Cytology of the cervix. What is it and why is it needed!

Normal and pathological anatomy

The endometrium is the mucous membrane lining the uterine cavity. This is a complex system consisting of many cells, glands and blood vessels, which each menstrual cycle, under the influence of hormones, prepares a place for implantation and further development of the fetus. And if pregnancy does not occur, the endometrium is completely rejected and manifests itself in the form of menstruation. But it happens that endometrial cells begin to divide excessively, and during menstruation not all of it is rejected.

Hyperplasia is an increase in the volume of the functional layer of organs. In addition to the body of the uterus, hyperplasia can develop in other organs (in the lymphoid tissue of the intestine, in the lymph nodes, in the spleen, in the gastric mucosa, etc.).

Endometrial hyperplasia is its thickening due to the uncontrolled proliferation of structural elements.

Depending on the type of these elements, types of uterine and cervical hyperplasia are distinguished:

1. Glandular. Excessive growth of the glandular component of the endometrium is manifested by an irregular menstrual cycle, heavy menstruation, abnormal bleeding, lack of ovulation and infertility.
2. Glandular-cystic – changes in the glandular layer of the endometrium with elements of cystic changes.
3. Focal (polypous) - the growth of glandular, glandular-cystic and cystic polyps on the mucous membrane of the uterine cavity.
4. Atypical (adenomatous) - proliferation of the functional layer of the endometrium due to atypical cells (precancer).

All types of endometrial hyperplasia can develop into cancer. The most dangerous transformations are polypous and adenomatous forms.

Basal cell hyperplasia of the cervix can also be classified as precancer, but this disease affects the vaginal part of the cervix and is therefore not included in the general classification.

Smear test results

Decoding the obtained indicators is the most important stage in the cytology analysis. Based on the results, the doctor can get an idea of ​​the state of the microflora and flat epithelial cells, and the presence of inflammatory processes.

The results are deciphered using the Papanicolaou method; in total, there are five stages of development of various deviations, each with its own description.

• The first stage is characterized by the absence of any abnormalities, all epithelial cells are in normal condition, the mass of nuclei is not increased. This result speaks about the woman’s health.
• During the second stage, there are some minor changes in the cells. They are usually caused by various inflammatory processes in the reproductive system. The second stage is the norm, but additional research should be carried out to find out the cause of the changes. Sometimes single binucleate cells are found.
• At the third stage, cells with an abnormal structure are present. As a rule, these are binucleate cells. If you receive such a result, you need to do the smear again and undergo additional tests.
• During the fourth stage, there are malignant changes in the cells of the uterus. Changes appear in the structure of chromosomes and cytoplasm, and the mass of nuclei increases. Based on this result, a final diagnosis cannot be made; further examination is necessary.
• The fifth stage is characterized by the presence of a large number of malignant cells.

The test tries to determine whether there are abnormal cells on the surface of the cervix. Typically, oncogenic mutations affect both the nucleus and the cytoplasm of the cell. The altered cells have an enlarged nucleus, and the cytoplasm has developmental abnormalities.

Causes

All types of endometrial hyperplasia develop due to hormonal imbalances (excess estrogen and lack of progesterone).

There are a number of factors that increase the risk of developing hyperplasia:

• Endocrine diseases. The endocrine system is a single inextricable mechanism. And when the work of one gland is disrupted, sooner or later this entails failures of the entire system. Thus, diseases of the pancreas and thyroid glands, adrenal glands, and mammary glands can lead to malfunction of the ovaries and hyperplasia.
• Inflammatory diseases of the genital organs (adnexitis, salpingitis, etc.), often occurring against the background of chronic sexually transmitted infections, can also provoke excessive growth of endometrial cells.
• Frequent medical abortions and diagnostic curettages. Constant interference with the normal menstrual cycle or termination of pregnancy confuses the body, and hormonal activity can be seriously disrupted, leading to hyperplasia.
• Sclerocystic ovary syndrome (polycystic ovary syndrome). In women with polycystic ovary syndrome, the functioning of not only the reproductive system, but also the entire body is disrupted. Symptoms are similar to endometrial hyperplasia. Therefore, patients with polycystic disease need to be especially vigilant so as not to miss the process of transition from simple hyperplasia to cancer.
• Burdened hereditary history. There is a high probability of developing endometrial hyperplasia in women whose mothers and grandmothers suffered from this disease.

