every woman can bring herself to do this.
There are a number of indications in which a visit to a gynecologist for testing becomes almost mandatory:
- One of the most important criteria that determines the state of women's health is the cyclicity of the menstrual cycle. If it is violated, then you need to consult a doctor as soon as possible.
- Any infections in this organ system, especially those of a chronic nature, are a reason to take a smear for cytology. This also includes.
- Just planning to conceive a child, or if you suspect infertility, it is worth checking.
- Sometimes the test is ordered before surgery or another complex procedure.
- An intrauterine device is placed only after receiving the results.
There is a unique risk group, and if a woman falls into one of the following points, she should be regularly examined:
- Obesity.
- Genital.
If the patient uses hormonal contraceptives, has many sexual partners, or is simply weak, then she also needs to think about conducting a test. As a rule, this is not necessary only in two cases - if the girl has not yet begun to be sexually active, or if she has had a hysterectomy.
How to prepare for the procedure?
It is believed that the best day to take the test is approximately 13-20 cycles. The most important thing is to wait until your period ends. However, if other procedures, such as colposcopy, have been previously performed, then a smear can be prescribed only after two days.
Note! A PAP test is not performed during menstruation, as it will erroneously indicate the presence of red blood cells.
In order for the results to be as reliable as possible, it is necessary to properly prepare for the procedure. It means that:
- Two days before the test, you must stop all sexual intercourse.
- A week before the procedure, you should exclude all antibiotics.
- You cannot use various medications that affect the vaginal microflora, such as suppositories or sprays. It is also prohibited to use lubricants, but in combination with the lack of sexual intercourse, there is no need for them.
Two hours before the tests you should not go to the toilet. You'll have to wait until they're completed. Sometimes tissue collection is delayed due to severe inflammation, since the procedure can damage the vaginal walls.
You can't take tests during your period
How is a smear taken?
The procedure will take place on a regular gynecological chair. For sampling, the doctor uses a mirror, a special spatula and a brush. Three samples will be collected in approximately 15 minutes. These are the following types of smears for cytology:
- From the walls of the vagina,
- From the cervix
- From the cervical canal.
It is generally accepted that such a procedure does not cause pain, but it is worth paying attention to two points. Firstly, with the development of the inflammatory process, any mechanical intervention in the vagina will lead to pain.
Secondly, for a complete and reliable result, it is necessary to take not the very top cells, but those that are much deeper. Simply put, the doctor is obliged not to lightly run the instrument over the mucous membrane, but to pinch off part of it. Most often, pain is caused by cytology of a smear from the cervical canal.
Note. Some women feel discomfort when urinating after the test is taken, but this goes away quickly. If you feel unwell for a long time, you should consult a doctor.
The resulting samples are applied to the glass in an even layer, dried and sent to the laboratory. There they will be stained using the Pap test and carefully examined under a microscope.
What can the analysis show?
When examining a sample under a microscope, the laboratory technician will pay attention to the following indicators:
- Shape, structure and size of cells,
- Condition of the epithelium
- Particle location
- The number of certain elements
- Pathological structural changes.
Many people are interested in how many days it takes for research. As a rule, they pass within a day, but it also takes time for results to be delivered. After this, the doctor will be able to tell the patient what the cytology smear shows.
Most often, one of five possible results is given:
- Negative indicator, or the first type of change. This is the norm, that is, no pathological processes were detected, the patient is healthy.
- Inflammatory type. This becomes a reason to order additional tests to look for the cause of the infection. Three months later you will have to undergo a repeat examination.
- Presence of abnormal cells. If changes in the structure of the nuclei are detected, the woman is sent for microbiological and histological examination. A diagnosis can be made no sooner than the results of these tests are received. As with the inflammatory type, a repeat procedure will be required after three months.
- Suspicion of malignancy. If the tests reveal the fourth type, then colposcopy and other procedures will be prescribed to clarify the diagnosis.
- Oncological type. If the fourth type suggested the onset of a cancerous process, then the fifth speaks about it with almost complete confidence, although a diagnosis will still not be made on its basis alone. Subsequently, additional procedures are carried out, including, but, as a rule, they only determine the severity of the disease.
