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Cervical lesions causes: Cervical Cancer Stages, Signs, Treatment & Causes

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Symptoms, Treatments, Causes, and More

 

Cervical dysplasia is a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix or endocervical canal, the opening between the uterus and the vagina. It is also called cervical intraepithelial neoplasia (CIN). Strongly associated with sexually transmitted human papillomavirus (HPV) infection, cervical dysplasia is most common in women under age 30 but can develop at any age.

Cervical dysplasia usually causes no symptoms, and is most often discovered by a routine Pap test. The prognosis is excellent for women with cervical dysplasia who receive appropriate follow-up and treatment. But women who go undiagnosed or who don’t receive appropriate care are at higher risk of developing cervical cancer.

Mild cervical dysplasia sometimes resolves without treatment, and may only require careful observation with Pap tests every three or six months. But moderate-to-severe cervical dysplasia — and mild cervical dysplasia that persists for two years — usually requires treatment to remove the abnormal cells and reduce the risk of cervical cancer.

Causes of Cervical Dysplasia

In many women with cervical dysplasia, HPV is found in cervical cells. HPV infection is common in women and men, and most often affects sexually active women under age 20.

In most cases, the immune system eliminates HPV and clears the infection. But in some women, the infection persists and leads to cervical dysplasia. Of the more than 100 different strains of HPV, more than one-third of them can be sexually transmitted, and two particular types — HPV 16 and HPV 18 — are strongly associated with cervical cancer.

HPV is usually passed from person to person during sexual contact such as vaginal intercourse, anal intercourse, or oral sex. But it also can be transmitted by any skin-to-skin contact with an infected person. Once established, the virus is capable of spreading from one part of the body to another, including the cervix.

Among women with a chronic HPV infection, smokers are twice as likely as nonsmokers to develop severe cervical dysplasia, because smoking suppresses the immune system.

Chronic HPV infection and cervical dysplasia are also associated with other factors that weaken the immune system, such as treatment with immunosuppressive drugs for certain diseases or after an organ transplant, or infection with HIV, the virus that causes AIDS.

Risk Factors for Cervical Dysplasia

Persistent HPV infection is the most important risk factor for cervical dysplasia, especially moderate-to-severe cervical dysplasia.

In women, an increased risk of a persistent HPV infection is associated with:

  • Early initiation of sexual activity
  • Having multiple sex partners
  • Having a partner who has had multiple sex partners
  • Having sex with an uncircumcised man

Diagnosis of Cervical Dysplasia

Because a pelvic exam is usually normal in women with cervical dysplasia, a Pap test is necessary to diagnose the condition.

Although a Pap test alone can identify mild, moderate, or severe cervical dysplasia, further tests are often required to determine appropriate follow-up and treatment. These include:

  • Repeat Pap tests
  • Colposcopy, a magnified exam of the cervix to detect abnormal cells so that biopsies can be taken
  • Endocervical curettage, a procedure to check for abnormal cells in the cervical canal
  • Cone biopsy or loop electrosurgical excision procedure (LEEP), which are performed to rule out invasive cancer; during a cone biopsy, the doctor removes a cone-shaped piece of tissue for lab examination. During LEEP, the doctor cuts out abnormal tissue with a thin, low-voltage electrified wire loop.
  • HPV DNA test, which can identify the HPV strains which are known to cause cervical cancer.

Treatments for Cervical Dysplasia

The treatment of cervical dysplasia depends on many different factors, including the severity of the condition and the age of the patient. For mild cervical dysplasia, often only continued monitoring with repeat Pap tests is needed. For older women with mild cervical dysplasia, usually no treatment is needed unless mild cervical dysplasia has persisted for two years, progressed to moderate or severe cervical dysplasia, or there are other medical problems.

Treatments for cervical dysplasia include two of the procedures also used for diagnosis: cone biopsy or LEEP.

Other treatments include:

  • Cryosurgery (freezing)
  • Electrocauterization
  • Laser surgery

Because all forms of treatment are associated with risks such as heavy bleeding and possible complications affecting pregnancy, it’s important for patients to discuss these risks with their doctor prior to treatment. After treatment, all patients require follow-up testing, which may involve repeat Pap tests in six and 12 months or an HPV DNA test. After follow-up, regular Pap tests are necessary.

Prevention of Cervical Dysplasia

Women can lower their risk of cervical dysplasia by avoiding the high-risk sexual behaviors associated with HPV infection, such as early sexual initiation and having multiple sexual partners. Sexually active women whose male partners correctly use condoms during every sexual encounter may have up to a 70% reduced risk of HPV infection.

Other preventive measures include avoiding smoking and following the American Cancer Society guidelines for the early detection of cervical cancer, which recommend that every woman should begin cervical cancer screening at age 21.

Three vaccines — Gardasil, Gardasil-9, and Cervarix — have been approved by the FDA to help prevent infection with some types of HPV, including the types that cause most cases of cervical cancer.

According to guidelines endorsed by the CDC and the American College of Obstetricians and Gynecologists, boys and girls both should be vaccinated between ages 11 and 12 before they become sexually active; those between ages 13 and 26 who have not yet received the vaccine should also be vaccinated. The vaccine has  been approved for women up to age 45.

What Is a Precancerous Cervical Lesion? – Cervical Cancer Center

One of the best ways to prevent cervical cancer is to have regular Pap tests, which can detect a precancerous cervical lesion so that it can be removed before it becomes cancer. Pap tests take a sample of your cervical cells for examination in a lab. If the results of this cervical cancer screening test are abnormal, you may have changes in the cells of your cervix that could indicate a precancerous cervical lesion.

A precancerous cervical lesion, which is also called an intraepithelial lesion, is an abnormality in the cells of your cervix that could eventually develop into cervical cancer.

There are two main types of cervical cells, squamous and glandular, and abnormalities can occur in either type. The most common types of precancerous cervical lesions include:

  • Atypical squamous cells. If your doctor tells you that you have atypical squamous cells, it means that abnormalities have been detected in the squamous cells of your cervix. This can indicate that you have a human papillomavirus (HPV) infection, another infection, or possibly precancerous cells of another cause. Your doctor may recommend further testing to determine what the abnormalities mean for you. In some cases, this may simply mean a repeat Pap test in a few months. A Pap test with this kind of finding may be reported as “atypical squamous cells of uncertain significance,” abbreviated as ASCUS.
  • Squamous intraepithelial lesion (SIL). This lesion means that you have changes on your cervix that may be precancerous. SIL lesions are classified as either low-grade (LSIL) or high-grade (HSIL), with high-grade lesions being more likely to progress to cervical cancer.
  • Atypical glandular cells. These signal a possible precancerous lesion in the upper area of your cervix or inside the uterus.

Testing and Treating a Precancerous Cervical Lesion

A Pap test screens for cancer or a precancerous condition; it is not used to diagnose a condition. So if your Pap test indicates that you might have a precancerous cervical lesion, your doctor probably will recommend further testing. The screening recommended for you depends on a number of factors, including your age, menopausal status, Pap test results, and whether you are pregnant. Follow-up testing may include one or more of the following:

  • Repeat Pap test. Some women just need another Pap test within a few months to see if the abnormality is still present.
  • HPV testing. Since many abnormalities are caused by an HPV infection, your doctor may recommend that your cervical cells be tested for HPV. Some types of HPV infection clear on their own and don’t tend to cause precancerous changes or cancer, but others, if not cleared by the body, are more likely to cause cancer.
  • Colposcopy. This test allows your doctor to get a better look at your cervix through a magnifying device.
  • Cervical biopsy. This involves removing a small sample of your cervical tissue and sending it to a lab for testing.
  • Endometrial sampling. This involves taking a sample of your endometrium, or uterine lining, for study in a lab.

If this testing determines that you do, in fact, have a precancerous cervical lesion, there are treatments that can help reduce the chances that the lesion will develop into cervical cancer. Treatment options for a precancerous cervical lesion include:

  • Loop electrosurgical excision procedure (LEEP). A thin, electrically charged wire is used to remove abnormal lesions from your cervix.
  • Freezing (cryotherapy). Some precancerous cervical lesions can be destroyed by freezing them with a cold probe; this causes them to eventually shed from your cervix.
  • Laser treatment. The precancerous cervical lesion is destroyed with a beam of laser light.
  • Conization. A small, cone-shaped piece of tissue containing the abnormal area of the cervix is removed surgically.

It can be scary to find out that you have a precancerous cervical lesion, but keep in mind that having a lesion does not mean that you will get cervical cancer. In fact, early treatment of a precancerous cervical lesion can almost always help women avoid getting cervical cancer.

Cervical cancer: Overview | Cancer Council Victoria

The cervix

The cervix is part of the female reproductive system, which also includes the fallopian tubes, uterus (womb), ovaries, vagina (birth canal) and vulva (external genitals).

The cervix, also called the neck of the uterus, connects the uterus to the vagina. It has an outer surface that opens into the vagina and an inner surface that faces into the uterus.

The cervix has a number of functions, including these:

  • producing moisture to lubricate the vagina, which keeps the vagina healthy
  • opening to let menstrual blood pass from the uterus into the vagina
  • producing mucus that helps sperm travel up the fallopian tube to fertilise an egg that has been released from the ovary
  • holding a developing baby in the uterus during pregnancy by remaining closed, then widening to let a baby be born through the vagina.

The cervix has an outer surface that opens into the vagina (ectocervix) and an inner surface that lines the cervical canal (endocervix). These two surfaces are covered by two types of cells: squamous and glandular

Squamous cells

Squamous cells are flat, thin cells that cover the outer surface of the part of the cervix that opens into the vagina (ectocervix). Cancer of the squamous cells is called squamous cell carcinoma.

Glandular cells

Glandular cells are column-shaped cells that cover the inner surface of the cervix (cervical canal or endocervix). Cancer of the glandular cells is called adenocarcinoma.

The area where the squamous cells and glandular cells meet is called the transformation zone. This is where most cervical cancers start.

 

About cervical cancer

Cervical cancer begins when abnormal cells in the lining of the cervix grow uncontrollably.

Cancer most commonly starts in the area of the cervix called the transformation zone, but it may spread to tissues around the cervix, such as the vagina, or to other parts of the body, such as the lymph nodes, lungs or liver.

Types

There are two main types of cervical cancer, which are named after the cells they start in:

  • squamous cell carcinoma
  • adenocarcinoma.

A small number of cervical cancers feature both squamous cells and glandular cells. These cancers are known as adenosquamous carcinomas or mixed carcinomas.

Other rarer types of cancer that can start in the cervix include small cell carcinoma and cervical sarcoma.

Squamous cell carcinoma

The most common type of cervical cancer, squamous cell carcinoma (often shortened to SCC) starts in the squamous cells of the cervix. It accounts for about seven out of ten – or 70 per cent – of cases.

Adenocarcinoma

Adenocarcinoma is less common type, making up about one in every four cases or 25 per cent. It starts in the glandular cells of the cervix. Adenocarcinoma is more difficult to diagnose because it occurs higher up in the cervix and the abnormal glandular cells are harder to find.

How common is it?

About 850 people in Australia are diagnosed with cervical cancer every year. Cervical cancer accounts for about 2 out of 100 (2 per cent) of all cancers diagnosed in people with a cervix. It is more common in people over 30, but it can occur at any age. About one in 195 people will develop cervical cancer before the age of 75.

