What does a Pap smear detect. How are abnormal results followed up. What other tests may be needed to diagnose cervical cancer. When is a colposcopy recommended. How are cervical biopsies performed.

The Importance of Cervical Cancer Screening

Cervical cancer screening plays a crucial role in early detection and prevention. The primary screening methods include Pap smears and HPV tests, which can identify abnormalities before they develop into cancer. Regular screening is essential for maintaining cervical health and catching potential issues at their earliest, most treatable stages.

What Does a Pap Smear Detect?

A Pap smear, also known as a Pap test, is designed to detect abnormal cells in the cervix. These abnormalities can include:

• Precancerous changes in cervical cells
• Early-stage cervical cancer
• Cellular changes caused by HPV infection
• Inflammation or infection of the cervix

By identifying these abnormalities early, healthcare providers can intervene before they progress to more serious conditions, potentially preventing cervical cancer altogether.

Interpreting Abnormal Pap Smear Results

Receiving abnormal Pap smear results can be concerning, but it’s important to understand that abnormal results don’t necessarily indicate cancer. Many abnormalities are minor and may resolve on their own. However, follow-up testing is crucial to determine the nature and severity of the abnormality.

Common Abnormal Pap Smear Results

Abnormal Pap smear results can include:

• ASC-US (Atypical Squamous Cells of Undetermined Significance)
• LSIL (Low-grade Squamous Intraepithelial Lesion)
• HSIL (High-grade Squamous Intraepithelial Lesion)
• AGC (Atypical Glandular Cells)

Each of these results requires different follow-up actions, which your healthcare provider will discuss with you based on your individual case.

The Role of HPV Testing in Cervical Cancer Screening

Human Papillomavirus (HPV) testing has become an integral part of cervical cancer screening. HPV is a common virus that can cause cellular changes in the cervix, potentially leading to cancer. By testing for high-risk HPV strains, healthcare providers can better assess a patient’s risk of developing cervical cancer.

HPV and Cervical Cancer Risk

While HPV infection is common, most infections clear on their own without causing problems. However, persistent infections with high-risk HPV types can lead to cervical cancer. Understanding your HPV status can help guide further testing and treatment decisions.

Follow-Up Tests for Abnormal Screening Results

When Pap smear or HPV test results are abnormal, additional tests may be necessary to determine the extent of the abnormality and guide treatment decisions. These follow-up tests are diagnostic in nature, providing more detailed information about the cervical cells.

Colposcopy: A Closer Look at the Cervix

Colposcopy is a common follow-up procedure for abnormal Pap or HPV test results. During this examination, a healthcare provider uses a special magnifying device called a colposcope to examine the cervix more closely. The colposcope allows for a detailed view of the cervical tissue, helping to identify areas of concern that may require biopsy.

How is a colposcopy performed?

1. The patient lies on an exam table, similar to a pelvic exam.
2. A speculum is inserted into the vagina to provide a clear view of the cervix.
3. The colposcope is positioned outside the body, providing magnification of the cervical tissue.
4. A weak acetic acid solution is applied to the cervix to highlight any abnormal areas.
5. If suspicious areas are identified, a biopsy may be performed.

Colposcopy is generally a well-tolerated procedure with minimal discomfort, similar to a routine pelvic exam.

Cervical Biopsy Techniques

When abnormal areas are identified during colposcopy, a biopsy may be necessary to obtain a definitive diagnosis. There are several types of cervical biopsies, each serving a specific purpose in the diagnostic process.

Colposcopic Biopsy

A colposcopic biopsy involves removing a small sample of tissue from an abnormal area identified during the colposcopy. This procedure is typically quick and causes minimal discomfort. The tissue sample is then sent to a laboratory for analysis to determine the presence of precancerous or cancerous cells.

