Dr.

Meritë Demiri- Demolli


Obstetrician / Gynecologist


tel: +38344862103

Screening for cervical cancer saves lives.

Over the past 30 years in the United States, the number of cases of cervical cancer and deaths has halved.

This is mainly the result of women having regular check-ups for cervical cancer.

What are the possible causes of cervical cancer?

With rare exceptions, cervical cancer results from genital human papillomavirus (HPV) infection, which is a known carcinogen to humans.

Although HPV infections can be transmitted through asexual routes, most come from sexual contact.

Consequently, the main risk factors identified in epidemiological studies are as follows:

• Sexual intercourse at a young age


• Multiple sexual


partners • Debauched male partners


• History of sexually transmitted diseases


• Smoking


• Use of birth control pills - especially for more than 5 years

HIV infection is associated with a 5-fold increase in the risk of cervical cancer.

What is the clinical picture?

Because many women are routinely screened, the most common finding is an abnormal Papanicolaou (Pap) Pap test result.

Typically, these patients are asymptomatic.

Clinically, the first symptom of cervical cancer is abnormal vaginal bleeding, usually postcoital.

Vaginal discomfort, foul-smelling secretions and dysuria are not uncommon.

The tumor grows extending along epithelial surfaces, both squamous and glandular, up into the endometrial cavity, across the vaginal epithelium, and laterally into the pelvic wall.

It can directly infiltrate the bladder and rectum, leading to constipation, hematuria, fistula, and ureteral obstruction, with or without hydroureter or hydronephrosis.

The triad of leg edema, pain, and hydronephrosis suggests involvement of the pelvic wall.

Common sites for distant metastases include extrapelvic lymph nodes, liver, lungs, and bone.

What is cervical cancer screening?

Cervical cancer screening is an essential part of a woman's routine health care.

Almost all cases of cervical cancer are caused by infection with sexually transmitted oncogenic species or with a high risk of human papillomavirus or HPV.

The main purpose of screening is to identify precancerous lesions caused by HPV, so that they can be removed to prevent the development of invasive cancer.

A secondary goal is to find cervical cancers at an early stage, when they can usually be treated successfully.

Routine examination of the cervix has been shown to greatly reduce the number of cases of cervical cancer and deaths from this disease.

For many years, cytology-based screening, known as the Pap test, was the only screening method.


Its use reduced the incidence of cervical cancer and deaths in places where screening is common.

However, with the advent of the ability to test for HPV, screening for cervical cancer now involves three approaches: HPV testing, which requires the presence of high-risk HPV types in cervical cells, Pap test, and coestation HPV / Pap, which checks the same cell sample for both high-risk HPV types and cervical cell changes.

How is human papillomavirus (HPV) detected?

Since HPV is the leading cause of cervical cancer, screening for this cancer is about identifying the presence of HPV infection and consists of taking a quantity of cells from the surface of the cervix or vagina to be analyzed.

The sample is taken to the laboratory and analyzed for the presence or absence of HPV types, causing high-risk cervical cancer (hr-HPV).

If the presence of HPV infection is identified it does not mean that you have cancer but you are simply infected with HPV, and if you are not followed up or treated further, this infection can progress to cancer.

Therefore, in such a situation, to better control the cervix you need to perform a second examination called a colposcope.

If the specialist performing the colposcopy identifies abnormal cells, he or she will suggest that you remove them, and this is usually done during the colposcopy procedure.

What is a PAP test?

A procedure in which a small brush is used to gently remove cells from the surface of the cervix and the area around it, so that they can be examined under a microscope for cervical cancer or cell changes that may lead to in cervical cancer.

A Papanicolaou test can also help detect other conditions, such as infections or inflammation.

It is usually done at the same time as the pelvic exam and can also be done at the same time as a test for certain types of human papillomavirus (HPV).

What is HPV / Pap test?

For women age 30 and older, both HPV / Pap co-testing and HPV testing alone are more sensitive than Pap tests alone. Therefore, a woman with a negative HPV test and a normal Pap test - or simply a negative HPV test - has a very low risk of developing precancerous lesions of the cervix over the next few years.

Both Pap and HPV testing and HPV testing alone can improve the detection of glandular cell abnormalities, including cervical adenocarcinoma (cervical gland cell cancer).

Glandular cells are mucus-producing cells found in the endocervical canal (opening in the center of the cervix) or in the uterine mucosa.

Glandular cell abnormalities and cervical adenocarcinoma are less common than squamous cell abnormalities and squamous cell carcinoma.

The Pap test is not as good at detecting adenocarcinoma and glandular cell abnormalities as it is at detecting squamous cell abnormalities and cancer.