The incidence of cervical cancer in Australia has decreased significantly since a national screening program was introduced in the 1990s  and a national HPV vaccination program was introduced in 2007.

What are the symptoms?

In its early stages, cervical cancer usually has no symptoms.

The only way to know if there are abnormal cells in the cervix, which may develop into cervical cancer, is to have a cervical screening test.

If symptoms are present, they usually include these:

  • vaginal bleeding between periods, after menopause or during or after sexual intercourse
  • pelvic pain
  • pain during sexual intercourse
  • an unusual vaginal discharge
  • heavier periods or periods that last longer than usual.

Although these symptoms can also be caused by other conditions or medicines, it is very important to rule out cervical cancer. See your doctor if you are worried or the symptoms are don’t go away. This is important for anyone with a cervix, whether straight, lesbian, gay, bisexual, transgender or intersex.

 

Causes

Almost all cases of cervical cancer are caused by an infection called human papillomavirus (HPV). There are also other known risk factors.

Infection with human papillomavirus (HPV)

HPV is the name for a group of viruses. HPV is a common infection that affects the surface of different areas of the body, such as the cervix, vagina and skin.

There are more than 100 different types of HPV, including more than 40 types that affect the genitals . Genital HPV is usually spread from the skin during sexual contact. About four out of five  of all people will become infected with at least one type of genital HPV at some time in their lives. Some other types of HPV cause common warts on the hands and feet.

Most people will not be aware they have HPV as it is usually harmless and doesn’t cause symptoms. In most people, the virus is cleared quickly by the immune system and no treatment is needed.  In some people with a cervix, the infection doesn’t go away and they have an increased risk of developing changes in the cervix. These changes usually develop slowly over many years.

Approximately fifteen types of genital HPV cause cervical cancer. Screening tests are used to detect these types of HPV or the pre-cancerous cell changes caused by the virus. See more information on screening tests . There is also a vaccination against HPV.

National HPV Vaccination Program

The HPV vaccine used in Australia protects against nine strains of HPV known to cause around 90 per cent of cervical cancers.

The vaccine also offers some protection against other less common cancers associated with HPV, including vaginal, vulvar, penile, anal and oropharyngeal cancers.

As part of the national HPV vaccination program, the vaccine is free for all children aged 12–13.

People who are already sexually active may still benefit from the HPV vaccine. Ask your doctor for more information. The HPV vaccine does not treat pre-cancerous cell changes or cervical cancer.

If you’ve been vaccinated, you will still need regular screening tests as the HPV vaccine does not provide protection against all types of HPV.

For more information, visit hpvvaccine.org.au.

Pre-cancerous cervical cell changes

Sometimes the squamous cells and glandular cells in the cervix start to change. They no longer appear normal when they are examined under a microscope.

These early cervical cell changes may be pre-cancerous. This means there is an area of abnormal tissue (a lesion) that is not cancer, but may lead to cancer. Only some people with pre-cancerous changes of the cervix will develop cervical cancer.

Pre-cancerous cervical cell changes are caused by certain types of the human papillomavirus (HPV). These cervical cell changes don’t have symptoms but can be found during a routine cervical screening test. 

There are two main types of cervical cell changes:

  • abnormal squamous cells
  • abnormal glandular cells.

Abnormal squamous cells 

These are called squamous intraepithelial lesions (SIL). They can be classified as either low grade (LSIL) or high grade (HSIL). SIL used to be called cervical intraepithelial neoplasia (CIN), which was graded according to how deep the abnormal cells were within the surface of the cervix:

  • LSIL, previously graded as CIN 1, usually disappear without treatment
  • HSIL, previously graded as CIN 2 or 3, are pre-cancerous. High-grade abnormalities have the potential to develop into early cervical cancer over ten to fifteen years if they are not found and treated. They can often be treated without affecting fertility.

Abnormal glandular cells

These are called adenocarcinoma in situ. They will need treatment to reduce the chance they develop into adenocarcinoma. Anyone with abnormal glandular cells in the cervix should be referred to a gynaecologist for a colposcopy.

Treating pre-cancerous cervical cell changes will prevent them developing into cervical cancer.  

Risk factors

There are several risk factors for cervical cancer.

Smoking and passive smoking

Chemicals in tobacco can damage the cells of the cervix, making cancer more likely to develop in people with a cervix who also have a human papillomavirus (HPV) infection.

Long-term use of oral contraceptive (the pill)

Research has shown that women who have taken the pill for five years or more are at increased risk of developing cervical cancer. The reason for this is not clear. The risk is small and the pill can also help protect against other types of cancer, such as uterine and ovarian cancers. Talk to your doctor if you are concerned.

Having a weakened immune system

The immune system helps rid the body of human papillomavirus (HPV). People with a weakened immune system are at increased risk of developing cervical cancer and need to have more frequent cervical screening tests. This includes peoplewith the human immunodeficiency virus (HIV) and people who take medicines that lower their immunity. Ask your doctor if this applies to you  and how often you should have a screening test.

Exposure to diethylstilbestrol (DES)

This is a synthetic (artificial) form of the human sex hormone oestrogen. DES was prescribed to pregnant women from the 1940s to the early 1970s to prevent miscarriage. Studies have shown that the daughters of women who took DES have a small but increased risk of developing a rare type of cervical adenocarcinoma.

Health professionals you may see

Your doctor will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will be referred to a specialist, such as a gynaecologist or gynaecological oncologist.  The specialist will arrange further tests.

If cervical cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care. . The table below describes the roles of the people who may be in your MDT.

Health professional Role
gynaecologist* specialises in treating diseases of the female reproductive system; may diagnose cervical cancer and then refer you to a gynaecological oncologist
gynaecological oncologist* diagnoses and performs surgery for cancers of the female reproductive system (gynaecological cancers), such as cervical cancer
radiation oncologist* treats cancer by prescribing and overseeing a course of radiation therapy
medical oncologist* treats cancer with drug therapies such as targeted therapy, chemotherapy and immunotherapy
radiologist* analyses x-rays and scans; an interventional radiologist may also perform a biopsy under ultrasound or CT, and deliver some treatments
cancer care coordinator coordinates your care, liaises with MDT members, and supports you and your family throughout treatment; may be a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
nurse administers drugs and provides care, information and support throughout treatment
dietitian recommends an eating plan to follow during treatment and recovery
social worker, psychologist links you to support services; helps with emotional and practical problems associated with cancer and treatment
women’s health physiotherapist treats physical problems associated with treatment for gynaecological cancers, such as bladder and bowel issues, sexual issues and pelvic pain

*Specialist doctor

Expert content reviewers:

Associate Professor Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecological Oncologists, Tas; Karina Campbell, Consumer; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, Vic; Associate Professor Jim Nicklin, Director, Gynaecological Oncology, Royal Brisbane and Women’s Hospital, and Associate Professor Gynaecologic Oncology, University of Queensland; Professor Martin K . Oehler, Director, Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Megan Smith, Program Manager – Cervix, Cancer Council NSW; Pauline Tanner, Cancer Nurse Coordinator – Gynaecology, WA Cancer & Palliative Care Network, WA; Tamara Wraith, Senior Clinician, Physiotherapy Department, Royal Women’s Hospital, Vic

The illustration on this page has been adapted from An abnormal Pap smear result – what this means for you (National Cervical Screening Program, 2006). Used by permission of the Australian Government.

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Cervical Dysplasia: Kimmel Cancer Center

The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.

Cervical dysplasia is the abnormal growth of cells on the surface of the cervix. Considered a precancerous condition, it is caused by a sexually transmitted infection with a common virus, the Human Papillomavirus (HPV).  Cervical dysplasia affects between 250,000 and one million women throughout the United States every year. Though women of any age can develop cervical dysplasia, the condition occurs most frequently in those between ages 25 and 35. With proper management and treatment, the condition may revert or improve before becoming cancerous. Although doctors have been able to screen for cervical cancer for more than half a century, it is the second leading cause of cancer deaths among women.

Cervical cancer, or invasive cervical cancer, occurs when abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs. Cervical cancer occurs most often in women over the age of 40. It is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas.

Risk factors

There are a few factors that increase a person’s chance of cervical cancer. Cigarette smoking, and even exposure to second-hand smoke, can triple a person’s risk of developing the condition. Having multiple sexual partners, especially those who have had multiple partners themselves, can increase the risk, though sometimes people can develop the condition from exposure to just one partner. People with compromised immune systems, such as those with HIV, transplant recipients or those taking immunosuppression drugs, also are at higher risk.

Symptoms

HPV infection and cervical dysplasia generally cause no symptoms. Regular gynecological visits including a pelvic exam and Pap test can identify the conditions. Then your physician can help manage them before they turn cancerous. In some cases, the body clears HPV infection on its own.

Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. The most common symptom is abnormal bleeding that starts and stops between regular menstrual periods, or that occurs after sexual intercourse, douching, or a pelvic exam. Other symptoms may include:

  • Heavier menstrual bleeding, which may last longer than usual
  • Bleeding after menopause
  • Increased vaginal discharge
  • Pain during intercourse

These symptoms may resemble other conditions or medical problems. Consult a physician for diagnosis.

Understanding HPV and Pap Test Results

Most women who receive abnormal cervical cancer screening results either have human papillomavirus (HPV) infections or have early cell changes that can be monitored (since they often go away on their own) or treated early (to prevent the development of cervical cancer). The information on this page can help you to learn more about abnormal cervical cancer screening results and follow-up tests and treatments.

On This Page

HPV Infection

Human papillomaviruses (HPVs) are a group of related viruses, some of which are spread through sexual contact. Some of these HPV types, called high-risk HPV, cause nearly all cases of cervical cancer. They can also cause anal cancer, penile cancer, vaginal cancer, vulvar cancer, and oropharyngeal cancer (cancer in the throat, usually the tonsils or the back of the tongue). 

Learn more about how HPV causes cancer in HPV and Cancer.

HPV Test and Pap Test

The HPV test and the Pap test are two different cervical cancer screening tests. Screening means checking for a disease or for changes that may develop into disease before there are symptoms. Women need routine cervical cancer screenings even if they feel fine. Screening can help find changes in cervical cells so you can receive the proper follow-up care and treatment you need to stay healthy. 

The HPV test checks cells for infection with high-risk HPV types.

The Pap test (also called a Pap smear or cervical cytology) collects cervical cells and looks at them for changes caused by HPV that may—if left untreated—turn into cervical cancer. It can also detect cervical cancer cells. A Pap test also sometimes finds conditions that are not cancer, such as infection or inflammation.

The HPV/Pap cotest uses a Pap test and HPV test together to check for both high-risk HPV and cervical cell changes.

What to Expect During an HPV or Pap Test

The cervix is part of the female reproductive system. It’s the lower, narrow end of the uterus, which leads to the vagina, as shown in the image above. The cervix opens during childbirth to allow the baby to pass.

Both types of cervical cancer screening tests are usually done during a pelvic exam, which takes only a few minutes. During this exam, you lie on your back on an exam table, bend your knees, and put your feet into supports at the end of the table. The health care provider uses a speculum to gently open your vagina in order to see the cervix. A soft, narrow brush or tiny spatula is used to collect a small sample of cells from your cervix.  

The sample of cervical cells is sent to a lab, where the cells can be checked to see if they are infected with the types of HPV that cause cancer (an HPV test). The same sample can be checked for abnormal cells (a Pap test). When both an HPV test and a Pap test are done on the same sample, this is called HPV/Pap cotesting.