Endocervical Curettage

Endocervical curettage, also known as endocervical scraping, is performed when the transformation zone (the area at risk for HPV infection and precancer) cannot be fully visualized during colposcopy. This procedure involves using a narrow instrument to gently scrape tissue from the endocervical canal for laboratory examination.

Cone Biopsy (Conization)

A cone biopsy, or conization, involves removing a cone-shaped piece of tissue from the cervix. This procedure serves both diagnostic and therapeutic purposes, as it can remove precancerous lesions while also providing a larger tissue sample for analysis.

There are two main types of cone biopsies:

• Loop Electrosurgical Excision Procedure (LEEP): Uses a thin wire loop heated by electrical current to remove the abnormal tissue.
• Cold Knife Conization: Involves using a scalpel to remove the tissue under general anesthesia.

Understanding Cervical Cancer Stages and Treatment Options

If cervical cancer is diagnosed, staging is crucial for determining the extent of the disease and guiding treatment decisions. Cervical cancer stages range from I to IV, with stage I being the earliest and most treatable form of the disease.

Treatment Approaches for Cervical Cancer

Treatment options for cervical cancer depend on the stage of the disease, the patient’s overall health, and personal preferences. Common treatment modalities include:

• Surgery (ranging from local excision to radical hysterectomy)
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy

Many early-stage cervical cancers can be treated successfully with surgery alone, while more advanced cases may require a combination of treatments.

The Importance of Regular Screening and Follow-Up

Regular cervical cancer screening is essential for early detection and prevention. The frequency of screening depends on various factors, including age, previous test results, and individual risk factors. It’s crucial to follow your healthcare provider’s recommendations for screening intervals and follow-up care.

Screening Guidelines

Current guidelines for cervical cancer screening vary slightly depending on the organization, but generally recommend:

• Starting screening at age 21
• Regular Pap smears every 3 years for women aged 21-29
• Co-testing with Pap smear and HPV test every 5 years for women aged 30-65
• Potentially discontinuing screening after age 65 if previous results have been consistently normal

These guidelines may be adjusted based on individual risk factors and medical history.

Preventing Cervical Cancer: Beyond Screening

While regular screening is crucial for early detection, there are additional steps you can take to reduce your risk of developing cervical cancer.

HPV Vaccination

HPV vaccination is a powerful tool in preventing cervical cancer. The vaccine protects against the most common high-risk HPV types that cause cervical cancer. It is recommended for both males and females, ideally before becoming sexually active.

Lifestyle Factors

Certain lifestyle choices can also impact your risk of cervical cancer. Consider the following preventive measures:

• Practice safe sex to reduce the risk of HPV transmission
• Quit smoking or avoid starting, as smoking increases cervical cancer risk
• Maintain a healthy diet rich in fruits and vegetables
• Boost your immune system through regular exercise and stress management

By combining regular screening with these preventive measures, you can significantly reduce your risk of developing cervical cancer.

Coping with Abnormal Results and Diagnosis

Receiving abnormal test results or a cervical cancer diagnosis can be emotionally challenging. It’s important to remember that many abnormalities are treatable, especially when caught early. Here are some strategies for coping:

• Educate yourself about your condition and treatment options
• Seek support from family, friends, or support groups
• Communicate openly with your healthcare team
• Consider counseling or therapy to manage anxiety or stress
• Focus on self-care and maintaining overall health

Remember, you’re not alone in this journey. Many resources are available to support you through diagnosis, treatment, and recovery.

Advancing Cervical Cancer Research and Treatment

The field of cervical cancer prevention, detection, and treatment is continually evolving. Researchers are working on developing new screening methods, improving existing treatments, and exploring novel therapies to combat cervical cancer more effectively.

Emerging Technologies in Cervical Cancer Screening

Innovative approaches to cervical cancer screening are being studied, including:

• AI-assisted analysis of Pap smear images
• Self-sampling HPV tests for improved access to screening
• Advanced molecular testing for more accurate risk assessment

These advancements aim to make screening more accessible, accurate, and efficient, potentially leading to even better outcomes for patients.

