Cytology – course, results, interpretation. When to do a Pap test?

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Cytology is a test that diagnoses cervical cancer, which causes the death of as many as five Polish women a day. This is why every gynecologist should perform such an examination of his patients at least once a year. Don’t be surprised by this silent female killer. As many as 75 percent of women who enter sex are carriers of the human papillomavirus (HPV), the leading cause of cervical cancer.

Cytology is the basic gynecological examination for cervical cancer. Thanks to the examination, there is a chance of early detection of suspicious changes. The test should be performed by both teenagers and adult women of childbearing age. The study allows you to prevent up to 80 percent. cases of cervical cancer as it detects its early stages. In addition, cytology allows to diagnose HPV infection (human papilloma), which is closely related to the formation of a neoplasm.

It is also used as a conservative and surgical treatment of cervical erosions and is useful in diagnosing the condition of the vaginal epithelium and assessing the effectiveness of hormonal preparations. In some women, cytology is performed to determine the date of ovulation and the duration of the second phase of the cycle.

During the examination, a speculum is inserted into the woman’s vagina on the gynecological chair, and then a smear containing cells of the cervical mucosa is taken with a special brush. It is recommended that the first Pap smear is performed at the age of 20-25 years or as soon as sexual intercourse is started. The sooner sexual initiation is started, the sooner cytology should be performed.

Check out the indications for a visit to the gynecologist.

Cytology is a test that can save your life. With it, you can detect precancerous conditions and prevent the development of cervical cancer. If the lesions are detected early enough, the chance of a complete recovery is very high. Thanks to cytology, it is also possible to detect an infection of the genital tract and abnormal cells that may turn into cancer cells in the future. Getting the right treatment can help prevent the development of cancer. Remember, however, that in order to detect the disease in good time, you should have a regular Pap smear. At Medonet Market you can buy a pap smear test with a gynecological consultation. Do not wait and take care of your health today.

Cytology allows you to detect about:

  1. 90 percent cases of cervical cancer,
  2. 50 percent cases of endometrial cancer,
  3. 10 percent ovarian cancer cases.

Cytology is a test performed free of charge under insurance, and in private facilities it costs about PLN 30-40. On the other hand, Poland is one of nine EU countries where a screening program is available. Unfortunately, women use it quite rarely, although they receive personal invitations for a cytology test.

Cytology is as important as the gynecological examination. It is recommended to perform it every 3 years (if the last test result was correct).

Every woman aged:

  1. at least 25 years (regardless of whether she has started sexual intercourse or not),
  2. under 25 if sexually active for at least 3 years.

There is no upper age limit beyond which cytology is not required. Even women who have been through the menopause (do not have periods) should have this test performed regularly. This is because not all cervical cancers come from viral infections (although most cases arise from an STI).

After consultation with a doctor, cytology may be stopped by women aged 65-70 years, provided that the results of their three consecutive tests were normal and that no abnormalities were found in the gynecological examination in the last 10 years. However, it should be an individual decision of each woman, made after consultation with a gynecologist.

If you are unable to see the gynecologist in person, you can use the e-visit. On the haloDoctor.pl website, you can make an online teleconsultation appointment with a gynecologist without leaving your home. Get expert help today.

If necessary – of course. It should be remembered that the hymen does not overgrow the entrance to the vagina as it is shaped like a crescent moon. The virgin cytology doctor uses a thinner speculum and inserts it very gently into the vagina. If the gynecologist does not ask if you are a virgin before performing the examination, let him know.

It all depends on how old you are and what was the result of your last Pap smear test. Talk to your gynecologist about the best solution. Most women have a Pap smear every 3 years. However, in some situations, regardless of age, you should have a Pap smear every year.

This is the case if:

  1. you have a weak immune system, for example after an organ transplant, after chemotherapy or as a result of using steroids
  2. Your mom was exposed to diethylstilbestrol (DES – a synthetic estrogen used in the 50s to treat early pregnancy risk miscarriage) while she was pregnant with you.
  3. you are HIV positive
  4. you are being treated for dysplasia, erosion, or a precancerous condition of the cervix.