A pelvic exam may include more than taking samples for an HPV and/or Pap test. Your health care provider may also check the size, shape, and position of the uterus and ovaries and feel for any lumps or cysts. The rectum may also be checked for lumps or abnormal areas. Most health care providers will tell you what to expect at each step of the exam, so you will be at ease. You may also ask to be tested for sexually transmitted infections (STIs).

Where to Get Cervical Cancer Screening: Clinics that Offer Screening

Doctors’ offices, clinics, and community health centers offer HPV and Pap tests. Many women receive these tests from their ob/gyn (obstetrics/gynecology) or primary care provider. If you don’t have a primary care provider or doctor you see regularly, you can find a clinic near you that offers cervical cancer screening by contacting:

Questions to Ask Before and After Your Exam

Before Your Exam:

Ask your health care provider:

  • What tests will I have?  
  • What is the purpose of these tests?
  • What will happen during the exam?
  • Will I have any discomfort?

Your health care provider may ask you:

  • What was the start date of your last menstrual period?
  • When did you have your last cervical cancer screening test? 
  • Have you ever had any abnormal test results or treatment for abnormal cells on your cervix?
After Your Exam:

Ask your health care provider:

  • When will I get my test results? 
  • How will I get these results (e.g., by mail, online, or a phone call)?
  • What phone number should I call if I do not get my test results?
  • When I get my results, will they explain what I should do next?

Screening Guidelines: When and How Often to Get Screened for Cervical Cancer

Cervical screening recommendations have been developed by several organizations, including the United States Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), and others.  

The details of the recommendations vary, but all are based on research findings, including:

  • HPV-caused changes in cervical cells happen slowly and often go away on their own, especially in younger women
  • more effective screening tests 
  • the harms of overtesting and overtreatment for cervical changes that would have gone away on their own

Age 21–29 years: USPSTF recommends that women get their first Pap test at age 21 and have Pap testing every 3 years. Even if a woman is already sexually active, Pap tests are not recommended until the age of 21.

Age 30–65 years: USPSTF recommends that women in this age group be screened for cervical cancer using one of these methods:

  • HPV test every 5 years
  • HPV/Pap cotest every 5 years
  • Pap test every 3 years

ACS has recently published updated cervical cancer screening guidelines that recommend women start screening at age 25 with an HPV test and have HPV testing every 5 years through age 65. However, testing with an HPV/Pap cotest every 5 years or a Pap test every 3 years is still acceptable. To read about the reasons for the changes, see ACS’s Updated Cervical Cancer Screening Guidelines Explained.

Older than 65 years: Women in this age group should talk with their health care provider to learn if screening is still needed. If you have been screened regularly and had normal test results, your health care provider will probably advise you that you no longer need screening. However, if your recent test results were abnormal or you have not been screened regularly, you need to continue screening beyond age 65.

Exceptions to the Guidelines

Your health care provider may recommend more frequent screening if you:

  • are HIV positive
  • have a weakened immune system
  • were exposed before birth to a medicine called diethylstilbestrol, (DES) which was prescribed to some pregnant women through the mid 1970s
  • had a recent abnormal cervical screening test or biopsy result
  • have had cervical cancer

Women who’ve had an operation to remove both their uterus and cervix (called a total hysterectomy) for reasons not related to cancer or abnormal cervical cells do not need to be screened for cervical cancer. However, if your hysterectomy was related to cervical cancer or precancer, talk with your health care provider to learn what follow-up care you need. Women who’ve had an operation to remove their uterus but not their cervix (sometimes called a partial or supracervical hysterectomy) should continue routine cervical cancer screening.

HPV Test Results: What a Positive or Negative Result Means

HPV test results show if high-risk HPV types were found in cervical cells. An HPV test will come back as a positive test result or a negative test result:

  • Negative HPV test result: High-risk HPV was not found. You should have the test again in 5 years. You may need to come back sooner if you had abnormal results in the past. 
  • Positive HPV test result: High-risk HPV was found. Your health care provider will recommend follow-up steps you need to take, based on your specific test result.   

HPV test results usually come back from the lab in about 1–3 weeks. If you don’t hear from your health care provider, call and ask for your test results. Make sure you understand any follow-up visits or tests you may need.

What does it mean if a woman has a positive HPV test after years of negative tests?

Sometimes, after several negative HPV tests, a woman may have a positive HPV test result. If you have a new sexual partner, this is most likely a new infection. If you do not have a sexual partner, or if you are in a monogamous relationship, this is not necessarily a sign of a new HPV infection, and it doesn’t mean that your partner has a new sexual partner. Sometimes an HPV infection can become active again after many years. Some other viruses behave this way as well; for example, the virus that causes chickenpox can reactivate later in life to cause shingles. 

There is no way to tell whether a newly positive HPV test result is a sign of a new infection or a reactivation of an old infection. Researchers don’t know whether a reactivated HPV infection has the same risk of causing cervical cell changes or cervical cancer as a new HPV infection.

Pap Test Results: What a Normal, Abnormal, or Unsatisfactory Result Means

Pap test results show if cervical cells are normal or abnormal. A Pap test may also come back as unsatisfactory.

  • Normal Pap test results: A normal test result may also be called a negative test result or negative for intraepithelial lesion or malignancy. If only the Pap test was done, you should have the next test in 3 years. If the Pap test was done together with an HPV test (this is called a Pap/HPV cotest), you can have the next test in 5 years. You may need to come back sooner if you had abnormal results in the past.
  • Abnormal Pap test results: An abnormal test result may also be called a positive test result. An abnormal test result does not mean you have cervical cancer. Possible abnormal findings on a Pap test include ASC-US, AGC, LSIL, ASC-H, HSIL, AIS, or cervical cancer. Your health care provider will recommend follow-up steps you need to take based on your specific test result and your past test results.
  • Unsatisfactory Pap test results: The lab sample may not have had enough cells, or the cells may have been clumped together or hidden by blood or mucus. Your health care provider will usually ask you to come in for another screening test in 2 to 4 months.  

Pap test results usually come back from the lab in about 1-3 weeks. If you don’t hear from your health care provider, call and ask for your test results. Make sure you receive your test results and understand any follow-up visits or treatments that you need.

  • Atypical Squamous Cells of Undetermined Significance (ASC-US) is the most common abnormal Pap test finding. It means that some cells don’t look completely normal, but it’s not clear if the changes are caused by HPV infection. Other things can cause cells to look abnormal, including irritation, some infections (such as a yeast infection), growths (such as polyps in the uterus), and changes in hormones that occur during pregnancy or menopause. Although these things may make cervical cells look abnormal, they are not related to cancer. Your health care provider will usually do an HPV test to see if the changes may be caused by an HPV infection. If the HPV test is negative, estrogen cream may be prescribed to see if the cell changes are caused by low hormone levels. If the HPV test is positive, you may need additional follow-up tests. 
  • Atypical Glandular Cells (AGC) means that some glandular cells were found that do not look normal. This can be a sign of a more serious problem up inside the uterus, so your health care provider will likely ask you to come back for a colposcopy. 
  • Low-Grade Squamous Intraepithelial Lesions (LSIL) means that there are low-grade changes that are usually caused by an HPV infection. Your health care provider will likely ask you to come back for additional testing to make sure that there are not more serious (high-grade) changes. 
  • Atypical Squamous Cells, cannot exclude HSIL (ASC-H) means that some abnormal squamous cells were found that may be a high-grade squamous intraepithelial lesion (HSIL), although it’s not certain. Your health care provider will likely ask you to come back for a colposcopy.
  • High-Grade Squamous Intraepithelial Lesions (HSIL) means that there are moderately or severely abnormal cervical cells that could become cancer in the future if not treated. Your health care provider will likely ask you to come back for a colposcopy. 
  • Adenocarcinoma in situ (AIS) means that an advanced lesion (area of abnormal growth) was found in the glandular tissue of the cervix. AIS lesions may be referred to as precancer and may become cancer (cervical adenocarcinoma) if not treated. Your health care provider will likely ask you to come back for a colposcopy. 
  • Cervical cancer cells (squamous cell carcinoma or adenocarcinoma) are sometimes found on a Pap test. However, this finding is very rare for women who have been screened at regular intervals. You can learn more about cervical cancer, including staging and treatment options, in Cervical Cancer Treatment (PDQ ®).  

These images show how cervical cells that have long-lasting infections with high-risk HPV can change over time and become abnormal. Abnormal cervical cells may also return to normal even without treatment, especially in younger women. LSIL and HSIL are two types of abnormal changes to cervical squamous cells.

Follow-up Tests and Procedures after an Abnormal Pap or HPV Test

Keep in mind that most women with abnormal cervical screening test results do not have cancer. However, if you have an abnormal test result, it’s important to get the follow-up care that your health care provider recommends. 

Next Steps after an Abnormal Pap Test, HPV Test, or HPV/Pap Cotest

Until recently, follow-up recommendations were based on the results of a woman’s most recent screening test. However, updated ASCCP risk-based management consensus guidelines advise a more tailored approach to follow-up care.  

What these updated guidelines mean is that, in addition to your current Pap, HPV, or cotest screening result, your health care provider will consider additional factors when recommending follow-up care, including:

  • previous screening test results,
  • previous treatments for precancerous cervical cell changes, and 
  • personal health factors, such as your age.

Based on your individual risk of developing severe cervical cell changes that could become cervical cancer, you may be advised to:

These updated guidelines focus on detecting and treating severe cervical cell changes that could develop into cervical cancer while also decreasing testing and treatment for less severe conditions (low-grade cervical cell changes). 

Colposcopy and Biopsy

Colposcopy and biopsy are two procedures that allow a closer look at the cells of your cervix.

During a colposcopy your health care provider inserts a speculum to gently open the vagina and view the cervix. A vinegar solution will be applied to the cervix to help show abnormal areas. Your health care provider then places an instrument called a colposcope close to the vagina. It has a bright light and a magnifying lens and allows your health care provider to look closely at your cervix. 

A colposcopy usually includes a biopsy. A small piece of cervical tissue will be removed, or a procedure called endocervical curettage will be used to take a sample of abnormal tissue from the cervix. These cervical cells are then checked under a microscope for signs of disease.

Talk with your health care provider to learn what to expect during and after your biopsy procedure. Some women have bleeding and/or discharge after a biopsy. Others have pain that feels like cramps during menstruation. 

Biopsy samples are checked by a pathologist for cervical intraepithelial neoplasia (CIN). CIN is the term used to describe abnormal cervical cells that were found on the surface of the cervix after a biopsy.

CIN is graded on a scale of 1 to 3, based on how abnormal the cells look under a microscope and how much of the cervical tissue is affected. LSIL changes seen on a Pap test are generally CIN 1. HSIL changes seen on a Pap test can be CIN 2, CIN2/3, or CIN 3.  

  • CIN 1 changes are mild, or low grade. They usually go away on their own and do not require treatment.
  • CIN 2 changes are moderate and are typically treated by removing the abnormal cells. However, CIN 2 can sometimes go away on its own. Some women, after consulting with their health care provider, may decide to have a colposcopy with biopsy every 6 months. CIN 2 must be treated if it progresses to CIN 3 or does not go away in 1 to 2 years.
  • CIN 3 should be treated right away, unless you are pregnant.

Treatment for High-Grade Cervical Cell Changes 

These treatments are used when a woman has high-grade cervical cell changes that have a high risk of developing into cancer.  