Personalized Treatment Approaches

As our understanding of cervical cancer biology improves, treatment approaches are becoming more personalized. Molecular profiling of tumors can help guide treatment decisions, allowing for more targeted and effective therapies tailored to each patient’s unique cancer characteristics.

Ongoing clinical trials are exploring new combinations of existing treatments, as well as novel therapies such as immunotherapy and targeted molecular agents. These research efforts hold promise for improving outcomes and quality of life for cervical cancer patients.

The Global Impact of Cervical Cancer

Cervical cancer remains a significant global health concern, particularly in low- and middle-income countries where access to screening and treatment may be limited. Efforts to address this disparity include:

• Implementing low-cost screening programs in resource-limited settings
• Expanding HPV vaccination campaigns globally
• Developing point-of-care testing for HPV and cervical abnormalities
• Improving access to treatment in underserved regions

By addressing these challenges, the global medical community aims to reduce the burden of cervical cancer worldwide and improve outcomes for all women, regardless of their geographic location or socioeconomic status.

Empowering Patients Through Education and Advocacy

Knowledge is power when it comes to cervical health. By understanding the importance of screening, recognizing potential symptoms, and staying informed about prevention strategies, women can take an active role in protecting their health.

The Role of Patient Advocacy

Patient advocacy groups play a crucial role in raising awareness, supporting research, and improving access to care for cervical cancer patients. These organizations often provide valuable resources, including:

• Educational materials about cervical cancer prevention and treatment
• Support services for patients and their families
• Advocacy for improved access to screening and treatment
• Funding for cervical cancer research

Getting involved with these organizations can be empowering for patients and contribute to the broader fight against cervical cancer.

Communicating with Healthcare Providers

Effective communication with your healthcare team is essential for optimal care. Don’t hesitate to ask questions about your screening results, treatment options, or any concerns you may have. Some tips for productive conversations with your healthcare provider include:

• Prepare a list of questions before your appointment
• Take notes during discussions
• Bring a trusted friend or family member for support
• Ask for clarification if you don’t understand something
• Discuss your preferences and concerns openly

By actively participating in your healthcare decisions, you can ensure that your care aligns with your needs and values.

The Future of Cervical Cancer Prevention and Treatment

As research continues to advance our understanding of cervical cancer, the future looks promising for improved prevention, detection, and treatment strategies. Some areas of ongoing research and development include:

• More sensitive and specific screening tests
• Improved HPV vaccines targeting additional high-risk strains
• Novel immunotherapy approaches
• Personalized medicine based on genetic profiling
• Minimally invasive surgical techniques

These advancements hold the potential to further reduce the incidence of cervical cancer and improve outcomes for those affected by the disease.

The Role of Telemedicine in Cervical Health

Telemedicine is playing an increasingly important role in cervical health care, particularly in improving access to specialists and follow-up care. Some benefits of telemedicine in this field include:

• Remote consultations with gynecologic oncologists
• Virtual support groups for patients
• Improved access to care for patients in rural or underserved areas
• Streamlined communication of test results and treatment plans

As technology continues to advance, telemedicine is likely to become an even more integral part of cervical cancer care, complementing in-person visits and improving overall patient care.

Conclusion: A Holistic Approach to Cervical Health

Maintaining cervical health requires a comprehensive approach that includes regular screening, prevention strategies, and prompt follow-up on any abnormal results. By staying informed, advocating for your health, and working closely with your healthcare team, you can take control of your cervical health and reduce your risk of cervical cancer.

Remember that cervical cancer is largely preventable and, when caught early, highly treatable. With ongoing advancements in screening, prevention, and treatment, the future of cervical health looks increasingly bright. Stay vigilant, stay informed, and prioritize your health – your cervix will thank you.