Also, women who frequently change sexual partners should have a Pap smear every year as the risk of HPV infection increases. In pregnant women, cytology should be performed twice (in the first and third trimesters of pregnancy).

Check what are the most important pregnancy tests.

Many factors can falsify the results of a Pap smear test. Therefore, doctors recommend that the following should be avoided within 2 days before the examination:

  1. long baths and the use of intimate hygiene cosmetics,
  2. the use of tampons,
  3. creams, globules and other forms of vaginal medications,
  4. deodorants and vaginal powders,
  5. having sex and / or using a vibrator.

– Bathing in a bathtub, swimming pool or intercourse may disturb the pH in the vagina, which in turn can lead to an infection that may prevent the collection of material from the neck for cytology – explains the drug. Marta Mączka gynecologist, aesthetic medicine doctor at the WOMAN and MOTHER Medical Center.

If during the scheduled visit to the gynecologist you have inflammation of the reproductive organ (it can be evidenced by e.g. discharge, itching, burning, pain), it is better to postpone the examination until the infection is cured.

Do you need an appointment for a cytology? Use the Medonet Market website. You can quickly and safely make an appointment for a Pap smear at Polmed facilities throughout the country. Do not hesitate – it is important.

Can cytology be performed during menstruation?

Not. The smear test is best done when you are not having your period. The optimal cytology date is between the 10th and 20th day of the monthly cycle.

Before the Pap smear test, your gynecologist will interview you and ask about the date of your last menstrual period, the regularity of your cycle and the length of your bleeding. It will also be important to provide information on past and current illnesses, pregnancies and childbirths, and the medications taken.

Pap smear is part of a routine gynecological examination. This is a quick test. The doctor will ask you to undress from the waist down and lie on the gynecological chair with your legs on the backrests. Then he will insert a small speculum into the vagina and then into the disc of the cervix. Through its light, it will introduce a three-tooth brush on a rather long handle. The doctor will take samples of exfoliated epithelium from at least two places of the cervix along with the mucus on the brush.

Each sample is transferred to a separate slide, stained and viewed under a microscope. The cytology result is usually ready after 3-4 days. In centers where microscopic examination is not carried out, the waiting time for the test result is longer – usually from 2 to 3 weeks.

Curiosity: until some time ago, cytology was performed with a stick on which cotton wool or a wooden spatula was wound. Unfortunately, with such devices it was impossible to take a smear from a sensitive place in the cervix. Currently, the European Commission requires the use of special brushes of a specific shape and material.

Cytology is painless. Some patients only say that they feel a light rubbing while taking the sample.

Until recently, the result indicated which of the five cytological groups the patient belongs to. If the woman had the first or second group, the result was correct. If the third, fourth or fifth – incorrect. Currently, the Polish Gynecological Society recommends a study description according to the Bethesda classification from 2001. As a result, the description is more detailed and contains additional information, especially important for the doctor.

From the patient’s point of view, it is important whether the smear contains only cells of the normal epithelium of the endocervix and the cervical canal (which means the result is normal), or whether the preparation also contains suspicious or abnormal cells (the result is then abnormal and the woman requires further tests and treatment).

Cytology – interpretation of the study according to Papanicolau

Currently, the Pap smear result is interpreted based on 5 groups:

Group I – it is characterized by normal cells of the superficial layer of the squamous epithelium of the cervical shield. Glandular cells from the cervical canal and individual inflammatory cells are observed.

Group II – in addition to the cells identified in the first group, there is a large number of inflamed and epithelial cells characterized by degenerative changes. In addition, group II includes cells derived from regenerative processes. If inflammation has occurred, its type should be determined. Most women are advised to undergo a follow-up after anti-inflammatory treatment. Importantly, in the second group, there are no dysplastic or neoplastic cells. Group II often occurs in women with erosions.