Treatments that remove abnormal cells are called excisional treatments:

  • Cold knife conization: A scalpel is used to remove a cone-shaped section of abnormal tissue. This procedure is done at the hospital and requires general anesthesia.
  • LEEP (loop electrosurgical excision procedure): A thin wire loop, through which an electrical current is passed, is used to remove abnormal tissue. Local anesthesia is used to numb the area. Your health care provider usually performs this procedure in the office. It takes only a few minutes, and you will be awake during the procedure.

Treatments that destroy abnormal cells are called ablative treatments:

  • Cryotherapy: A special cold probe is used to destroy abnormal tissue by freezing it. This procedure is done in your health care provider’s office. It takes only a few minutes and usually does not require anesthesia.
  • Laser therapy: A laser (narrow beam of intense light) is used to destroy abnormal tissue. This procedure is done at the hospital and general anesthesia is used.

Pregnancy and Treatment for High-Grade Cervical Cell Changes

If you are pregnant or plan to become pregnant, your health care provider will talk with you about procedures that are recommended for you and the timing of these procedures. Depending on your specific diagnosis, you may be treated postpartum, or after delivery.

Questions to Ask Before Treatment

  • What are the possible treatments for the condition that I have? 
  • Which treatment do you recommend for me, and why? 
  • What are the advantages and disadvantages of this treatment?
  • What will happen during the treatment?
  • What are the possible risks of this treatment? 
  • How might this treatment affect a future pregnancy?
  • How long will the procedure take? 
  • Will general anesthesia or local anesthesia be needed?
  • What side effects might I have from this procedure? How long might these side effects last?
  • Are there any activities that I should avoid after the procedure?

Precancerous Cervical Lesions and Associated Factors Among Women Atten

Background

Cancer is a general term used to refer to a condition in which the body’s cells begin to grow and reproduce in an uncontrollable way. 1 Persistent infection with cancer-causing HPV types is the cause of most cervical cancer.2 Cervical pre-cancer is a distinct change in the epithelial cells of the transformation zone of the cervix; the cells begin developing in an abnormal fashion in the presence of persistent or long-term HPV infection.2

According to Globocan (estimates for 2018), there were 569,847 new cases and 311,365 deaths of cervical cancer in 2018 worldwide. Cervical cancer is the second most common cancer in women living in less developed regions. Both the incidences and deaths (90%) are occurring in low and middle-income countries.3

According to Globocan, there were about 6,294 newly diagnosed cervical cancer cases and 4,884 cervical cancer deaths in 2018 (estimates for 2018) in Ethiopia, accounting for about 11.7% and 15.3% of total cancer cases and deaths in females, respectively. It is the second most commonly diagnosed cancer as well as the second leading cause of cancer related deaths in Ethiopia. 3

Cervical cancer (CC) is usually developed after a prolonged phase of pre-invasive lesions in the cervix. Therefore, early identification and treatment at its pre-invasive stage may benefit the clients and decrease the burden of morbidity and mortality resulting from cervical cancer.4

Visual Inspection with Acetic Acid (VIA) is one of the screening modalities of cervical pre-cancerous lesion.5 Screening with VIA in resource limited setting is the commonly preferred method compared to Human Papilloma Virus (HPV) test and cytological or Pap smear. This is because it does not need more advanced testing requirements (trained cytotechnicians or pathologists) and other program requirements.6

Recently in Ethiopia, cervical cancer screening centers are being established to provide screening services for all eligible women. It had reported VIA sensitivity for detecting precancerous lesions comparable to or greater than cervical cytology, while requiring fewer resources and feasible to carry out in low level health facilities. In addition, VIA provides immediate results, thus promoting linkage of screening with treatment. This “see and treat” method ensures adherence to treatment soon after diagnosis, and reduces the risk that women will get lost in the referral system. VIA combined with cryotherapy (freezing of precancerous lesions of the cervix), ideally a single visit approach (SVA), is an effective and efficient strategy for secondary prevention of cervical cancer in low resource settings, and can be conducted by competent clinicians and nurses.7

Evidence has shown that in the South-East Asia Region mortality rates from cervical cancer are very high due to the late stage at diagnosis and suboptimal therapeutic facilities which justifies the importance of VIA.8

Detection of cancer at an early stage may be considered as a marker for access to health care and preventive health services, including cervical cancer screening. Both incidence and mortality can be reduced by detecting precancerous lesions then prompt treatment which can prevent its progression, thereby increasing patient survival.9

Routine access to cervical cancer screening was not available and treatment for precancerous cervical lesions did not exist in Ethiopia until implementation of the Addis Tesfa project in 2009.10

The National Cancer Control Plan is a response by the FMoH and stakeholders to prioritize cancer Control in Ethiopia. The strategy aims to promote cancer prevention and early detection, and to improve diagnosis and treatment, including palliative care. It also aims to promote cancer surveillance, registration and research. The country has achieved some activities through this strategy such as cervical cancer information dissemination for community through health extension workers, HPV vaccination for before sexually active girls and expansion of cancer treatment services.1 The Ethiopian Health Sector Development Plan IV (HSDP-IV) is a policy in Ethiopia which includes the prevention and control of cancer.11 Based on this policy guidance, Federal Ministry of Health(FMoH) has recently designed and developed a national guideline on prevention and control of cancer.7

Identifying factors associated with the precancerous cervical lesion is important for planning a more targeted screening program to decrease the high morbidity and mortality of the disease in the country. However, the risk factors for cervical precancerous lesions among the general population in the setting of Ethiopia are not well identified. This study, therefore, aimed to find out the prevalence of precancerous lesion and associated factors among women of reproductive age group attending Adama Hospital and Medical College (Figure 1).

Figure 1 Conceptual framework of the study.

Methods

Study Area

The study was conducted at Adama Hospital and Medical College which is a regional referral hospital established 77 years ago (1946). It is one of the hospitals in Oromia with a high patient load and located at Adama town. It is about 98 km east of Addis Ababa. Adama hospital and Medical College started cancer screening in 2010 E.C and serves as referral center for surrounding health centers.

Study Design and Period

Hospital based cross-sectional study was carried out from June11 to July 11, 2019.

Source Population

The source population was all women of reproductive age group who came for cervical cancer screening.

Study Population

The study population was all women of reproductive age group who came for cervical cancer screening at Adama Hospital Medical College cervical screening center during study period.

Sample Size Determination

The sample size was determined using a single population proportion formula (n = (Zα/2) 2P (1-p)\d2). Prevalence of precancerous lesion is 6.7%, taken from study conducted in Adwa, North Ethiopia,12 3% margin of error, 95% CI were considered to estimate the optimal sample size. Hence, the final sample size was 293.

Sampling Procedure

Based on a prior month’s facility report before data collection, 598 women were reported to have been screened for precancerous lesion. Considering the report as a source population, a sample of 293 was selected using systematic random sampling method. The first study subject was selected by lottery method and then every 2nd woman coming for the test was selected till the required sample size was achieved.

Study Variables

Independent variable for the study was precancerous lesion.

Socio-demographic characteristics of the study participants like age, marital status, educational level, occupation, religion and average monthly income were used.

Others like number of children, age of first intercourse, number of sexual partners, history of sexual transmitted infections and women’s HIV status were also considered as independent variables in the study.

Data Collection Instrument and Procedure

Questionnaire adapted from similar studies and visual inspection with acetic acid were used to collect data. The questionnaire was prepared in English and then translated to local languages (Afan Oromo and Amharic) by legal translators of respective languages, then back translated to English to check for consistency and ensure the quality of translation.13

Screening using VIA was done by two already trained midwives who were working at cervical cancer screening and treatment center.

Before performing the VIA test, the procedure was explained to each woman. External genitalia were opened and urethral opening was checked for discharge. Skene’s and Bartholin’s glands were palpated.

Using speculum, cervix was checked for evidence of infection (cervicitis) such as whitish purulent discharge (mucopus), ectopy (ectropion), grossly apparent tumors or Nabothian cysts, ulcers or “strawberry” lesions (Trichomonas infection). Clean cotton swab was used to remove any discharge, blood or mucus from the cervix. Then, a clean swab in dilute acetic acid solution was soaked and applied to the cervix. This was repeated until the cervix has been thoroughly washed with acid (if necessary) and waited for 2 minutes to observe the cervix for acetowhite changes. Squamo-columnar junction carefully inspected. Cervix was also carefully checked for easily bleeds. The area was carefully inspected for any raised and thickened white plaques or acetowhite epithelium.

During inspection acetic acid swab was reapplied to cervix to remove any mucus, blood or debris that develops as it may obscure the view. At the end of the procedure, a fresh cotton swab was used to remove any remaining acetic acid from the cervix and vagina. For positive VIA test results, women were counseled and linked for immediate treatment. Infection prevention strategies were carefully used throughout and after the procedure.

Data Quality Control

The questionnaire was pre-tested in 20 women in Bishoftu Hospital which is outside of the study area. Following pre-test, necessary modification was made to the questionnaire. Regarding survey questionnaire, two days training was given to data collectors and supervisors on basic technique of conducting interview including research ethical principles.

Supervision was strictly done during data collection and VIA testing. Filled questionnaires were checked for completeness and consistency on daily basis and addressed.

Data Processing and Analysis

Data was cleaned, coded, entered in to Epi version 7 and exported to SPSS version 20.1 for analysis. Bivariate and multivariate logistic regression analysis was used to measure the association between variables. Variables with P-value < 0.2 in the bivariate analysis were included in the multivariate logistic regression model. Adjusted odds ratio with its 95% CI and P value less than 0.05 was used to decide about the presence of association.

Operational Definitions

VIA Positive test result was when raised and thickened white plaques or aceto-white epithelium, usually near Squama-columnar junction is seen while VIA Negative test result was when smooth, pink, uniform and featureless cervix, cervical ectropion, polyp, cervicitis, inflammation and/or cyst after applying dilute solution of acetic acid is seen.7

Results

Socio-Demographic Characteristics of Women Interviewed

The total of 293 women of reproductive age group who came to Adama Hospital Medical College cervical screening center for cervical cancer screening during study period were included in the study making response rate 100%. The mean (±standard deviation) age of participants was 35.97+5.87 years old. About 83 (28.3%) participants were in the age range of 36–40 years followed by 82 (28%) who were in the age range of 31–35 years. Close to the half, 139 (47.4%) were Orthodox religion followers. With regards to educational status, 109 (37.2%) had primary education followed by 81 (27.6%) who had no formal education. Around two thirds, 202 (68.9%), were married. By occupation, 135 (46.1%) were housewife (Table 1).

Table 1 Socio-Demographic Characteristics of Women Attending Precancerous Cervical Lesion Screening at Adama Hospital Medical College, 2019

Clinical and Sexual Behavior

All study participants had never been screened for cervical cancer before. About 182 (62.1%) of the study participants reported that they started their first sex at the age of 18 and above. Three fourths of them, 224 (76.5%), had never used condom in their lifetime. Forty-five (15.4%) had history of pelvic infections and 71 (24.2%) had history of sexual transmitted diseases. About 108 (36.9%) had a history of multiple sexual partners. One hundred and twenty five (43.8%) were tested positive for HIV (Table 2).

Table 2 Clinical and Sexual Behavior of Women Attending Precancerous Cervical Lesion Screening at Adama Hospital Medical College, 2019

Prevalence of Precancerous Cervical Lesion

Out of the total 293 screened women, 15.7% (95% CI: 11.3%-20.1%) were found to be positive for precancerous cervical lesion (Figure 2).