Who needs a monthly Pap test?

A cytology smear must be performed on all women over 18 years of age for preventive purposes, but there are certain risk groups for whom it is advisable to have the test done once a month.

If at least one of these abnormalities is present, a Pap test should be performed monthly:

• Irregularities in the menstrual cycle;
• Venereal diseases;
• Genital herpes;
• Genital warts;
• Infertility;
• Weak immunity;
• Past cancers.

How does the disease manifest itself?

The symptoms of all types of endometrial hyperplasia are similar and are manifested by non-cyclic bleeding.
These include constant delays in menstruation and breakthrough bleeding in the middle of the cycle. But there are times when menstruation comes on time, but the discharge is scanty and not the same as before. Women often do not attach importance to this, and seek medical help only in cases where the desired pregnancy does not occur for a long time. And if a woman becomes pregnant with hyperplasia, then the likelihood of carrying this pregnancy to term is extremely low. Some women also complain of nagging pain in the lower back and lower abdomen. Women during menopause are especially often diagnosed with hyperplasia. Any, even the slightest, bloody discharge from the genital tract in a woman who has entered the postmenopausal period is a serious cause for concern and an emergency visit to the gynecologist. In some cases, endometrial hyperplasia may be asymptomatic, and becomes a diagnostic finding during a routine examination.

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Help: Sometimes, women who are faced with the problem of infertility or miscarriage may hear a diagnosis of endometrial hypoplasia. This disease also occurs due to hormonal imbalance and is manifested by scanty menstruation. Signs of a thin endometrium are determined during an ultrasound examination according to the norms for the days of the menstrual cycle.

Forms

Sometimes this pathology is classified according to other parameters. In particular, it is popular to divide it according to the type of changed or growing tissue:

1. Glandular - with it, glandular tissue mainly grows; to a lesser extent, some other tissue may be involved in the process;
2. Glandular-cystic - a condition in which predominantly glandular tissue changes, but some cells acquire cystic characteristics over time;
3. Polypous - when the growth is strictly local and looks like a polyp.

All atypical types of changes are also divided into two large groups:

• Complex atypical diffuse endometrial hyperplasia is a pathology in which cells throughout the entire endometrium are involved in the process of pathological growth and change;
• Complex atypical focal endometrial hyperplasia is a pathology when growth or atypical changes are observed only in a certain area of ​​the endometrium.

There are some other parameters by which classification is carried out, but they are not so common.

Diagnostics

After a speculum examination and a bimanual examination, the doctor will recommend that you undergo:

1) Ultrasound of the pelvic organs. During the examination, the diagnostician will determine the condition of the uterus, tubes and ovaries, evaluate the structure and measure the thickness of the endometrium.

Endometrial thickness according to the phase of the menstrual cycle:

Norm:

• The first days of the menstrual cycle – 0.2-0.5 cm;
• Mid-menstrual cycle – 0.9-1.3 cm;
• Second half of the menstrual cycle – 1.0-2.1 cm;
• Before menstruation -1.2-1.8 cm;

Pathology:

• An endometrial thickness of more than 1.5 cm indicates hyperplasia;
• A thickness of more than 2.0 cm is a sign of adenocarcinoma.

Endometrium less than 6 mm excludes the diagnosis of hyperplasia.

2) Separate diagnostic curettage of the walls of the uterine cavity and endocervix with further examination of the material.

3) Papanicolaou smear (Pap test) - taking the epithelium of the uterine mucosa and cervical canal for examination using special brushes with further examination under a microscope.

4) Pipelle biopsy is a modern method of taking a small amount of endometrial tissue for examination. A quick and painless way.

Hysteroscopy

5) Hysteroscopy is a method of examining the uterine cavity with a special optical system, consisting of a tube that is inserted into the uterus through the cervical canal and a camera that transmits an image to the screen. If a problem is detected, the doctor can convert the diagnostic hysteroscopy into a therapeutic one. Despite the fairly high price of the procedure, today it is the most informative minimally invasive method for diagnosing and treating hyperplasia.