Does HPV always lead to cervical cancer?

Only a small number of women with dangerous types of HPV will be affected by cervical cancer.

Due to the body's natural ability to fight infection, most HPV infections go away on their own.

These short-term infections usually cause only mild or "low-grade" changes in the cells of the cervix.

The cells return to normal as the HPV infection clears.

In a small number of women, HPV does not go away.

If the HPV infection lasts for a long time, it is described as a "persistent" infection.

Persistent HPV infection with high-risk species can cause more severe, or "high-grade" changes in cervical cells.

High-grade changes that persist for 1 or 2 years are more likely to become cancerous if left untreated.

Factors such as smoking, a weakened immune system, and infection with the human immunodeficiency virus (HIV) are thought to increase the likelihood that HPV infection will continue, but persistent infections also occur in women without these factors.

When should a woman start screening for cervical cancer and how often should she be screened?

Women should talk to their doctor about when to start the examination and how often they should be checked.

The updated instructions are as follows:

• Women aged 21 to 29 should be tested with a Pap test every 3 years


• Women aged 30 to 65 should be tested with one of three tests:

→ Every 5 years only with high risk HPV testing


→ Every 5 years with Pap test and high risk HPV testing


→ Every 3 years only with Pap test

Women with certain risk factors may need to have more frequent check-ups or continue the examination after the age of 65.

These risk factors include:

• Infected with the human immunodeficiency virus (HIV)


• Being treated for a precancerous lesion of the cervix or cervical cancer

Screening for cervical cancer is not recommended for:

• Women younger than 21 years old


• Women older than 65 years old, who have had an adequate preliminary examination, with normal results and who are not at high risk for cervical cancer


• Women who have had a hysterectomy total (surgery to remove the uterus and cervix) and have no history of high-grade cervical lesions or cervical cancer

What do the results of cervical cancer screening tests mean?

A health care provider may simply describe a Pap test result for a patient as "normal" or "abnormal."

Likewise, HPV test results may be either "positive", meaning that the patient's cervical cells are infected with one or more of a group of high-risk types of HPV (which is which detect most HPV tests available on the market), or "negative".

indicating that none of the high-risk HPV types were found.

Some HPV tests are specific for HPV16 and HPV18 - the types that cause most cervical cancers.

A woman may want to ask her doctor for specific information about her Pap and HPV test results and what these results mean.

Most labs use a standard set of terms, called the Bethesda System, to report Pap test results.

According to the Bethesda System, samples that do not have cell abnormalities are reported as "negative for intraepithelial or malignant lesions."

A negative Pap test report may also indicate some benign findings, such as common infections or inflammation.

Pap test results also indicate whether the sample was satisfactory or unsatisfactory for examination.

The guidance committees are re-evaluating the way cervical screening test results are reported, based on the most up-to-date research on the natural history of HPV infections.

The Bethesda system considers squamous cell and glandular cell abnormalities separately.

Squamous cell abnormalities fall into the following categories, ranging from the mildest to the most severe.

Atypical squamous cells (ASC) are the most common abnormal finding on Pap test.

The Bethesda system divides this category into two groups, ASC-US and ASC-H:

▪ ASC-US: atypical squamous cells of undetermined importance. The cells do not look completely normal, but the cause is unclear. The changes may be related to an HPV infection, but may also be caused by other factors.


C ASC-H: atypical squamous cells, can not exclude a high-grade squamous intraepithelial lesion. ASC-H lesions may be at higher risk of being precancerous than ASC-US lesions.


Shk Low-grade squamous intraepithelial lesions (LSIL) are considered mild abnormalities caused by HPV infection. LSILs often return to normal as the immune system controls the infection, especially in younger women.


Të High-grade squamous intraepithelial lesions (HSIL) are the most severe abnormalities that are more likely to progress to cancer if left untreated.


In Carcinoma in situ (CIS) refers to very abnormal cells that look like cancer cells but remain on the surface of the cervix and have not invaded deeper or spread beyond the cervix.


Sk Squamous cell carcinoma is cervical cancer. Abnormal squamous cells have penetrated deeper into the cervix or into other tissues or organs. In a well-controlled population, such as that in the United States, the detection of cancer on examination of the cervix is ​​extremely rare.

Glandular cell abnormalities describe abnormal changes that occur in the tissues of the cervical glands.

The Bethesda system divides these anomalies into the following categories:

At Atypical glandular cells (AGC), which means that glandular cells do not look normal, but doctors are not sure what cell changes mean.