Figure 2 Prevalence of precancerous lesion among women attending precancerous cervical lesion screening at Adama Hospital Medical College, 2019.

Factors Associated with Cervical Precancerous Lesions

Variables with P-value < 0.2 on bivariate analysis were included in the multivariate logistic regression model. On multivariate analysis, after controlling for the effect of other confounding factors, four variables – absence of menses, history of pelvic infection, history of STI, and having partner who had another partner – were found to be significantly associated with precancerous cervical cancer at p-value below 0.05 (Table 3).

Table 3 Factors Associated to Cervical Precancerous Lesions Among Women Attending Precancerous Cervical Lesion Screening at Adama Hospital Medical College, 2019

Odds of having cervical precancerous lesion among women who had no menses were 82% less likely to develop precancerous cervical lesions compared to those women who had regular menses (AOR = 0.18: 95% CI: 0.04, 0.87). Women who had history of pelvic infection were 2.82 times more likely to have cervical precancerous lesion compared those that did not have history of pelvic infection (AOR = 2.82: 95% CI: 1.21, 6.59) (Table 3).

Women who had history of STI were 2.65 times more likely to have cervical precancerous lesion compared to their counterparts [AOR = 2.65: 95% CI: 1.26, 5.56). Women who had partner having another sexual partner were 2.41 times more likely to have precancerous cervical lesion compared to those who have single partner (AOR = 2.41: 95% CI: 1.08, 5.38) (Table 3).

Discussion

The aim of our study was to assess precancerous cervical lesions and associated risk factors among women attending cervical screening at Adama Hospital Medical College, Central Ethiopia, using Visual Inspection with acetic acid (VIA) screening method. From 293 women screened for precancerous cervical lesions, 46 (15.7%) of them were found to be positive for the lesion. This finding was almost consistent with studies conducted in Addis Ababa (12.8%),13 Yirgalem General Hospital, southern Ethiopia (16.5%)14 and Jimma model clinic of Family Guidance Associating (12.9%).15

However, findings from our study were higher than a study in Rwanda which showed 5.9% precancerous cervical lesion among similar study population.16 The discrepancy might be due to difference in socio-demographic characteristics of the study participants. Differences in availability or accessibly of screening and treatment services among the two countries may also contribute to the discrepancies between the compared findings. Our finding was also higher than the study conducted in the North part of Ethiopia which showed 6.7% precancerous cervical lesion.12 This could be due to study area and study period difference.

The results of our study highlighted a number of health related risks that could increase the women’s chance to develop cervix cancer. The risks are merely inherent to the reproductive health: menstrual history, history of pelvic infection, history sexually transmitted infections, and having partner who had another partner.

In this study, women who did not see menses were 82% less likely to have precancerous cervical lesion compared to those who had regular menstrual history. This could be attributed to women’s practices during menstruation which could expose them to several risks. Materials used for protection during menstruation could contribute to heightened risk of human papillomavirus infections. Studies reported that these practices are potentially harmful. The re-use of washed cloths is particularly risky as the human papillomavirus has been detected in menstrual blood and vaginal discharge.17 It is obvious that the association between certain strains of HPV and cervical cancer is already well established.18 Disappearance of the menses could also be related to using some type of contraceptive which could reduce/interrupt/prevent women’s menses. Finding from other study also stipulated that women who have a hormonal intrauterine device (IUD) may experience lighter or no menses, because Levonorgestrel released from IUD prevents the ovaries from releasing eggs.19 On the other hand, study also showed that women who had ever used an intrauterine device (IUD) had a lower risk of cervical cancer.20

Finding from this study also showed that women who had history of pelvic infection were more likely to have precancerous cervical lesion compared to those who did not have history of pelvic infection. This could be due to the fact that HPV infection is the known cause for pelvic infection and cervical lesion as well.18,19

In our study, women who had history of STI were more likely to have cervical precancerous lesion as compared to those who did not have the infections. This result was supported by study from Swaziland.20 This finding was also in agreement with the studies conducted in Ethiopia12,14 which identified aceto-white lesion positive women who had been suffering from sexual transmitted diseases. Similarly, this finding was also supported with another study conducted in central part of Ethiopia.21 This could be due to the fact that HPV infection is the most common cause of sexually transmitted disease which can also cause cervical lesion.19 Study also reported that HPV prevalence was found to be significantly higher among patients with PID, suggesting that patients suffering from PID apparently have a higher risk of cervical cancer.20

This study also found that women who had a partner having another sexual partner were more likely to have precancerous cervical lesion compared to those who had partner not having another sexual partner. This result was consistent with studies conducted in Swaziland,23 Rwanda,16 and Ethiopia.13,22 This could imply that women who have a sexual partner having another sexual partner have a higher risk of acquiring HPV infection which then causes precancerous cervical lesion.

Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedures for early cervical lesions especially in setting (middle and low income countries) where medical facilities are limited, provided by trained health workers. It is a safe, acceptable, and effective test that can save lives from cervical cancer even in remote areas with few resources.24,25 Although VIA reveals precancerous cervical lesion with more accuracy than even a typical Pap smear, yet it also has more false positive test results which could be mentioned as a limitation of our study.25 The study was conducted in facility level, which may limit generalizability of the findings to all women, particularly to those in rural areas.

Conclusion

The magnitude of precancerous cervical lesion among women of reproductive age group at Adama Hospital and Medical College was 15.7%. Menstrual history, history of pelvic infection, having STI, and had sexual partner who have another sexual partner were found to be predictors for precancerous cervical lesion.

Abbreviations

AIDS, Acquired Immuno Deficiency Syndrome; CC, Cervical Cancer; CCS, Cervical Cancer Screening; CIN, Cervical Intraepithelial Neoplasia; EFMOH, Ethiopia Federal Ministry of Health; HIV, Human Immunodeficiency Virus; HPV, Human Papilloma Virus; HSDP-IV, Health Sector Development Plan-IV; PCCL, Precancerous Cervical Lesion; SCJ, Squamo-Columnar junction; STI, Sexual Transmitted Infections; SVA, Single Visit Approach; VIA, Visual Inspection with acetic acid.

Data Sharing Statement

Data sets supporting the presented findings were incorporated into the manuscript. For detail contact the corresponding author.

Ethics Approval and Informed Consent

Ethical clearance was obtained from Arsi University College of health science ethical review board. Permission letter was written to Adama Hospital Medical College Precancerous cervical lesion screening unit. We conducted the study in accordance with the ethical principles of the Declaration of Helsinki. All the study participants were informed about the purpose of the study and written consent was obtained from each before data and sample collection. Participants were also informed that they have full right not to participate or to discontinue at any point in the process of data/sample collection. Each respondent was also assured that information they provided was confidential and used only for the purpose of this study. Study participants whose VIA test result was found to be positive and cancer was suspected, they counseled and linked to treatment center for immediate initiation of the recommended treatment.

Consent for Publication

Not applicable.

Acknowledgments

First we would like to thank Adama Hospital and Medical Collage for providing the chance to conduct this study. We would like to also express our deepest appreciation to study participants, data collectors and supervisor for their active and unreserved involvement in the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The whole research fund was covered by Oromia Regional Health Bureau and authors. However the university had no role in the design of the study, collection, analysis, interpretation of data and in writing the manuscript.

Disclosure

The authors declare that there is no conflict of interests.

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Cervical dysplasia: MedlinePlus Medical Encyclopedia

American College of Obstetricians and Gynecologists. Practice Bulletin No. 168: cervical cancer screening and prevention. Obstet Gynecol. 2016;128(4):e111-e130. PMID: 27661651 pubmed.ncbi.nlm.nih.gov/27661651/.

American College of Obstetricians and Gynecologists. Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338-1367. PMID: 24264713 pubmed.ncbi.nlm.nih.gov/24264713/.

Armstrong DK. Gynecologic cancers. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 189.

Freedman MS, Hunter P, Ault K, Kroger A. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older – United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(5):133-135. PMID: 32027627 pubmed.ncbi.nlm.nih.gov/32027627/.

Hacker NF. Cervical dysplasia and cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore’s Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 38.

Immunization Expert Work Group, Committee on Adolescent Health Care. Committee Opinion No. 704: human papillomavirus vaccination. Obstet Gynecol. 2017;129(6):e173-e178. PMID: 28346275 pubmed.ncbi.nlm.nih.gov/28346275/.

Robinson CL, Bernstein H, Poehling K, Romero JR, Szilagyi P. Advisory Committee on Immunization Practices Recommended immunization schedule for children and adolescents aged 18 years or younger – United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(5):130-132. PMID: 32027628  pubmed.ncbi.nlm.nih.gov/32027628/.

Salcedo MP, Baker ES, Schmeler KM. Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva): etiology, screening, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 28.

Saslow D, Solomon D, Lawson HW, et al; ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172. PMID: 22422631 pubmed.ncbi.nlm.nih.gov/22422631/.

US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674-686. PMID: 30140884 pubmed.ncbi.nlm.nih.gov/30140884/.

90,000 Diseases of the cervix. Diagnostics and treatment of cervical diseases – Gyneko – gynecological clinic

Diseases of the cervix – not just a small gynecological problem, but a real risk of developing oncology.

In most cases, diseases of the cervix are almost asymptomatic and are detected during a woman’s visit for a routine examination to the doctor. That is why all women, at least twice a year, are recommended to undergo preventive examinations by a gynecologist.

Sometimes changes in the cervix can manifest itself in the form of bloody discharge from the genital tract, not associated with the menstrual cycle, often occurring after intercourse or physical exertion. This serves as a mandatory reason for an unscheduled visit to the doctor.

The cause of cervical diseases can be hormonal disorders, severe traumatic childbirth, abortion, infectious and inflammatory diseases, a general weakening of the immune system.

Diagnosis of diseases of the cervix

The main means of timely diagnosis of cervical diseases is a regular examination by a gynecologist. For this, in addition to visual examination of the cervix in the mirrors, more accurate examination methods are used, such as colposcopy (examination of the cervix using a special microscope) and cytological examination of scrapings from the cervix (PAP test).

The cervix is the part of the uterus that can be viewed through the vagina.Inside it is the cervical canal, which leads to the uterine cavity. There are 2 parts of the cervix: the internal endocervix (facing the cervical canal) and the external exocervix (located on the side of the vagina). The surface of the endocervix is ​​normally covered with a cylindrical epithelium, and the exocervix is ​​covered with a flat epithelium. Only in girls, up to a certain age, the cells of the columnar epithelium extend beyond the inner part of the cervix and cover the outer part of the cervix.This variant of the norm is usually called “congenital erosion”.

The area located at the junction of the outer and inner parts of the cervix is ​​called the transformation zone. This is an extremely important area that is a source of reserve cells. This type of cell is capable of transforming into cells of both squamous and columnar epithelium. It is here that most often there are various processes that can cause various diseases of the cervix.