Using a microscope, a laboratory doctor determines the histological picture: the stages of early, middle and late endometrial proliferation. It is these changes that characterize hyperplasia (at the stage of late proliferation, the growth of structural elements is not inhibited, and too many of them grow).

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What is the procedure?

A smear cytology is an examination of the entire upper layer of the cervix using a microscope. The examination is used for timely detection of oncology. This method is the most convenient due to its painlessness and simplicity.

Cervical cytology is useful not only for detecting cancer, it allows you to learn about changes in the structure and functioning of cells, and identify incipient infections and inflammations.

Another name for such an examination is a PAP test. It is recommended for all women aged 20 to 60 years for preventive purposes at least once a year. A PAP test helps to accurately determine all abnormalities in the female reproductive system.

What is the purpose of a PAP test?

Every woman needs cytology of the cervical canal for prevention. Deviations in the structure of the cellular structure can be very dangerous not only for well-being, but also for life. A Pap test helps detect possible cancer at an early stage.

A smear gives an idea of ​​the condition of the mucous membrane and the presence of pathogenic microorganisms on it. The analysis cannot give accurate indicators, therefore, to accurately determine the distribution of microbes, additional research must be resorted to.

Treatment

When choosing a treatment method, the doctor must be guided by the current protocols of the Ministry of Health.
In case of emergency treatment of a woman with uterine bleeding, a decision must be made quickly. How to stop the bleeding: by curettage of the walls of the uterus or by taking pills, the doctor decides after examination, questioning, based on the medical history and medical records (from previous visits).

Conservative treatment – ​​used for typical forms of hyperplasia.

Drug groups:

• Contraceptives. Recommended for young and nulliparous women (Lindinet, Logest, Yarina, Janine, Klaira);
• Progestogens (Microlut, Norkolut, Duphaston) are progesterone preparations.
• Gonadotropic releasing hormone agonists (Diferelin, Buserelin).

Depending on the patient’s age and the form of the disease, the doctor may recommend a course of taking the drug from 3 months to a year. If drug treatment is ineffective or inappropriate, they proceed to surgery.

Surgery:

• Separate diagnostic curettage of the uterine mucosa under hysteroscopy control;
• Ablation (resection) of the endometrium is the surgical removal of the uterine mucosa.
• Hysterectomy – removal of the uterus without the cervix;
• Extirpation of the uterus with appendages (together with the cervix).

The required amount of surgical intervention depends on the type of hyperplasia, the age of the patient and other factors determined by the doctor.

Evidence-based medicine denies the effects of homeopathy and traditional medicine in the treatment of endometrial hyperplasia. It is recommended to immediately seek qualified medical advice. help to prevent complications.

Transition to cancer

The idea that hyperplasia is cancer is wrong. However, it is worth considering that complex atypical endometrial hyperplasia can develop into an oncological process. And this is one of the most unpleasant consequences it can lead to. Endometrial cancer is quite difficult to diagnose and treat.

The fact is that the appearance of atypical cells in itself indicates the course of the precancerous process. However, this development of the disease occurs only without treatment in 30-50% (according to various studies) of patients. Moreover, in adult women it is more common than in adolescents.

If there are no atypical cells, the probability of progression to cancer is very low - about 10%. And then, this will only happen if atypia appears. Which rarely happens.

Symptoms

The symptoms of this disease are nonspecific, so it is quite difficult to diagnose, and sometimes too late. This is especially true for focal forms. Basically, the changes are associated with the menstrual cycle. Phenomena such as:

• Irregular cycle, significant changes, often a slight delay;
• Large volume of discharge, its sharp or gradual increase;
• The presence of acyclic bleeding, which is breakthrough in adolescents, but common in adult women.

Due to significant blood loss, a number of accompanying symptoms develop. These are phenomena such as pallor, weakness, drowsiness, and increased fatigue. Blood tests during this period will diagnose anemia.

Complications

Both atypical and non-atypical hyperplasia can lead to a number of unpleasant consequences. Among them are the following:

• Anemia due to constant significant blood loss;
• Infertility due to the fact that the embryo does not attach to the pathological endometrium;
• Transition to an oncological process due to atypical changes in cells.

Severe complications develop only if there is no treatment. With timely and complete treatment, the disease can be cured quite successfully.