Situ Endocervical adenocarcinoma in situ (AIS), which means that severely abnormal cells are found but have not spread beyond the cervical gland tissue.


En Adenocarcinoma involves not only cancer of the endocervical canal itself.

But, also in some cases, endometrial cancer, extrauterine and other cancers.

What follow-up tests are done if cervical cancer screening results are abnormal?

Depending on the test results, a woman may be recommended to have repeated tests within a year because some abnormalities, especially the smaller ones (ASC-US), will go away on their own as the immune system controls the HPV infection.

If a woman has more severe cell changes (ASC-H or HSIL) and / or evidence of HPV16 or HPV18, she may be recommended to have a colposcopy, a procedure that involves using an instrument (called a colposcope) for examine the cervix.

Should women who have been vaccinated against HPV still be screened for cervical cancer?

Yes.

Current HPV vaccines do not protect against all types of HPV that cause cervical cancer, so it is important that vaccinated women continue to undergo routine cervical cancer screening.

If I have had a hysterectomy, do I still need a cervical cancer examination?

Women who have had a hysterectomy may still need to be examined.

The decision is based on whether the cervix was removed, why a hysterectomy was needed, and whether there is a history of severe cervical cell changes or cervical cancer.

Even if the cervix is ​​removed at the time of the hysterectomy, cervical cells may still be present at the top of the vagina.

If you have a history of cervical cancer or high-grade changes in cervical cells, you should continue to have the screening for 20 years after the time of your surgery.

How can I protect myself differently from cervical cancer?

The HPV vaccine is an important way to help protect against the HPV infections that most commonly cause cancer.

But the HPV vaccine does not protect against all types of HPV that can cause cancer.

So women who have been vaccinated against HPV should still follow the cervical cancer screening recommendations for their age group.

Are there women who may need more frequent examination?

Women who have a history of cervical cancer, are infected with HIV, have a weakened immune system, or who have been exposed to diethylstilbestrol (DES) before giving birth may need more frequent screening and should not follow these. routine instructions.

Why is screening for cervical cancer not recommended before the age of 21?

Cervical cancer is extremely rare in this age group.

Less than 1 in 1000 cases of cervical cancer occur in young women 15 to 19 years old.

Most women become infected with HPV as soon as they start having vaginal intercourse.

These infections almost always go away on their own within 1 to 2 years without causing any changes in the cells of the cervix.

If changes occur, the cells almost always return to normal.

Research shows that screening for cervical cancer in this age group does not reduce the rate of cervical cancer and may lead to unnecessary treatment.

Are these guidelines likely to change again?

Yes.

Experts continue to develop new and better ways to control cervical cancer and manage abnormal outcomes.

Experts are also learning more about HPV infection and how it affects women of different ages.

The goal is to develop a testing strategy that finds the majority of cases of cervical cancer or precancerous changes with the least number of unnecessary follow-up tests and treatments.

Do I have to visit my gynecologist every year if the annual cervical cancer screening is no longer recommended?

Yes.

It is still important to visit your obstetrician-gynecologist regularly for a routine care visit.

These visits are an opportunity for you to learn how to prepare for pregnancy, discuss your birth control options, or address menopausal issues.

In addition, your gynecologist can help you identify if you are at risk for certain other medical conditions, such as diabetes mellitus or heart disease.

And your visit may include a pelvic exam.

What does it mean if I have an abnormal cervical cancer screening test result?

Many women have abnormal cervical cancer screening results.

An abnormal result does not mean you have cancer.

Remember that cervical cell changes often return to normal on their own.

If they do not, it often takes several years for even large-scale changes to become cancerous.

If you have an abnormal screening test result, additional tests are needed to find out if high-grade changes or cancer is actually present.

If follow-up test results show large-scale changes, you may need treatment to remove the abnormal cells.

How accurate are the results of a cervical cancer screening test?

As with any laboratory test, the results of cervical cancer examination are not always accurate.

Sometimes, the results show abnormal cells when the cells are normal.

This is called a false-positive result.

Examination of cervical cancer may also not detect abnormal cells when they are present.

This is called a false-negative result.

Many factors can cause false results:

• The sample may contain very few cells.


• There may not be enough abnormal cells to study.


• An infection or blood can hide abnormal cells.


Douching or vaginal medications can wash or dilute abnormal cells.


• To help prevent false-negative or false-positive results, you should avoid deep vaginal cleansing, sexual intercourse, and the use of vaginal medications or hygiene products for 2 days before your test.

counsel

Go to the doctor, do a checkup and get pap tests regularly.

Cervical cancer is very preventable and if you catch it early, there are many ways to treat it.

/ Telegraphy /