Diseases of the cervix

The main pathologies of the cervix include:

  • Cervical erosion is a change in which a section of columnar epithelial cells of various sizes is determined in the outer part of the cervix (exocervix).Most often, cervical erosion looks like a “wound” or damaged area;
  • leukoplakia of the cervix – this whitish spot on the cervix can be compared to a kind of callus. This disease is most often viral in nature. Leukoplakia can progress with the development of precancerous conditions.
  • endometriosis – proliferation of cells of the inner layer of the uterine wall outside of it;
  • polyps – the appearance of neoplasms of various structures on the mucous membrane of the cervical canal.
  • ectropion is an eversion of a portion of the cervical canal towards the vagina. Most often occurs after childbirth.
  • retention cyst of the cervix (nabot cysts) – the appearance of closed and dilated glands in the cervix, filled with secretions accumulated in them;
  • papillomas and condylomas of the cervix – viral manifestations on the cervix;
  • Cervical dysplasia is a precancerous disease characterized by the presence of atypical cells with a high risk of malignancy.
  • cervical carcinoma – cervical cancer.

Treatment of cervical diseases

Among the various options for the treatment of diseases of the cervix, in modern medicine preference is given to the radio wave method. The time has passed when “moxibustion” left scars and was a contraindication for nulliparous patients. Now it is possible to cure the disease and eliminate the threat of cervical cancer with the help of an effective and painless radio wave procedure on the Surgitron apparatus.

This technique is the gold standard for the treatment of cervical diseases, suitable for nulliparous patients, performed on an outpatient basis by experienced gynecological surgeons.

Gynecology: Diseases of the cervix – diagnosis and treatment in St. Petersburg, price

In the structure of gynecological pathology, the leading position is occupied by diseases of the cervix. Therefore, every woman with the onset of puberty is recommended to undergo regular examination by a gynecologist.

It is not news that cervical diseases can result in the development of cervical cancer, and this pathology is increasingly common among young women giving birth and middle-aged women who do not present any complaints. The need for early diagnosis is important because the process of cancer formation is staged and includes underlying and precancerous diseases, cancer in situ (cancer in situ) and advanced cervical cancer.In this regard, the study of both benign and precancerous diseases is of great preventive value.

Risk factors for cervical disease include bacterial and viral infections, especially human papillomavirus (HPV) and herpes simplex virus (HSV). The role of HPV in cervical cancer has been proven. Also, risk factors include: early onset of sexual activity and early first pregnancy (up to 16 years), many sexual partners, unprotected intercourse, cervical trauma during childbirth and abortion, smoking, menstrual irregularities, immunodeficiency.

Classification of diseases of the cervix

1. Background diseases

38% of women of different ages are susceptible to the development of background diseases of the cervix, which include:

  • Ectropion – eversion of the mucous membrane of the cervical canal (typical for women giving birth).
  • Erosion of the cervix – a defect in the epithelium covering the vaginal part of the cervix. True erosion is extremely rare, therefore, under the erosion of the cervix, they most often mean a defect in the mucous membrane, which is also called pseudo-erosion or ectopia.In this disease, the multilayer squamous epithelium of the cervix is ​​replaced by cylindrical cells from the cervical canal.
  • Polyp of the cervical canal – focal proliferation of the mucous membrane of the cervical canal. Polyps, as a rule, are formed as a result of chronic inflammation and must be removed.
  • Cervical papilloma is one of the clinical manifestations of the human papillomavirus.
  • Exo – and endocervicitis – inflammation of the cervix.
  • Leukoplakia is also the result of a viral lesion of the cervix.
  • Endometriosis – the appearance of foci (“eyes”) of the endometrium on the cervix.
2. Precancerous diseases
  • Cervical dysplasia of various degrees – characterized by the presence of altered cervical epithelial cells. As a rule, it does not cause any symptoms and can be detected during a routine routine examination in mirrors and in a smear for oncocytology.Necessarily requires clarification and treatment.
3. Oncological diseases of the cervix

Currently, this pathology is “getting younger” and is often found in young nulliparous women. The leading cause of occurrence is the human papillomavirus (HPV). There are many types of this virus, but the main oncogenic types have been identified – 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. The “gold standard” in the detection of cervical cancer is the annual examination : smear for oncocytology, and, if necessary, an in-depth examination (colposcopy, cervical biopsy).

Identification of cervical pathology occurs during an outpatient examination of the patient and includes:

Primary:

  • Cytological examination of smears from the surface of the cervix and cervical canal.

According to indications:

  • Extended colposcopy using 3% acetic acid and 2% Lugol’s solution (under the control of a microcolposcope, the color and relief of the cervical mucosa, features of the vascular pattern, the epithelium junction are visually assessed).
  • Cervical biopsy – taking material from the cervix with subsequent histological examination.
  • Curettage (scraping) of the cervical canal.
  • Examination for infections and vaginal flora.
  • Study of hormonal status.
  • Immunogram.

Treatment of diseases of the cervix

  1. 1.Local therapy in accordance with the results of the examination carried out during 2-3 menstrual cycles (sanitation of the vagina using suppositories or solutions).

  2. 2. Destruction of the cervix:

  • Laser vaporization (exposure to a low intensity laser beam).
  • Chemical coagulation (the cervix is ​​treated with special preparations).
  • Cryodestruction (use of liquid nitrogen).
  • Diathermocoagulation (electric shock).
  • Diathermoconization (exposure to electric current with removal of altered tissue).

Timely detection and adequate treatment of background and precancerous diseases of the cervix prevents the occurrence of its malignant transformation. Therefore, the treatment of diseases of the cervix should not be postponed and treat this pathology as something insignificant.Be responsible for your own health!

Cervical diseases: how they are diagnosed and treated

The cervix with one end extends into the vagina, and the other into the uterine cavity itself. The inner walls of the organ have a very thin layer of epithelium, which means that tissues are easily damaged and become vulnerable to bacteria and various viruses. In the absence of appropriate preventive monitoring, you can miss important symptoms of the development of diseases and, as a result, not have time to prevent the development of cancer problems on the cervix and other serious problems.

Varieties of pathologies

All diseases of the cervix have different symptoms and are caused by a variety of viruses or bacteria. There are also some pathologies provoked by tissue trauma. Among the most common diagnoses are the following:

  • Cervicitis. It consists in an inflammatory process that is asymptomatic or accompanied by pus and mucous discharge with abdominal pain. Appears against the background of viral infections, can develop under the influence of E. coli or parasites, and can also be caused by ingestion of streptococci and staphylococci
  • Erosion .Violation of the integrity of the mucous membrane on the surface of the external cervical os. Visually looks like a reddened spot. It occurs due to inflammation and hormonal disorders, and can result from trauma. It manifests itself as painful sensations during sex, during menstruation or during urination, can provoke purulent and unusual discharge
  • Ectopia (pseudo-erosion). The epithelium at the same time gets a bright red color, outwardly the spots are similar to erosive ones. Congenital and completely asymptomatic ectopia does not require treatment, you just need to be observed by a doctor.Traumatic or infectious requires appropriate treatment
  • Cyst (closed nabotova cyst). Occurs when the glands of the mucous membrane on the cervix are blocked and look like light, small balls containing mucus. They are removed by radio waves, and it is also permissible to open and drain damaged areas, after which you can cauterize the tissue.
  • Dysplasia. The cellular structure on the mucous membrane of the cervix is ​​disturbed, a pathological tissue change occurs.The causes of the problem are erosion and ectopia, which were not promptly treated. It can also occur against the background of leukoplasia or human papillomavirus. Has no symptoms at first, but then there is a lingering pain in the lower abdomen
  • Leukoplakia. Represents keratinization of the mucous membrane on the cervix, outwardly similar to white spots or a film with a milky tint. May be accompanied by post-sex ichor or mild pain. Women with this diagnosis cannot tolerate pregnancy.Causes of the disease – hormonal disruptions, mucosal injury or infection
  • Ectropion. Injury to the mucous membrane during abortion or childbirth sometimes leads to eversion of the mucous membrane in the vagina. Is accompanied by pain in the lower abdomen, as well as irregularities in the cycle of menstruation in a woman
  • Polyps. Benign small tumors are formed on the mucous membrane of the pharynx of the cervix and are clearly visible on examination. It is possible to eliminate polyps by scraping (hysteroresectoscopy)
  • Condylomatosis. Appears in the form of overgrown connective tissues on the surfaces of the cervical mucosa, which eventually provokes the onset of cancer. The cause of the problem is the human papillomavirus, which can be transmitted sexually. It is accompanied by itching and burning, bleeding, is treated systemically

Cervical diseases cannot be treated at home on their own, and wrong approaches cause negative consequences, provoking serious complications. Sometimes the pathology of the cervix is ​​so difficult to diagnose that the doctor, even after examination, cannot draw appropriate conclusions about the diagnosis without special tests in a professional laboratory.Treatment in each case is individual and assigned after the diagnosis is strictly under the supervision of doctors.

Diagnosis of diseases of the cervix

In order to correctly determine what kind of cervical pathology the patient has, it is necessary to fully examine the person and conduct the following studies:

  • Cytological examination. It includes scraping of the epithelium, allowing to determine the development of cancerous or even precancerous diseases
  • Swabs for infections and flora. Materials for research are collected from the mucous membrane, after which, during laboratory research, the tissues are stained with special agents. This allows you to determine the presence of fungal infections and bacteria in the body
  • Colposcopy. Detailed examination with a binocular-like colposcope with integrated lighting. This allows you to view and enlarge the surveyed areas in detail, and a twenty-fold increase provides an appropriate result. Colposcopes can be both digital and optical or video colposcopes
  • Biopsy. At the same time, some fabrics are taken in order to study them separately. This is one of the most accurate and correct methods for diagnosing diseases and pathologies of the cervix. Biopsy examines the cervix for early detection of cancer or precancerous cells
  • Cervicoscopy. Inspection is carried out using a special device – a cervicoscope. This makes it possible to visualize the epithelium and assess the condition of all areas of the damaged mucosa.It also allows you to accurately identify the affected areas and make an accurate and correct sampling of material
  • Ultrasound of the pelvic organs. Standard ultrasound examination that can be done through the abdomen and vagina and through the rectum. This requires special preparation: it is necessary to exclude carbonated drinks and fatty foods 2 days before the study, and also refuse salty and spicy, raw vegetables and fruits, as well as dairy products during this period

Professional obstetricians-gynecologists work in our clinic in Mytishchi, who will conduct a competent examination using modern equipment.This will make it possible to correctly diagnose and then prescribe the appropriate treatment for the pathology of the cervix. If treatment is prescribed in a timely manner, then you can quickly get rid of the problem and not have serious complications in the future.

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90,000 Cervical pathology – Women’s Health Clinic

Every year, more than half a million women are diagnosed with cervical cancer, with about 200,000 fatalities. Over the past 20 years, there has been a clear tendency to “rejuvenate” precancer and cervical cancer, which ranks first among all oncogynecological diseases in women under 30 years of age.

Diagnosis of diseases of the cervix, vulva and vagina:

  • cytology (PAP test)
  • HPV test
  • colposcopy
  • biopsy of the cervix, vulva and vagina with histological examination
  • tumor markers
  • Cytological examination

Cytology is the first key step in examining the cervix. In addition, this method allows detecting very early pathological changes occurring at the cellular level, including in the absence of visible changes.The material is taken with special cervical brushes. This manipulation is completely painless. Further, the drug is processed with a special fixing solution and sent to the laboratory, where, after a detailed study of the drug, a detailed cytological report is issued.

  • Human papillomavirus test.

In modern conditions, HPV – the test must be carried out along with the cytological method of research, because it has a higher sensitivity compared to the cytological method of research, which makes it possible to diagnose HPV with a high degree of probability – associated lesions of the cervix, vagina and vulva at the early stages of its development.