In general, it is important to remember that the results of a smear for cervical cytology only indicate that certain changes have occurred in the cells. For example, elevated white blood cells (the norm is within 15 units) indicate inflammation. Even the most accurate decoding will not reveal a definite diagnosis, nor will it tell us about the causes of the inflammatory process.
Cytology smear examinations take place throughout the day, after which the result will be known
What diseases can cause cell changes?
A wide variety of diseases can lead to types 2, 3 and even 4. For example, common or most common.
In addition, one of the following pathologies is often present:
- Human papillomavirus infection. It appears as warts on the walls of the vagina.
- sexually transmitted.
- , occurring a little less frequently than, but still quite common.
- . This infection affects the genitourinary system and often causes infertility.
By taking a sample, the doctor can see changes in the cells due to diseases such as cervicitis or parakeratosis. Thus, a positive smear only suggests the development of some pathological process, but additional tests are necessary for further treatment.
Procedure during pregnancy
Cytology smears during pregnancy are usually performed about three times. In this case, even the identified second type is a fairly good indicator. However, if the results indicate type 3 or even higher, then this may be a danger signal.
During pregnancy, it is important not only what cytology smears show, but also other symptoms. For example, expectant mothers complain of burning or itching, and sometimes they notice changes in the discharge.
The Pap test, indicated for pregnant women, does not require any special tools. Everything will happen using conventional technology. However, if there is no serious need for immediate testing, then it is better to do this after childbirth, when the uterus comes into tone.
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Sofia asks:
How is a smear taken from the cervical canal (cytology smear)?
A cytology smear is taken during a routine gynecological examination. Taking a smear lasts no more than one minute. In order for the doctor to take a smear for cytology, the woman must lie down on the gynecological chair, fix her legs in the stirrups and relax. After which the doctor usually inserts a Cusco gynecological speculum into the vagina, which allows you to expose the cervix and make it accessible for examination and manipulation.
The doctor then wipes the cervix with a sterile cotton swab soaked in saline solution. While wiping the cervix, the mucous plug is also removed from the cervical canal. The plug is removed using a special cervical brush or wooden scraper. After performing all these preparatory manipulations, which take no more than one minute, the doctor actually takes a smear for cytology.
To collect a smear for cytology, special sterile, plastic and disposable instruments are used, such as an Eyre spatula, a Volkmann spoon, a screenet, an endobranche and others. Any of the listed instruments is inserted shallowly into the cervical canal and rotated around its axis to collect mucus from the walls of the cervical canal. The instrument is then removed from the cervical canal without touching anything. This completes the procedure for taking a smear for cytology for a woman.
The doctor removes the speculum from the vagina and the woman can get up from the chair. After which the doctor takes a glass slide and distributes mucus from the cervical canal onto it directly with the same instrument that was used to collect the material.
The finished smear is air dried and dipped in a container with 96% alcohol for 5 minutes to fix. After that, the finished smear is packaged in a plastic bag, accompanied by a direction indicating the woman’s name and the return address of the medical institution.
During the process of taking a smear for cytology, most women do not feel anything. But some women feel pressure on the cervix. However, taking a Pap smear never causes pain.
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Often, when visiting a gynecologist, after an examination in a gynecological chair and an ultrasound, a woman receives a referral for a smear for cytology. Let us consider this type of research in detail, name the indications for its implementation, and the features of collecting material.
What is “cytology” in gynecology?
In most cases, when cervical cytology is prescribed, the girl does not know what it is. To begin with, it must be said that the cervical canal is an anatomical formation that in appearance resembles a tube. It directly connects the vagina to the uterine cavity. It contains stratified and columnar epithelium.
Taking material from this area of the reproductive system helps to identify atypical cellular formations in a timely manner. This makes it possible to diagnose a precancerous condition and prescribe appropriate treatment. Evaluation of cellular structures occurs under a microscope with high magnification. The nuclear contents of the cells are thoroughly analyzed.
