evden eve nakliyat


Cervical Cancer develop when cervical cells are infected with HPV, become abnormal  and slowly turn into cancer cells. Cervical screening is performed to find women who have these abnormal cells at a early precancerous stage while the disease still can be treated.


Who should be screened?

In Turkey, cervical screening should be performed in all women between the ages of 20 and 65. This test is done after marriage or sexual intercourse due to country and cultural reasons. Having menopause, tubal ligation or not having a sexual life doesn’t change the necessity of smear.

How often smear should be done?

although there is not a definite calendar formed in Turkey in this regard, smear tests should be performed annually after the age of 20s unless otherwise is recommended by the physician. You should contact to your physician for extension of smear test and other required recommendations.

What should be done?

due to lack of a planned and scheduled screening program all over the country in Turkey, responsibility remains in women to a great extent. Until a system that invites you to the health center for smear test when the time comes as it is in European countries, is also put into service in Turkey as well, you should plan this process yourself and with your physician.

Your appointment should be in the middle of your menstrual period, approximately 2 weeks after the end of your last menstruation. When you call the clinic to make an appointment, preparations you need to do before coming to the appointment will be explained:

  • •you should avoid using any intravaginal treatment for 2 days prior to your appointment
  • • You should avoid sexual intercourse the night before your appointment.


The purpose of these recommendations is to ensure the accurate screening of your cervical smear and avoid making another appointment to repeat the procedure
When you go for your appointment, you will be asked to lie down on the examination table and a tool called a speculum will be inserted into your vagina slowly. Most women do not experience pain during the procedure, but if you are very tense, you may be uncomfortable.

Speculum gives the physician or nurse the opportunity to see your cervix in detail and then a sample of your cervical cells are taken using a spatula or brush. These cells are sent to the laboratory for the detection of abnormal cells and examined under a microscope. If abnormal cells are detected they are graded according to the severity of abnormalities seen. A report will be sent to your physician and he will send you a letter explaining the results or recommend an appointment for you to stop by again.

Screening Tests

There are several different methods for Cervical Screening:

Cervical Cytology

  • • Classic traditional smear test
  • • Fluid-Based Cytology
  • • Cervical cytology
  • • Conventional smear test
  • • Conventional Pap test, is done in approximately  the same way as described by Georges Papanicolaou who is the founder of the test in 1943 during a Short duration of vaginal examination your physician will take sample of cells from your cervix using a small spatula or brush. In Classic Pap test, these cells are spread on a glass microscope slide immediately and then the liquid is sprayed to protect these cells on a slide. The slide is sent to the laboratory and there, cells are processed to be seen more easily.
  • • They are examined under a microscope for detection of abnormal cells. If abnormal cells are detected, they are graded according to the severity of abnormalities observed and the report will be sent to your physician.

Liquid-Based Cytology

  • •  Liquid-Based Cytology is a new method used in the preparation of cervical smear. The main difference between conventional cervical smears with LBC, cells taken from the cervix  are not spread to glass microscope slide but put into the glass vessel containing protective liquid directly.
  • • Therefore, there is very little change in terms of women. Vaginal examination is exactly the same  and cervical cell sample is taken in the same manner with the conventional cervical smears. But then  the samples taken with a brush or spatula, washed in a glass container that includes preservative fluid or held. The glass container is sealed and sent to a lab , cervical cells in the liquid  are used in the preparation of glass microscope slides. From this point, the microscope slide is treated very similarly with the classic cervical smear. They are processed to be see the cells more easily and examined under a microscope for detection of abnormal cells. If abnormal cells are detected, they are graded according to the severity of abnormalities observed and the report will be sent to your physician.


The reliability of these tests


Classic Pap test

Pap-smear test has saved the lives of thousands of women since it started to be practiced in 1940. However, it cannot be said to be an excellent screening test. Pap test can also miss some abnormal cells(false negative test result) or some normal cells can be termed as abnormal (false positive test result).

This error is generally due to the following reasons:

  • • The area of abnormal cells where the samples are obtained may be missed  by the brush or spatula
  • • These cells may be taken by brush or spatula, but may not be moved to the studied glass,
It can be skipped depending on the experience of the examining person although there is no problem in obtaining the sample or transferring it to the slide.  
Cells which are reported to be Abnormal may seem such due to other causes and may not be related to cancer.

For these reasons, if the Pap test is repeated regularly it serves as an effective screening program. High quality of cervical cancer screening provides 80% protection from this disease.