Colposcopy – a method of examining the mucous membrane of the vulva, vagina and the vaginal part of the cervix using an optical device – a colposcope. A colposcope is a special microscope with an illumination source that allows you to view an object with a magnification of several tens of times.

Various diseases of the cervix are characterized by specific colposcopic pictures that can only be interpreted by an experienced colposcopist. The procedure is painless and does not require any special preparation of the patient.

In the women’s health clinic, an examination of the cervix, vagina, vulva is carried out using an expert class colposcope. Colposcopy helps to identify altered areas with atypical epithelium, which allows targeted biopsy.

  • Biopsy of the pathological area of ​​the cervix

followed by morphological examination allows the final diagnosis to be established, if this cannot be done using colposcopy, cytological examination, HPV testing.

Ectopia of the cervix

Ectopia of the cervix is ​​not a disease, but it is necessary to carry out colposcopic and cytological studies to exclude the pathology of the cervix that is hidden during a routine examination. Ectopia is congenital.

In girls, for a number of reasons, the border of the junction of the epithelium remains on the vaginal part of the cervix, that is, while the columnar epithelium is located outside the cervical canal. Patients with ectopia most often do not complain, but they can sometimes be bothered by leucorrhoea (discharge from the genital tract), spotting from the vagina after intercourse.

Cervical erosion

Erosion of the cervix (true erosion) – a violation of the integrity or change in the epithelial cover of the vaginal part of the cervix. When viewed with the help of mirrors, areas of bright red color around the external os of the cervix are determined.

Literally the word “erosion” is “ulcer”, in other words – a defect in the epithelial integument. The formation of this defect can be a consequence of inflammatory diseases of the cervix (more often of a viral, herpetic origin), its injury by barrier and chemical contraceptives, as a result of inept douching.Ulceration is also formed during the cancerous process. Examination and treatment are required.

Cervical ectropion

Ectropion is an eversion of the mucous membrane of the cervical canal that occurs after childbirth, traumatic dilatation of the cervix during abortion and diagnostic curettage.

One of the common complaints is profuse discharge from the genital tract. An examination is necessary, if necessary, treatment.

Leukoplakia of the cervix, vulva

Leukoplakia is a violation of the maturation of the epithelium, characterized by the appearance of plaques on the mucous membranes.The causes of this pathology are varied: infection, injury, hormonal imbalance and immunity.

This disease does not manifest itself in any way, however, it can often accompany precancerous processes. Before treating this disease, it is recommended to take a biopsy from the altered area of ​​the cervical mucosa.

Cervicitis (exo- and endocervicitis)

Cervicitis is an inflammatory disease of the cervix. Cervicitis is divided into exocervicitis – inflammation of the vaginal part of the cervix and endocervicitis – inflammation of the cervical canal of the cervix.Basically, they are combined with inflammation of the vagina or are its consequences.

Cervicitis can be caused by pathogens of specific and non-specific etiology. Specific cervicitis is caused by the following sexually transmitted infections: gonococcus, Trichomonas, chlamydia, ureplasma. Nonspecific cervicitis is caused by opportunistic microorganisms: gardnerella, fusobacteria, clostridia, etc. (bacterial vaginosis), fungi of the genus Candida, Escherichia coli, enterococci, staphylococci, streptococci, Proteus, Pseudomonas aeruginosa, etc.

Acute cervicitis is characterized by profuse mucous or purulent discharge from the genital tract, itching, burning, contact bloody discharge. In the chronic stage, discharge may be insignificant. It is necessary to carry out treatment depending on the identified pathogen. In some cases, with chronic cervicitis, destructive treatment is carried out using a CO2 laser, radiosurgery, and cryosurgery.

Cervical polyp

Cervical polyp is a tumor-like formation growing from the wall of the cervical canal of the cervix.Polyps of the cervical canal, like polyps of other localizations, can be single and multiple.

The reasons for the formation of polyps are considered to be hormonal disorders, chronic inflammatory processes, and sometimes mechanical trauma. Treatment of cervical polyps is reduced to the removal of polyps (subsequent histological examination is required).

Cervical dysplasia

Cervical dysplasia is a precancerous disease of the cervix. There are several degrees of dysplasia: mild, moderate, and severe.Moderate and severe cervical dysplasia is, as a rule, a consequence of infection with papillomavirus infection associated with viruses of high risk of carcinogenicity – types 16, 18, 31, 33, 35, 39, 5, 51, 52, 56, 58, 59, 68 .. Clinically, cervical dysplasia may not manifest itself in any way. Examination, diagnosis and treatment are essential!

Genital warts of the cervix, vulva and vagina

Genital warts of the cervix, vulva and vagina are warty growths on a short stalk.

Papillomas can be located in the form of clusters or single formations. Depending on the location, genital warts can be flesh-colored, pale pink, or red. However, they can be painful, itchy, easily injured. Most often, genital warts are detected in the area of ​​the entrance to the vagina, on the large and small labia, less often on the cervix, as well as on the perineum and around the anus. In pregnant women, genital warts can be found on the fornices of the vagina and on the vaginal part of the cervix.During the rapid growth of genital warts, a burning sensation may be felt, ulceration and secondary infection with genital warts are possible. At the same time, pain, itching and an unpleasant odor are noted. Genital warts of the urethra can lead to difficulty urinating. The cause of genital warts is infection with non-oncogenic types (6, 11) of the human papillomavirus.
Treatment of patients with genital warts consists in the impact on the lesion. At the same time, various destructive methods of treatment are used.

TREATMENT OF CERVICAL, VULVA AND VAGINA DISEASES USING MODERN SURGICAL TREATMENT METHODS :

  • Laser destruction (CO 2 laser)
  • radio wave surgery
  • cryodestruction
  • laser therapy in the recovery period after destructive methods of treatment.

Laser destruction

CO-2 lasers are widely used in gynecology, emitting at a wavelength of 10.6 microns, an output power of 5-100 W, a beam size of 1.5-10 mm.These lasers are highly efficient.

Laser destruction is performed under the control of a colposcope.

Advantages of laser surgery: The exposure occurs at a distance, without direct contact with the tissue, under colposcopic control, which allows achieving high precision in the control of the laser beam. The zone of necrosis during laser coagulation is negligible, due to a decrease in leukocyte infiltration (reduction of the phases of exudation and proliferation). The operation is almost bloodless, which is associated with the formation of a coagulation thrombus.Safe for use in nulliparous women.

Radio wave surgery

Modern atraumatic method. The mechanism of action is based on the effect of converting electric current into radio waves.

Removal of the pathological part of the cervix is ​​achieved due to the heat generated by the resistance of tissues to the penetration of high-frequency radio waves emanating from the electrode.

Thanks to this, the cells encountered on the path of the waves are subjected to evaporation, while the underlying tissue is not damaged.

Cryodestruction

This method is painless, bloodless, does not cause scarring, adhesions on the cervix, therefore it is widely used in nulliparous women.

  • laser therapy in the recovery period after destructive methods of treatment.

Laser therapy in the recovery period after destructive methods of treatment.

We have developed a new method for the treatment of background and precancerous diseases of the cervix using low-intensity laser radiation with different wavelengths.The technique is patented.

The Women’s Health Clinic has modern equipment necessary for the diagnosis and treatment of diseases of the cervix.

90,000 Human papillomavirus (HPV) and cervical cancer

What is HPV?

Human papillomavirus (HPV) is the most common viral infection of the genital tract. Most sexually active women and men acquire the infection at some point in their lives, and some may be reinfected.

The peak infection period for both women and men begins shortly after they become sexually active. HPV is sexually transmitted, but penetrative sex is not required to transmit the virus. Bodily genital contact is a well established route of transmission.

Many types of HPV do not cause problems. HPV infections usually go away on their own, without any intervention, a few months after infection, and about 90% go away within 2 years.A small proportion of infections with certain types of HPV can continue and lead to the development of cervical cancer.

Cervical cancer is by far the most common HPV-related disease. Almost all cases of cervical cancer can be attributed to HPV infections.

Infection with some types of HPV can also lead to cancers of the anus, vulva, vagina, penis and oropharynx, which can be prevented using the same primary prevention strategies as for cervical cancer.

HPV types that do not cause cancer (especially types 6 and 11) can lead to genital warts and respiratory papillomatosis (a disease in which tumors grow in the airways leading from the nose and mouth to the lungs). Although these conditions very rarely lead to death, they can often lead to illness. Genital warts are widespread, highly infectious and have a negative impact on sex.

How does HPV infection lead to cervical cancer?

Although most HPV infections and precancerous lesions resolve on their own, there is a risk for all women that HPV infection can become chronic and precancerous lesions develop into invasive cervical cancer.

Women with normal immune systems develop cervical cancer within 15–20 years. In women with weakened immune systems, such as those with HIV infection if untreated, it may take as little as 5-10 years to develop.

Risk factors for the persistence of HPV and the development of cervical cancer

  • HPV type – its carcinogenicity, or the ability to cause cancer;
  • Immune status – people with weakened immune systems, such as people with HIV infection, are more likely to have persistent HPV infections that develop more rapidly into precancer and cancer;
  • coinfection with other sexually transmitted pathogens such as herpes simplex, chlamydia and gonorrhea pathogens;
  • number of births (number of children born) and early first births;
  • tobacco use.

Global burden of cervical cancer

Cervical cancer is the fourth most common cancer among women globally, with an estimated 570,000 new cases in 2018, accounting for 7.5 % of all female deaths from cancer. It is estimated that more than 85% of the more than 311,000 annual deaths from cervical cancer occur in low- and middle-income countries. Women with HIV are six times more likely to develop cervical cancer than women who are not HIV infected, and an estimated 5% of all cervical cancer cases are HIV-related (2) .

High-income countries have programs that provide opportunities for girls to get the HPV vaccine and women for regular screening. Screening detects precancerous lesions at stages where they can be easily treated.

In low- and middle-income countries, access to such preventive measures is limited, and cervical cancer is often detected only late in the course of symptoms. In addition, access to treatment for the disease at such advanced stages (for example, surgery, radiation therapy and chemotherapy) can be very limited, resulting in high mortality rates from cervical cancer in these countries.

High global mortality from cervical cancer (age-standardized rate: 6.9 / 100,000 in 2018) can be reduced through effective interventions.

Tackling cervical cancer: an integrated approach

The WHA’s Global Strategy to Accelerate Elimination of Cervical Cancer as a Public Health Issue in 2020 recommends a comprehensive approach to the prevention and control of cervical cancer. The recommended set of measures includes activities covering the entire life cycle.

should be multidisciplinary and include community education, social mobilization, vaccination, screening, treatment and palliative care components.

Primary prevention starts with HPV vaccination of girls aged 9-14, that is, before they become sexually active.

Sexually active women should be screened for abnormal cervical cells and precancerous lesions from the age of 30. Screening for sexually active women with HIV infection should begin at an earlier age, immediately after a positive HIV test result.

For the treatment of precancerous lesions, removal of abnormal cells or lesions is recommended on an outpatient basis (abnormal cervical tissue can be destroyed with cryotherapy or thermal ablation).

If there are signs of cervical cancer, treatment options for invasive cancer include surgery, radiation therapy, and chemotherapy, and patients should be referred to the correct level of care.

