Cervical cytology has become a screening method globally used to identify asymptomatic risk patients, in a stage of the disease when efficient intervention is possible. The investigation may not be used as a final means of diagnosis, but it must be confirmed through histopathological diagnosis (a biopsy in the affected area).
Cytology is able to determine the malignancy of the cells, but it cannot specify their exact source; hence, in case Pap Smear shows any changes, a colonoscopy is required, followed by a biopsy or a dynamic monitoring, as the case may be.
Colposcopy and cytology help diagnose, monitor and establish the cervical pathology conduct. The major role of colonoscopy is to locate the cervical or vaginal injury, signalled by the exfoliative cytology and to allow the doctor to collect a targeted biopsy from the abnormal areas on the cervix, vagina, vulva. It is performed on days 8-12 of the menstrual cycle or on days 3-5 in the case of patients on combined birth control therapy, after the inflammations that may lead to alterations are treated.

Colonoscopy is performed in the following cases:

  • cytology changes
  • intercourse bleeding with normal cytology
  • abnormal cervix appearance upon unaided naked eye examination
  • cervical dysplasia monitoring
  • pre-operative assessment
  • anal and genital condylomatosis assessment

Cytology highlights the presence of abnormal cells or of exfoliated abnormal cells at the level of the cervical or vaginal tissue. Many abnormal Pap Smears are caused by viral infections, such as the Human papillomavirus (HPV) infection or other types of infections, such as the ones caused by bacteria, fungi or protozoa (Trichomonas), but the most frequent cause is HPV infection.
The natural cervix cell changes (atrophic vaginitis) occurred during menopause can also cause abnormal Pap Smear results. In general, cellular changes reverse spontaneously or after the infection cures by itself or following the treatment. In some cases, untreated changes in the cervix cells causing an abnormal Pap Smear result can lead to precancerous or cancerous conditions.

Exfoliative cytology methods:

– dry medium Pap Test
– liquid medium Pap Test

The liquid medium Pap Test was developed out of the desire to improve the cervical pathology diagnosis method. A liquid transportation medium is used to preserve the collected cells, as well as a special processing device to eliminate waste and uniformly spread the cells onto the slide. In the classical test, 80% of the collected cells remain on the brush and do not reach the smear.

HPV INFECTION

HPV is transmitted through direct skin-to-skin contact, both by sexual intercourse and by prolonged contact with contaminated contact, or it may be transmitted from the mother to the foetus during childbirth. Certain types of high risk HPV, especially types 16 and 18, were associated to the onset of cervical cancer.
However, in general, cervical cell changes slowly progress and several years are required before they turn into cancerous cells.

Risk factors:

  • multiple sexual partners (the use of condoms does not provide proper protection, because the virus can also be transmitted by skin-to-skin contact in the areas that are not protected by the condom)
  • age: HPV infection is more frequent in sexually active women aged between 18 and 30; the prevalence of the infection abruptly drops after the age of 30
  • raspunsul imun al gazdei: importanta decisiva in evolutia infectiei o are raspunsul imun primar al gazdei
  • smoking
  • HPV variant: an important factor in the appearance of cervix, vagina or vulva injuries is the HPV variant
  • viral load
  • local traumas
  • the associations with other infections (such as the herpes virus infection)

Most HPV infections are transitory; 92% of the HPV infection positive population becomes negative within 24 months. Several patients feature no symptoms and they transmit the infection without even knowing it. Women with a persistent infection feature (especially in the case of a high risk HPV) a pre-neoplasic or neoplasic injury risk. There are 14 high risk HPV types, of which HPV 16 and 18 are the most important ones.

The cervix cancer symptoms may be:

  • abnormal vaginal bleeding
  • bleeding when something comes into contact with the cervix (such as during intercourse or upon the introduction of a diaphragm)
  • abnormal blood-streaked vaginal discharge

What Should You Do In The Case of An Abnormal Pap Smear?

Though most abnormal Pap Tests are caused by infections or inflammations that can be treated, a new subsequent evaluation is required in order to make sure that the abnormal cell alterations were solved. The treatment options vary depending on the cell alteration level: minor, moderate or severe.
In the case of minor cell changes, the simple medical follow-up (waiting and monitoring), an HPV test or, in some cases, a colposcopy, could be enough.
In the case of moderate or severe cell alterations, the follow-up must be accompanied by a colonoscopy and cervical biopsy. Subsequently, the treatment methods destroying or specifically removing the abnormal cells might be recommended, depending on the biopsy results.