Liquid Based Cytology (LBC)

LBC offers some advantages comparing to conventional smear method and its reliability is more:

In classic smear method, the cells which are  obtained from the ones that are poured from the cervix are sent to the lab , but in liquid-based cytology the brushes used are  completely sent to the lab and thus the all cells can be examined.

  • • Since liquid-based cytology  cells extracts cell residues such as blood and mucus from the examination area, insufficient or incorrect assessment is very low.
  • • Do you have an abnormal test result?
  • • The majority of cervical smear results are normal, but some are not. If the result is abnormal, it means abnormal cells have been detected in the cervix.
  • *These abnormalities are usually mild and does not mean that you have cancer. In fact, results treatment is not needed in the majority of women with abnormal cervical smear. However, in some of them treatment is required and all women with abnormal results, no matter how slight they may be staged, should be carefully monitored to reduce the risk of developing cervical cancer.


Cytology (smear) results

If abnormal cells are detected in smears these are graded according  to the severity (dyskaryosis) of the abnormalities observed. This staging is helpful for the physician in deciding what kind of follow up is required. A report will be sent to your physician and your physician will send you a notification of results.

In the Smear classification system implemented in our country, your smear results  can be in the following forms:
Normal

Insufficient  smears

Boundary changes (ASCUS - Atypical Squamous Cells of Undetermined Significance)

Mild  dyskaryosis  (LGSIL - Low Grade Squamous intraepithelial lesion)

Medium and High Grade dyskaryosis (HGSIL - High Grade Squamous intraepithelial lesion)

Cervical CA
 
Normal

If your results are normal, you can continue your annual follow ups as recommended by your physician. This indicates that there is no suspicious condition or disease in your cervix.

Insufficient smear

Insufficient  result tells you that this smear  doesn’t contain  enough cell to reveal a result.  you will be invited to give a new smear within 3 months.

Boundary changes (ASCUS - Atypical Squamous Cells of Undetermined Significance)

This diagnosis reveals that there are cells in your smear which are suspected by the pathologist  and that you should be revaluated by your gynecologist and if necessary, further examinations should be performed.


Mild  dyskaryosis  (LGSIL - Low Grade Squamous intraepithelial lesion)

This diagnosis  indicates that low-grade dysplasia is detected in your cervix. you should get information from your physician for the required treatment and follow up for this condition which is defines as CIN 1 in the former classification.

1.    Colposcopy

Your physician r may want to perform a colposcopy directly. If abnormal findings are present in colposcopy, a part of the abnormal area (biopsy) is obtained. This sample will be sent to the laboratory and examined under a microscope, disease is diagnosed.

2.HPV Test


Although it veries according to facilities and experience and knowledge on the subject of the hospital and the physcian you admit, your physician may direct you to have HPV Test. According to the result, colposcopy or follow up may be determined.

Medium and High Grade dyskaryosis (HGSIL - High Grade Squamous intraepithelial lesion)

This diagnosis indicaties the detection of high-grade dysplasia in your cervix. You should consult to your physician for the required treatment as soon as possible and start your treatment in this condition which is defined af CIN II or CIN III in the former classification. Please note that rates of progressing to cervical cancer is higher, especially when patients in this group are not treated. Follow up after the treatment is a must.

Have you been directed to colposcopy?


Colposcopy is a simple procedure that allows your physician or nurse examine your cervix closely and evaluate any possible abnormality.

Colposcopy procedure is very similar to cervical smear; the difference is using a special microscope called a colposcope for examination. Since colposcopy is left outside of the vagina, this process does not give more discomfort than the  cervical smear process.

In colposcopy, you need to lie down on a stretcher in a special position that is used similarly during the cervical smear. the speculum is slowly inserted  into your vagina to see your cervix clearly . Sometimes a cervical smear is taken. After this operation, the doctor or nurse
examine your cervix using colposcopy from the outside of your vagina. Meanwhile, in order to facilitate the visualization of abnormal area, different fluids may be applied to the cervix.

If no abnormality is observed in colposcopy, next steps will vary depending on your cervical smear result.  Your doctor or nurse will give you information about these options.

If an abnormality is detected, a small sample (biopsy) may be taken from the abnormal region in order to decide whether treatment is required or not. Sometimes, if you are sent for colposcopy,  due to a cervical smear showing moderate or severe dyskaryosis, treatment may be recommended directly. Some women prefer it because the condition is rapidly intervened. Your physician or nurse, will inform you about the advantages or disadvantages


Colposcopy

Colposcopy is the examination with a larger microscope focusing on your cervix by your physician  in order to examine a kind of human tissue while lying on regular gynecological examination table. During this review process,  there is no extra pain. It is the examination of your cervix with an enhancing optical lens system during a short examination process.