HPV vaccination

There are currently 3 prequalified vaccines that protect against HPV
16 and 18, which are known to cause at least 70% of cervical cancers.A third vaccine protects against five more carcinogenic HPV types, which cause an additional 20% of cervical cancers. Given that vaccines that only protect against HPV 16 and 18 also have some cross-protection against these less common types of HPV that cause cervical cancer, WHO believes the three vaccines protect against cervical cancer equally. Two of these vaccines also protect against HPV types 6 and 11, which lead to the development of anogenital warts.

Clinical trials and post-marketing surveillance indicate that HPV vaccines are highly safe and effective in preventing HPV infections, severe precancerous lesions and invasive cancers (3) .

HPV vaccines are most effective when vaccinated before exposure to HPV. Therefore, WHO recommends vaccinating girls between the ages of 9 and 14, when most of them are not yet sexually active. Vaccines cannot treat HPV infections or HPV-related diseases such as cancer.

Some countries have introduced the vaccination of boys, given that vaccination prevents the development of genital cancer in both men and women, and the two available vaccines also prevent the development of genital warts in men and women.

WHO recommends vaccinating girls aged 9-14 years as this is the most cost-effective public health measure against cervical cancer.

HPV vaccination is not a substitute for cervical cancer screening. In countries where HPV vaccination is introduced, screening programs may still need to be developed or strengthened.

Screening for precancerous lesions and their treatment

Screening for cervical cancer includes testing for precancer and cancer, and more and more tests for HPV infection are being performed.Testing is performed in women who are asymptomatic and who are feeling perfectly healthy. If screening detects HPV infection or precancerous lesions, they can be easily treated and thereby prevent the development of cancer. Screening can also detect cancer at an early stage with a high likelihood of a cure.

Given the fact that precancerous lesions develop over the years, every woman is recommended to undergo screening from the age of 30 and then regularly (depending on the test used).For sexually active women with HIV infection, screening should be done as early as possible once they become aware of their HIV status.

Screening should be linked to the treatment and management of patients with positive screening results. Screening without proper patient management is not ethical.

WHO currently recommends 3 different screening types:

  • DNA testing for high-risk HPV types
  • visual inspection using acetic acid
  • conventional Pap test ( ) Pap and liquid cytology

For the treatment of precancerous lesions, WHO recommends the use of cryotherapy or thermal ablation, and electrosurgical loop excision if available.For advanced lesions, women should be referred for further research and appropriate treatment.

Treatment of invasive cervical cancer

Women with symptoms suggestive of cervical cancer should be referred to appropriate health facilities for further evaluation, diagnosis and treatment.

Symptoms of early stage cervical cancer may include:

  • Irregular spotting or minor bleeding between periods in women of reproductive age;
  • spotting or bleeding in the postmenopausal period;
  • bleeding after intercourse; and
  • profuse vaginal discharge, sometimes with an unpleasant odor.

As cervical cancer progresses, more serious symptoms may appear, including:

  • persistent back, leg and / or pelvic pain;
  • weight loss, fatigue, loss of appetite;
  • discharge with an unpleasant odor and discomfort in the vagina; and
  • edema of the leg or both lower extremities.

Other severe symptoms may occur in later stages, depending on which organs the cancer has spread to.

The diagnosis of cervical cancer should be made on the basis of histopathological findings. Determination of the stage is based on the size of the tumor and the spread of the disease within the pelvis and to distant organs. Treatment depends on the stage of the disease and includes surgery, radiation therapy, and chemotherapy. Palliative care is also an important element in the management of cancer patients to relieve excessive pain and suffering.

WHO activities

The World Health Assembly adopted a global strategy to accelerate the elimination of cervical cancer as a public health problem and its goals and targets for the period 2020-2030.(WHA73.2) (4) . The global strategy sets targets to accelerate elimination of cervical cancer:

  • the threshold for elimination as a public health problem set at 4 per 100,000 women per year;
  • For countries to be on the path to eliminating cervical cancer by 2030, the 90-70-90 targets below must be met; 90,031
  • 90% of girls should be fully vaccinated against HPV by age 15;
  • 70% of women should be screened with a high-performance test at age 35 and then at age 45;
  • 90% of women with diagnosed cervical disease should receive treatment (provide treatment for 90% of women with precancerous cancer; ensure 90% of women with invasive cancer are managed).

WHO has developed guidelines and tools for the prevention and control of cervical cancer through vaccination, screening and treatment for invasive cancer, which are hosted in a knowledge repository. WHO works with countries and partners to develop and implement comprehensive programs in line with the global strategy.

References

(1) Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018).Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today

(2) Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health 2020; published online Nov 16. DOI: S2214-109X (20) 30459-9 https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30459-9/fulltext

(3) Lei et al (2020) HPV Vaccination and the Risk of Invasive Cervical Cancer.N Engl J Med 2020; 383: 1340-8. DOI: 10.1056 / NEJMoa1917338

(4) World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem https://www.who.int/publications/i/item/9789240014107

Cervical inflammation – treatment prices, causes, symptoms and diagnosis of cervical inflammation in “CM-Clinic”

The causes of inflammation are diverse: they can be caused by common infectious diseases, mechanical influences and trauma (sexual intercourse, wearing a uterine ring, douching).An important role is played by a wide variety of microorganisms, fungi and Trichomonas, penetrating into the cervical canal.

Endocervicitis is often accompanied by pseudo-erosion of the neck, ectropion, colpitis, endometritis, salpingitis and other diseases of the reproductive system. In this case, endocervicitis may precede these inflammatory diseases, occur simultaneously or after damage to other parts of the reproductive system.

The penetration of microbes is facilitated by cervical trauma during childbirth, abortion, diagnostic curettage of the uterus.It should be noted that chlamydia settle on the mucous membrane of the cervix without previous damage. The inflammatory reaction in the endocervix manifests itself differently – its nature depends on the pathogen and the reactivity of the woman’s body. Sometimes endocervicitis occurs in an erased form from the very onset of the disease. Distinct clinical signs are inherent in endocervicitis of gonorrheal etiology and are less noticeable in chlamydia. Endocervicitis, not detected or not cured in the acute stage, becomes a long-term chronic process.

The duration of the course is associated with the penetration of pathogenic microbes into the branching glands of the mucous membrane, where they are less accessible for the action of local therapeutic procedures; reinfection is important, as well as the simultaneous existence of other diseases of the genital organs that weaken the body’s defenses. With endocervicitis, hyperemia of the mucous membrane and its edema are observed, especially pronounced in the acute stage of the disease. In the chronic stage, hyperemia, swelling and other signs of an inflammatory reaction are much less pronounced, regeneration of the mucous membrane occurs in places where the integumentary epithelium is rejected.

Chronic endocervicitis in some cases is the cause of cervicitis. The inflammatory reaction spreads to the underlying connective tissue and muscle elements, where infiltrates occur with the subsequent development of hyperplastic processes and dystrophic changes. There is a thickening and hypertrophy of the neck, which is facilitated by small cysts formed during the healing of pseudo-erosion.

what gynecologists usually don’t tell their patients about – MedLena Medical Center

Cervical dysplasia – the complexity of treatment, or “what gynecologists usually don’t tell their patients about”!

Modern realities are such that more and more women in the world are being diagnosed with cervical dysplasia. Do you know that this is a precancerous disease and, if left untreated, everything can end up with cervical cancer . Pitfalls “cervical dysplasia” is an asymptomatic course.

What is the cause of “cervical dysplasia” ? The nature of the disease in 95% of cases is human papillomavirus. But do not rush to blame your husband or your sexual partner! This virus could have settled in your body as early as childhood, or after the first sexual intercourse, or even after the pool.Its aggressiveness depends on the strength of your immunity. It is important to know that condoms do not save against HPV and the only way of prevention is a healthy lifestyle, strong immunity and vaccination with HPV vaccine against cervical cancer, preferably before the onset of sexual activity. It is very important to undergo a preventive examination by a gynecologist at least once every 3 years, perform a cytological smear (PAP test) and / or HPV testing. The sooner the disease is detected, the easier and cheaper the treatment will be, which means the more chances to prevent the development of cervical cancer .

But, your case is already different and the diagnosis “cervical dysplasia” is already in the medical card. Let’s figure out what to do next … How to be treated …

You should be aware that the diagnosis “cervical dysplasia” cannot be established simply by examination on the gynecological chair. If you have not taken a cytological smear, have not done a colposcopy with a biopsy, and are advised to do “cryodestruction”, then think about it. Such treatment is not safe.

It should also be noted that there is no specific drug therapy for HPV infection and for cervical dysplasia .The only generally accepted treatment in the medical world is to remove the diseased tissue in the cervix. The provoking factor for the persistence of HPV infection in a woman’s body is frequent vaginal infections or hormonal disorders. Therefore, at the first stage of treatment, it is imperative to exclude these pathological conditions, and then make a decision on surgical tactics, depending on the degree of damage to the cervix.

  • When detecting mild cervical dysplasia CIN I , it is not recommended to perform any “cauterization”.It is necessary to conduct an examination for sexually transmitted infections (chlamydia, trichomoniasis, mycoplasmosis, gonorrhea), for the presence of bacterial vaginosis (ureaplasmosis, gardnerellosis, etc.). When an infectious-inflammatory factor is detected, appropriate antimicrobial-anti-inflammatory treatment and correction of the vaginal biocenosis are carried out. Further – active observation of “mild cervical dysplasia” , and a return visit to the gynecologist after 6 and 12 months is mandatory. After a year, it is recommended to do a second HPV test, and if its result is negative, then observation can be continued up to 1.5-2 years; if the HPV test is positive, colposcopy and biopsy are performed.And then a decision is made on the use of electro-excisional methods of treatment. Previously, gynecologists actively performed “cryodestruction”, but now this method is highly discouraged, because after it there is a high risk of recurrence and rapid transition of cervical dysplasia to a more severe degree.
  • If you have been diagnosed with moderate dysplasia – CIN II , then the tactics of treatment depend on your age, reproductive plans and your medical history. For patients over 24 years old with HPV (+) status, with a recurrent course or progression of a milder form of cervical dysplasia (previously) to a more severe one, with weakened immunity (HIV, cytomegalovirus, herpes, autoimmune diseases, chronic often recurrent inflammatory diseases of the pelvic organs), loop electro excision or conization of the cervix is ​​recommended.
  • If the gynecologist has diagnosed “severe dysplasia – CIN III” , do not risk your life, go to the oncogynecologist. Unfortunately, there is a very fine line between CIN III and cervical cancer . Cervical dysplasia III degree must be removed by conization of the cervix and it is better to do this in a specialized medical institution.

And remember that in the first year after any treatment of cervical dysplasia it is necessary to observe a gynecologist every 3 months.

MC “MedLena” specializes in the diagnosis and treatment of cervical pathology . We accept professional gynecologists and gynecological oncologists, which guarantees you a qualified consultation for any degree of cervical dysplasia . Surgical treatment of cervical dysplasia (conization and excision by the radio wave method) is carried out on modern equipment with the highest qualifications of doctors. Trust your health to professionals!

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Primary prevention Secondary prevention Tertiary prevention
Girls 9-14 years

85

30 or older

All women as needed
Girls and boys as appropriate

  • Health education and warnings about tobacco use
  • Sex education, age-appropriate and culturally
  • Encouraging and providing condoms to persons who have sex
  • Male circumcision

  • Screening with a high-performance test equal to or better than his HPV test
  • Follow-up treatment of precancerous lesions started immediately or as soon as possible
Treatment of invasive cancer at any age

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Palliative care 901

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