Group III – the collected smear shows dysplastic cells. It is necessary for the gynecologist to determine what severity of dysplasia we are dealing with (low, high, medium). The result with group III is very important because the present slight dysplastic changes may sometimes be a consequence of a strong inflammation and disappear after the applied anti-inflammatory treatment. Diagnostics is extended by cervical specimen collection and cervical electroconizationwhen group III persists for several months despite treatment.

Group IV – characterized by the presence in the smear of cells with the features of pre-invasive squamous cell carcinoma.

Group V – the collected material shows neoplastic cells that are characteristic of squamous cell carcinoma infiltrating the cervix or other malignant neoplasm of the uterine body or cervix.

Of course, finding out that your Pap test result is abnormal is not pleasant. However, this does not mean you have cancer. Usually, the abnormal result is the result of another cervical disease process, such as infection or erosions.

Some pathological cells can develop into cancer cells. Most, however, will be self-eliminating. Treating those that remain can significantly lower your risk of developing cervical cancer. If your Pap smear result is abnormal, first of all discuss what to do with your gynecologist.

There are many reasons for an abnormal Pap smear result. If the test result is inconclusive or the cells in the preparation are slightly altered, your doctor may ask you to repeat the test.

If, on the other hand, the test result is clearly abnormal, and there are obvious changes in the collected cells, the doctor may recommend more detailed tests, e.g. colposcopy or biopsy.

Colposcopy. The doctor, using a colposcope – a special optical instrument placed in the vagina, examines the surface of the cervix, the lower part of the cervical canal and the vagina. The test detects preclinical forms of cervical cancer

Biopsy. The doctor takes a small piece of tissue from the cervical canal. The collected material is then sent to the laboratory and, after fixation, viewed under a microscope.

I had an operation to remove my uterus (hysterectomy). Do I still need to have a Pap smear test?

It all depends on the type of operation performed. Sometimes the body of the uterus is removed, leaving the whole or part of the cervix. Then cytology is necessary. For the answer to this question, it is best to consult the doctor who performed the surgery or the gynecologist who knows your medical history.

However, usually during a hysterectomy, the cervix is ​​also removed along with the uterus. This is called total hysterectomy. You may not need to have regular Pap smears if your surgery was not caused by cancer.

However, it should not be forgotten that every woman after a hysterectomy, regardless of the type of surgery, should visit her gynecologist every year for a gynecological examination.

In addition to having regular Pap smears, an effective way to prevent cervical cancer is to avoid infection with the human papillomavirus (HPV). It is the leading cause of cervical cancer. Infection with this virus is also one of the most common sexually transmitted diseases.

The risk of developing cervical cancer increases if:

  1. you started sexual intercourse at a young age (before the age of 18)
  2. you have had many sexual partners (especially if they had other sexual partners before you)
  3. you have or have had any sexually transmitted infections.

Basic information about the human papillomavirus (HPV)

The group of human papillomaviruses (HPV) includes over 100 different types of this germ.

  1. About 40 types of the virus are sexually transmitted.
  2. About 75 percent. sexually active people will become infected with HPV during their lifetime.
  3. Most women who are infected with HPV will not develop cervical cancer despite not being treated.
  4. Only certain types of HPV cause cervical cancer – if the infection is not treated with them.
  5. Some types of HPV cause warts on the genital organs (external and internal) – these types do not cause cervical cancer.
  6. Since HPV infection rarely produces any symptoms, most people who are infected are unaware that the virus is in the body.

How can I find out if I am infected with HPV?

Most HPV carriers are unaware that they are infected. If the infection does not go away on its own, the virus can cause changes in the cells in the cervix, leading to cancer development. Cytology allows you to detect pathological changes in a timely manner.

You can rule out HPV infection, also thanks to the laboratory tests available at medonetmarket.pl.

Cytology and the detection of venereal disease

Cytology does not detect other sexually transmitted diseases. If you suspect you may be a carrier of a venereal disease, please purchase a lab testing package. You can do them without leaving your home, which greatly improves the comfort during the examination.