Biopsy

Biopsy is obtaining a small tissue sample in size of a needle head from the abnormal region in the cervix.
Most women feel only a very slight pain during biopsy. The biopsy sample is sent to a lab and examined under a microscope in order to detect abnormal cells. After biopsy, a small amount of bleeding may occur for 3 or 4 days. You can use sanitary pads or tampons.

Biopsy results

If abnormalities are detected in biopsies, this condition will be graded according to the degree of abnormality and this condition will be presented your physician in a report form. Abnormalities in cervical biopsy is called as Cervical Intraepithelial Neoplasia (CIN) and staging varies  between CIN 1 (mild) and CIN 3 (severe) .

CIN 1 (LGSIL)

Mild abnormalities are detected on biopsy. More than half of the women with this result does not require treatment because these abnormalities disappear spontaneously. However, cervical disease which needs to be treated occur in some women.Keeping this in mind,

CIN 1 is designed.


If you are referred for colposcopydue to borderline or mild dyscaryosis and CIN1 (LGSIL) is found in your biopsy, there are to observation methods:
1.If  colposcopy is normal, you will be advised to repeat cervical smear after 6 months. Considering this repeated cervical smear ;

  • • It is normal, you will come for routine screening again
  • • Changes on the borderline – you’ll be advised to repeat cervical smear in 12 months
  • • Mild dyskaryosis (LGSIL) - you’ll be advised to repeat colposcopy  in 12 months
  • • Moderate or severe (HGSIL) – you’ll be referred  to colposcopy directly.

2.If the colposcopy shows low-grade disease, colposcopy within 6 months will be recommended again. Sometimes, depending on the circumstances, you can be recommended to come back for treatment for removal of the abnormal area in order to reduce the risk of developing cervical cancer.

CIN 2 (HGSIL)


In this classification, moderate abnormalities are detected and  abnormalities are more likely to progress. Therefore, the women having this result are recommended to come back for treatment for removal of the abnormal area in order to reduce the risk of developing cervical cancer.

CIN3 (HGSIL)

In this classification, severe abnormalities are detected. and  abnormalities are more likely to progress. Therefore, the women having this result are recommended to come back for treatment for removal of the abnormal area in order to reduce the risk of developing cervical cancer.


Treatment

Most of abnormal cells in the cervix, will disappear spontaneously without the need of treatment. Sometimes when they don’t disappear or show abnormalities in severe stage, they have to be removed to before they turn into cervical cancer.

There are many treatment methods for this:

Cryotherapy

In this method, small metal plate below the freezing point is placed on the cervix in order to eliminate abnormal cells by freezing them. Cryotherapy can be performed in some of the gynecologist’s clinics or at gynecology departments of the hospitals. It virtually does not cause pain and usually do not need local anesthesia.

Laser

In this procedure, laser is used for heating the abnormal cells at a degree that ensures evaporation of them. Laser treatment is usually applied at gynecology clinics of hospitals,  local anesthesia is used for a painless procedure.

LEEP

Loop diathermy (also known as LEEP or LLETZ).This This is the most commonly used and simple treatment of today. In this procedure, a small wire loop heated by electricity is used to eliminate abnormal cells. Loop diathermy can be applied at some gynecologists’ clinics or gynecology outpatient clinics of the hospitals. Local anesthesia is used for a painless procedure.

Cone Biopsy

Cone biopsy is used in removal of the abnormal cells from the cervix by cutting a cone shaped tissue piece. The wire loop (Loop Diathermy see above), the laser or a special knife may be used for it. This treatment is performed under local anesthesia or general anesthesia. If general anesthesia is used, one night of hospitalization may be required.

Post-treatment period

You may have bloody discharge for 3 to 4 weeks after the treatment. In this period,

  • • you should use sanitary pads, not tampon
  • • You should avoid excessive exercise
  • • Sexual intercourse should be avoided for 1 month and after a month, you should be using condom method for prevention during the recovery period of the area for one more month.  


Treatment of abnormal cells in the cervix are often very successful and most women do not experience any other problems. Abnormal cervical smears continue in a small number of women, and some may need additional treatment. Therefore, regular cervical smear checkup, may be with another colposcopy, is very important until your physician tells you that it is not necessary anymore. These treatments generallydoes not affect your ability in having a child or your sexual life.