What does a cytology smear show?
A common option for this type of test is the Pap test. It was first used at the beginning of the 20th century by the Greek scientist Papanikolaou. He was directly involved in the diagnosis of malignant processes in the early stages. This cytology smear also makes it possible to identify background processes of non-tumor origin that have a risk of developing into cancer.
Considering all the above possibilities of the PAP test, doctors prescribe it for the following changes in intraepithelial structures:
- abnormalities in the structure of cells of high and low severity;
- the presence of pathogenic microflora in high concentrations as a result of previous studies;
- disturbances in the menstrual cycle of unknown nature;
- diseases of the reproductive system of a viral nature (HPV, herpes);
- abnormal discharge from the vaginal cavity after menstruation.
Atrophic type of smear for cytology
The PAP test in gynecology is one of the main studies that helps identify the cellular ratio in the cervical canal. With the atrophic type of smear, in the field of view of the microscope, the laboratory assistant records a large content of squamous epithelial cells. This indicates changes in the structure of epithelial tissue, which is often recorded in dysplasia. Further diagnostics, by carrying out, establishes the degree and severity of the disorder. A smear for pathological cytology is the initial stage of a comprehensive examination of the reproductive system.
Inflammatory type of smear for cytology
Cytology of the cervix helps to identify inflammatory processes at an early stage and prescribe the correct therapy. With an inflammatory type of smear, changes are recorded at the cellular level - the ratio of glandular cells to squamous epithelial cells may increase. At the same time, the woman notes the presence of symptoms of inflammation, which are manifested in changes in the cycle - acyclic discharge, an increase in the volume of menstrual blood, strong.
When to take a smear for cytology?
Almost like any study of the reproductive system, cytology analysis is carried out on a certain day of the menstrual cycle. The procedure for collecting material is carried out 10-12 days from the moment it begins. It must be taken into account that the result may be inaccurate if there is an infectious process in the body. If necessary, the analysis is carried out even during illness, but after 2 months from the moment of recovery, a control study is prescribed. If a woman uses vaginal suppositories, performs baths, douches, analysis is possible 7 days after completion.
As for the indications for the study, doctors can prescribe the test for:
- frequent childbirth (3 times in 4 years, for example);
- early first childbirth (birth of the first child before the age of 18);
- placement of an intrauterine device;
- lack of examinations of the reproductive system during the last 3 years;
- the presence of visible changes when examined in a gynecological chair using mirrors;
- burdened medical history (tumor-like processes were recorded in the family on the female side).
Preparing for a smear for cytology
Liquid cytology involves assessing the material after immersing it in a special medium. Previously, a smear for cytology was carried out with the application and fixation of material on glass. To obtain an accurate result that reflects the condition of the uterine structures, a woman must adhere to the following rules before the procedure:
- exclusion of douching 5-7 days before sampling;
- exclusion of sexual intercourse for 3 days;
- do not use tampons, gels, or vaginal creams;
- do not urinate 2 hours before the procedure.
How is a smear taken for cytology?
The Pap smear is performed in a clinic setting. The woman sits in a gynecological chair. During the procedure itself, the gynecologist takes cells from the cervical canal area, from the vaginal mucosa. In the first case, a special probe is used - endobrush. It is administered after a slight expansion of the uterine canal by using a dilator. An Eyre spatula is used to collect material from the vaginal walls.
When liquid cytology of the cervix is performed, during the manipulation itself the woman may feel minor discomfort and mild pain. Its appearance is due to the expansion of the cervical canal, which is supplied with a large number of nerve endings. The duration of the procedure depends on the experience of the gynecologist, and averages 5-10 minutes. The resulting material is placed in a test tube with a reagent and sent to the laboratory.
Cytology smear - interpretation, normal
After a cytology smear has been performed, the results are deciphered exclusively by a doctor. Only a specialist can perform a comprehensive analysis of the situation by assessing the results of cytology. The state of cellular structures is a reflection of the state of the reproductive system. Based on the results obtained, doctors can suggest an oncological process and prescribe additional tests (colposcopy, curettage).