Cytology – opinions

Cytology belongs to the group of simple and painless tests, and thanks to its implementation, the chance of detecting cells that may change into cancer cells in the future increases. It should be remembered that treatment at this stage will completely heal and therefore save a life.

Pap smear successfully detects approximately 90% of cervical cancer, approximately 50% of endometrial cancer and 10% of ovarian cancer. In this case, the key is to diagnose the neoplastic disease as soon as possible, thanks to which the patient has the best prognosis.

It should be added that neoplasms in their early stages do not give symptoms yet and only a cytological examination makes it possible to diagnose them. That is why it is so important that this examination is performed regularly as a preventive examination.

Types of cytology

Cytologia płynna (LBC – ang. Liquid-Based Cytology) – is a method recommended by the Polish Gynecological Society and is much more sensitive and gentle than traditional cytology. It consists in taking a smear on a special liquid medium, thus minimizing the risk of cell damage. In addition, this method allows the removal of unwanted elements (e.g. blood, mucus, red blood cells, lymphocytes, inflammatory cells) from the collected material, which makes the microscopic examination more accurate and more reliable, and the sample can be subjected to further tests – e.g. in for the presence of HPV DNA (HR).

It is possible to perform liquid cytology without visiting a doctor. You can now order a mail-order cytology on the LBC liquid medium. You will collect the sample yourself, using the package sent by the laboratory, and then send it back for examination.

Exfoliative (exfoliative) cytology – the traditional method of delicately exfoliating the cells from the cervical mucosa and then smearing it on a dry glass slide. In the next step, the collected cytological swab is sent to the laboratory, where it is subjected to microscopic examination.

Cytology – Bathesda classification

The Bathesda classification is a system established in 1988 and is used to classify cytological images of the obtained smears from the vaginal part of the cervix. This system includes:

  1. FI – normal smear.
  2. LSIL (low-grade squamous intraepithelial lesion) – intraepithelial lesions with the features of slight dysplasia.
  3. HSIL (high-grade squamous intraepithelial lesion) – intraepithelial lesions with features of high dysplasia. Squamous stratified epithelium dysplasia is also referred to as CIS and CIN II. CIN III stands for Advanced Dysplasia.
  4. ACS (atypical squamous cells) – atypical epithelial cells
  5. ACS-US (atypical squamous cells of undetermined significance) – atypical epithelial cells with undefined meaning.
  6. ACS-H (atypical squamous cells – cannot exclude HSIL) – atypical epithelial cells of unknown importance, suspected of HSIL.

It should be noted that in In Poland, the incidence of cervical cancer is much higher than in the rest of Europe. This state of affairs is mainly due to the persistent very low public awareness of HPV infections (human papilloma, the main issue of cervical cancer), as well as the importance of cytology itself in the detection and treatment of cancer. It is also worth mentioning that when it comes to the frequency of cancer, it is cervical cancer ranks 6th in the case of cancer diagnosis among Polish women.

This type of cancer is diagnosed annually in approximately 3000 Polish women, and in more than half of them the disease is diagnosed too late. However, if a woman undergoes regular Pap smear tests, she has a very good chance that any disease will be quickly detected and cancerous and precancerous lesions will be fully healed.

Cytology – free examination

When it comes to the cost of a Pap smear, it fluctuates around PLN 30-40 in a private office. However, it is possible to undergo an examination at the National Health Fund and go to a public facility or use the government program for the prevention and early detection of cervical cancer, which guarantees free cytology every 3 years for women between 25 and 59 years of age.

This type of program is implemented in nine European Union countries, and Poland is one of them. However, as the data shows, women use this option rather rarely, and only 25 percent of women report to the research. In most cases, they are women from large cities, with higher education, from the Zachodniopomorskie and Warmińsko-Mazurskie voivodships.

It is worth mentioning that the quality of the tests performed under the government program is high, and in the event of an incorrect cytology result, each of the women is referred for further diagnostics and treatment.

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