About Cervical Cancer Screening - Screening or early detection of cervical cancer , can be obtained by multiple methods such as examining cervical cells under microscope , which is know by pap smear or cytology examination or by obtain cervical biopsy which differ as there whole cervical tissue examinations .
There are multiple questions in any female mind , when I should screen for cervical cancer ?, what the risk factors that I faced made me more need for that screening ? , what these methods of screening? How can I do it? ….. We are here to reply on every thing related to cervical cancer screening program.
Cervical cancer screening program
Guideline now refer that there are two main cancers , female should screen for , cervical cancer and breast cancer , as at the age of 30 years old females should done cervical cancer screening , beside breast cancer screening , when she become 40 years or more she should examine her blood pressure .
Methods of cervical cancer screening
1. Pap smear
what is pap smear !
Pap smear, or cytology, means study of the morphological changes occurs on cervical cells, which is suspicious to be later malignant cells , Pap smear have timing , that the new guidelines recommended , that any sexually active women should do that smear regularly every year , till she became 65 years old , and for public she may start doing that smear at the age of 30 years old .
Pap smear test steps
Pap smear is a very simple test , which can be done only in three steps ,first obtaining cervical cells , fixing it by alcohol in glass slide , staining it by special stain and finally examining it under microscope .
Obtaining cervical cells has special precautions for both doctors and patient to have successful cervical pap smear test , for patients , she should do no douching or coitus before the exam and for doctor he has not to use any lubricant , he can use only saline , doctors obtain cervical cells by special instruments. The first one called Ayer’s spatula , which has two ends , cervical end and vaginal end , other one called cotton tipped applicator , each instruments work will be explained in details , generally those instrument used to scrap the exofoliative epithial cells from three different parts, two parts from cervix , from the ectocervix ( lower cervical part ) , its obtained by ayer’s spatula and other part from endocervix and its cells obtained by cotton tipped applicator and third part from the vagina , the three different cells types , should be fixed immediately in alcohol 95% and then stained by special stain called papanicola stained and then sent to avery reliable quality assured cytological laboratory to be examined .
Pap smear results
Pap smear results can be
Normal pap smear test and in that case it should be done regularly every 6 to 12 months if it still negative it should repeated every one year other wise it should be done every 2 years , till you become 65 years old
Unsatisfactory pap smear , due to few cells ,no cervical cells , or the slide processed in wrong way , and in that case it should be repeated.
Suspicious pap smear in cases of cervical infections and in that case it should be repeated every 4 to 6 weeks under the umbrella of infection treatment , most cervical infections are due to trichomonas or gardenalla .
Abnormal pap smear test or (positive pap smear test)
Positive pap smear test has two main different classification ,
CIN classification (cervical intra epithial neoplisa)
That classification according to the number of abnormal cells replaced normal one and also it thickness. It classified into
CIN 1 : one third of epithial cervical thickness replaced by abnormal cells
CIN 2 : two third of epithial cervical thickness replaced by abnormal cells
CIN 3 : more that two thirds of cervical thickness replaced by abnormal
Another classification is to some extent complicated but to mad it as easy as any one can understand it , its called
Bestheda classification
That classification , classified abnormal cells two main catergories
- Abnormoal Squamous cells
Which subdivided into , atypical squmaus cells of uncertain significance ( ASUS) , and squamus intra epithial lesion ( SIL ) , which sub divided into
- Low grade SIL : its mainly due to Human papiloma virus infection , and mild abnormal cells may be found
- High grade SIL : which equal CIN two and three.
- Squamous cell carcinoma
- Abnormal glandular cells
Which subdivided into , atypical grandular cells of uncertain significance , endometrial cells cytologically begin in post menopausal women , and finally adenocarcinoma which may be cervical or endometrial .
Further cervical investigations for abnormal pap smear results
Dealing with abnormal pap smear results differ according to the stage of abnormal cells that found , and our aim by doing further investigations to define weather that lesion invade the basement membrane of cervix or not , and is that abnormality due to pre cervical lesion or actual cervical cancer , steps of further investigations according to the stages are :
- Low grade intraepithial lesion or CIN1:
In case of HPV infection only and no abnormality found in cells its advised to repeat that pap smear every 6 months three times if it positive in one of them there will be shift to colposcope , if negative she will go regular under the standard screening program .
In cases of mild abnormality with or without HPV infections , there are controversial in its forward investigation as some school recommended shift to do colposcope and others see to repeat that pap smear again after six months if it persist positive shift to colposcope .
- High grade intraepithial lesions or in CIN2 ,3 : its recommended to shift to colposcope examination
2.Colposcope
Colposcope is a system of lenses that is magnify cervix from 5 to 20 times , used to see the cervical lesions and also to take biopsy from that lesion.
Colposcope translate abnormal finding according to color tone , opacity , surface configuration and also blood vessels configurations and intercapilary distance , it should use acteic acid before seeing to disolve mucus.
Colposcope results
Normal epithial configuration : normal squamous cells in ectocervix are smooth, pink, and glistening , normal columnar cells in endocervix are red and polypoidal .
Abnormal epithial configuration : There are areas of hyperkeratosis (white areas that may appear before application of acetic acid) , that area changed to acteo-white after its application, also there are abnormal figures to blood vessels such as comma shaped , spaghetti shaped , which suggestive of invasion , these abnormal configuration , make the physician obtain cervical biopsy for accurate examination to exclude invasion and presence of cancer. N.B.: other generation of colposcope called colpomicroscopy which give more magnification with smaller field.
3. Biopsy
There are different ways for taking biopsy , such as taking biopsy under colposcope view or under schiller iodine test , in which the cervix is painted with iodine solution , in which normal epithial cells does not take the stain and abnormal cells take it or take biopsy called conization .
Conization (cervical conization)
It is a biopsy involve the whole cervical canal and large part of ectocervix.
Its has indications as in cases of the cervical lesion extended to the whole cervical canal and its upper limit cannot be seen , also in micro invasion is suspected in cases of CIN 3, also when the colposcope are not available or the result of the pap smear and bipsy are not agree.
Tag :
Cervical Cancer
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