Atypical cells in a smear for cytology
When a woman finds out that the results of the study revealed she has poor cytology, this news becomes a cause for concern. It is worth noting that such a conclusion does not mean cancer. According to the established terminology of medical reports, this definition indicates the presence of pathological changes in the epithelial layer of the vagina and cervical canal.
According to the generally accepted methodology for assessing results, changes are designated as follows:
- 0 – the collected material is of low quality, unsatisfactory (selected in small quantities, the patient was not properly prepared);
- 1st class – indicators are normal;
- Class 2 – atypical structures are present;
- Class 3 - there is dysplasia of varying severity;
- Class 4 – precancerous condition, first stage;
- 5th grade – cancer.
Squamous epithelial cells in a smear for cytology
When liquid cytology of the cervix diagnoses squamous epithelial cells in the canal, doctors talk about a disease such as hyperkeratosis. A large number of squamous epithelial scales are recorded in the field of view of the microscope. This type of cellular structures is present in analyzes with. This disease belongs to benign tumors. When conducting an additional study, colposcopy, a white area is recorded on the cervix.
It is worth noting that when the smear results contain only single scales, colposcopy is mandatory. If during its implementation no changes are revealed on the surface of the reproductive organ, then the analysis is considered normal. A cytology smear performed in this case has no diagnostic value. The patient is monitored - once every 3 months the woman visits the consultation department and is examined.
Glandular epithelium in a smear for cytology
Analysis of the smear for cytology, its interpretation, further helps to establish inflammatory processes in the uterus. One of these is cervical dysplasia. With a mild degree of the disorder, the disease can be easily corrected by prescribing anti-inflammatory drugs. Moderate and severe dysplasia can be regarded as a precancerous condition. In this case, a biopsy becomes a mandatory additional study - taking a section of the affected cervical tissue for histological examination.
Polymorphic rod flora in a smear for cytology
Cytology transcripts often contain the entry “polymorphic rod flora.” In order to understand what this means, it is necessary to say that the rods present in the vagina may have:
- morphotype of lactobacilli (similar in structure and appearance to Doderlein sticks);
- small sticks.
The first type of rods makes up the normal microflora of the vagina. At the same time, the presence of single leukocytes is allowed. The presence of small rods in a large number indicates a change in the composition of the microflora, which can be recorded with vaginal dysbiosis, gardnerellosis. Such conditions require urgent medical intervention and therapy.
Every woman who begins sexual activity should regularly visit a gynecologist and have a smear for cytology. The procedure for collecting a smear is performed by a doctor during a routine examination on a gynecological chair. Thanks to cytology studies, it is possible to study the condition of the mucous membrane of the vagina and cervix, to detect inflammatory, precancerous and oncological diseases of the woman’s genital area.
The difficulty of diagnosing gynecological pathologies often leads to a loss of time that could be spent on effective treatment. Sometimes oncology develops asymptomatically, and the root cause of the disease can only be identified with the help of a special study. Analysis of a smear for cytology allows you to identify an oncological condition at an early stage and begin treatment in a timely manner.
What does a smear reveal for flora and cytology? Its main purpose is to detect pathological changes in tissues, which can later transform into a cancerous tumor. If a cytology smear from the cervix is taken regularly, then negative indicators can be identified at an early stage - for example, an inflammatory disease, which can be cured in a short time with appropriate therapy and prevent further complications.
What does a cytology smear show? The results of the study can be both positive and negative.
Positive can be "bad", "abnormal", "atypical" or mean "dysplasia". It is clear that a bad cytology smear is not the norm, that is, there are inflammatory changes in the mucosa, atypical pathological cells are detected in the smear, which should not be there.
A negative smear is considered normal. This means that the cervix is healthy, the cellular structure of the epithelium is not changed, and the microflora does not contain pathogenic microbes. When to take a smear for cytology, the gynecologist decides. Experts advise conducting research at least twice a year.
Indications and contraindications
When to do a smear for cytology:
- when diagnosed;
- at ;
- in the case of, for example, an atrophic type of cytology smear will indicate hormonal changes in the body against the background of menopause;
- if used ;
- with genital herpes;
- for obesity;
- if human papillomavirus is detected in the body;
- if a woman is promiscuous;
- in preparation for the production.
This research is not always possible.
A smear for cytology is not taken:
- during menstruation, because red blood cells may be erroneously detected in a cytology smear;
- with acute inflammatory process in the genital area;
- with heavy vaginal discharge and severe itching.
Pregnancy cannot be a contraindication to the procedure. There is no point in taking this test for women who are not sexually active (virgins). The same applies to women who have undergone surgery to remove the uterus - a hysterectomy.
How to take a smear
How a smear is taken for cytology is of interest even to those women who have undergone this procedure more than once. A doctor or midwife takes a smear during an examination in a gynecological chair.
Before performing the procedure, the doctor inserts a speculum into the vagina. After a visual examination of the cervix, the specialist takes a sterile brush and makes a light scraping of the epithelium from the surface of the cervix and cervical canal, as well as from the urethra. The resulting biological material is applied to a slide mirror and sent to the laboratory for further study.
How long does it take to perform a smear for cytology? Usually the results of the study become known after 1 day.
To obtain reliable results, it is advisable to prepare for the smear procedure in advance:
- abstain from intimate relations for 24-48 hours before visiting a gynecologist;
- exclude the use of vaginal products - lubricants, sprays, suppositories, etc.;
- Do not urinate for at least 2 hours before taking a smear.
Decoding the results
Deciphering a smear for cytology allows us to draw conclusions about the degree of cleanliness of the vagina and the presence of pathologies in a woman.
In total there are 4 degrees of purity:
- First degree. Rarely seen. The smear reveals exclusively rod flora, a small amount of squamous epithelium and single leukocytes.
- Second degree. A common study finding found among healthy women. In the flora in the cytology smear there are squamous epithelial cells, single cocci and other non-pathogenic microorganisms.
- Third degree. This degree of purity means the initial stage of the inflammatory process. Detected inflammation in a cytology smear requires the start of other diagnostic studies to find the root cause of the problem. The smear contains polymorphic rod flora, neutrophilic leukocytes, granulocytes and glandular epithelium; in addition, the results of cytology of a smear from the cervical canal can reveal yeast fungi with a tendency to multiply and be active.
- Fourth degree. The inflammatory process is pronounced. Coccal and bacillary-coccal flora predominate. This research result requires an urgent search for the causative agent of infection and appropriate treatment.
Doctors often talk about the fifth degree of purity, the result of which is a harbinger of an oncological process in the woman’s genital area, since in this case a large number of atypical cells are detected in the smear.
Pap smear during pregnancy
A smear for cytology during pregnancy is taken at least 3 times - this can be done either in the gynecologist’s office or in a private laboratory - for example, in Invitro using liquid cytology. The study is important for monitoring the vaginal microflora of the expectant mother. If there is the slightest suspicion that a woman’s genital tract is infected, a cytological examination is performed additionally.
The result of a smear on flora above type 2 purity during pregnancy means an inflammatory process in the woman’s genital tract. In this case, the expectant mother may complain of itching and burning in the external genital area, as well as a change in the smell and color of vaginal discharge. Treatment is required and should be administered as soon as possible and before delivery to minimize infection of the membranes and fetus.
Timely diagnosis of various gynecological diseases is an important component in their successful treatment.
Cytological analysis of cervical cells (“cervical cytology”), helps to detect a fairly common cancer disease in time - cervical cancer.
But the “usefulness” of this analysis does not end there; based on its results, one can judge the beginning changes in the structure of cells and their functioning, the presence of inflammation and infection.
When performing a cytological analysis, tissue cells, their number, shape, relative position and other characteristics are examined. Of greatest importance is the ability to detect precancerous changes cervical cells.
Since such changes do not manifest themselves in any way in a woman’s general well-being, it is difficult to detect them in other ways. Material for research is taken by scraping a very small amount of tissue from the surface of the cervix with a spatula, spatula, spoon or probe.
The sampling takes place from three different parts of the cervix (vault, outer surface, canal). Before this, the uterus is cleaned of secretions with a cotton swab. The process is quick and painless during the examination of the woman on the gynecological chair. Usually, simultaneously with scraping tissue from the surface of the uterus, material is also obtained from the cervical canal in the same way, but using a special brush.
The resulting material is applied in a thin layer to a glass slide. (make a smear), and this glass is sent to the laboratory for research. The examination itself takes place under a microscope. In many clinics, cells are simultaneously examined by staining using the Papanicolaou method (PAP test), by drying and other methods.
An integrated approach allows you to obtain more accurate results. Assessing the condition of individual cells and the overall assessment of the material makes it possible to diagnose a disease or say that the woman is healthy. Based on the results of the analysis, a cytological conclusion is drawn up. Usually the doctor receives it 1-2 weeks after collecting the material.
There is an assessment of the results of a cytological study of cervical cells according to the already mentioned Papanicolaou technique.
This method allows us to distinguish between five states of cellular tissue (stages of disease development or classes):
To date the interpretation of the results of a cytological study of cervical cells is more popular from the cervical canal according to the Bethesda method.
This method reveals the presence of various changes in the cell nucleus (dyskaryosis).
Depending on the number of cells with dyskaryosis and their location, one or another diagnosis can be made.
Cervical cytology in this interpretation allows us to determine the following conditions:
- No pathological changes
- Various atypical cell conditions, including cervical dysplasia (cervical intraepithelial neoplasia)
- Carcinoma (cancer) of the cervix.
These states are designated by Latin letters. The table below will help you decipher them and understand what is hidden behind the combinations of Latin letters in the analysis results.
The most common tests are those with the designation CIN 1, 2 or 3 .
This designation means dysplasia of the first, second or third degree of severity.First degree dysplasia suggests the presence of dyskaryosis in single, mature cells located scattered or in small clusters among normal cells.
Second degree dysplasia– there are more pathological cells, pathologies are more diverse and are found not only in the surface layer, but also in approximately half the thickness of the epithelial layer.
Third degree– pronounced changes, about 2/3 of the epithelial layer is affected.
Presence in diagnosis CIN speaks of the need to be tested for the presence of the human papillomavirus (HPV), since it is this virus that in most cases provokes the development of cervical dysplasia.
The importance of cytological analysis
Considering the results that cytological analysis gives, its importance is difficult to overestimate. This is one of the simplest, cheapest and most reliable methods for determining the presence of precancerous conditions of the cervix.
Cervical cancer accounts for almost half of all cancers in women.
In the initial stages it occurs without symptoms, and until the mid-20th century it was almost impossible to diagnose precancerous conditions. But with the advent of the PAP test in the 40s of the 20th century, this became possible, which saved a huge number of women’s lives.
Timely detection of initial changes in cells makes it possible to treat dysplasia and other precancerous conditions relatively simply and effectively.
Doctors advise performing a cytological analysis of the cervix at least once a year.
It is believed that cancer cells develop quite slowly, so many doctors allow testing once every 2-3 years. But there are cases when the disease develops very quickly. Such a gap is acceptable if the previous two cytological tests were negative.
Regardless of the results of previous tests, women at risk ( HIV carriers taking steroids, chemotherapy, etc.)– the test must be taken every year or more often, as recommended by a doctor.
If a pathology is detected in the analysis, repeat it after three months, six months, or as recommended by a doctor.
We also note that cervical cytology in 5-10% of cases are false negative. Experts attribute this to improper collection of material and improper preparation for analysis.
For the result to be reliable, a woman needs at least two days:
- Abstain from sexual intercourse
- Do not sanitize (douche) the vagina
- Do not use vaginal suppositories, tablets, creams or other medications.
- Before directly collecting the material, do not urinate for 2-3 hours.
Cytology analysis cannot be taken:
Compliance with these simple rules will allow a woman to be calm about her health, and if any pathologies are detected, they can be treated effectively and relatively simply.