When Cervical Screening Test Results are Abnormal

• What other tests will I need?
• Tests for people with symptoms of cervical cancer or abnormal screening test results

Finding cervical cancer often starts with an abnormal HPV (human papillomavirus) or Pap test result. This will lead to further tests, which can diagnose cervical cancer or pre-cancer.

Cervical cancer may also be suspected if you have symptoms like abnormal vaginal bleeding or pain during sex. Your primary doctor or gynecologist often can do the tests needed to diagnose pre-cancers and cancers and may also be able to treat a pre-cancer.

If there is a diagnosis of invasive cancer, your doctor should refer you to a gynecologic oncologist, a doctor who specializes in cancers of women’s reproductive systems.

What other tests will I need?

 Your current screening test results along with your past test results, determine your risk of developing cervical cancer. Your doctor will use them to figure out your next test or treatment. It could be a follow-up screening test in a year, a colposcopy, or one of the other procedures discussed below to treat any pre-cancers that might be found.  

Because there are many different follow-up or treatment options depending on your specific risk of developing cervical cancer, it is best to talk to your healthcare provider about your screening results in more detail, to fully understand your risk of cervical cancer and what follow-up plan is best for you.

The Pap test and HPV test are screening tests, not diagnostic tests. They cannot tell for certain if you have cervical cancer. An abnormal Pap test or HPV test result may mean more testing is needed to see if a cancer or a pre-cancer is present. The tests that are used include colposcopy (with biopsy), endocervical scraping and cone biopsies.

Tests for people with symptoms of cervical cancer or abnormal screening test results

Medical history and physical exam

First, the doctor will ask you about your personal and family medical history. This includes information related to risk factors and symptoms of cervical cancer. A complete physical exam will help evaluate your general state of health. You will have a pelvic exam and maybe a Pap test if one has not already been done. In addition, your lymph nodes will be felt to see if the cancer has spread (metastasis).

Colposcopy

If you have certain symptoms that could mean cancer, if your Pap test shows abnormal cells, or if your HPV test is positive, you will most likely need to have a test called colposcopy. You will lie on the exam table as you do with a pelvic exam. A speculum will be placed in the vagina to help the doctor see the cervix more easily with a colposcope. The colposcope is an instrument that stays outside the body and has magnifying lenses. It lets the doctor see the surface of the cervix up close and clearly. Colposcopy itself usually causes no more discomfort than any other speculum exam. It can be done safely even if you are pregnant. Like the Pap test, it is better not to have it during your menstrual period.

At the time of the procedure, the doctor will apply a weak solution of acetic acid (similar to vinegar) to your cervix to make any abnormal areas easier to see. If an abnormal area is seen, a small piece of tissue will be removed (biopsy) and sent to a lab to be looked at carefully. A biopsy is the best way to tell for certain if an abnormal area is a pre-cancer, a true cancer, or neither.

Cervical biopsies

Several types of biopsies can be used to diagnose cervical pre-cancers and cancers. After these procedures, patients may feel mild cramping or pain and may also have some light bleeding.

Colposcopic biopsy

For this type of biopsy, the cervix is examined with a colposcope. Using biopsy forceps, a small section of the abnormal area is removed.

Endocervical curettage (endocervical scraping)

If colposcopy does not show any abnormal areas or if the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen with the colposcope, another method must be used to check that area for cancer.

A narrow instrument (either a curette or brush) is inserted into the endocervical canal (the part of the cervix closest to the uterus). The curette or brush is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the lab to be checked.

Cone biopsy

In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. The tissue removed in the cone includes the transformation zone where cervical pre-cancers and cancers are most likely to start. A cone biopsy is not only used to diagnose pre-cancers and cancers. It can also be used as a treatment since it can sometimes completely remove pre-cancers and some very early cancers.

Two common types of cone biopsies are:

• Loop electrosurgical procedure (LEEP or LLETZ):  In this method, the tissue is removed with a thin wire loop that is heated by electricity and acts as a small knife. For this procedure, a local anesthetic is used, and it can be done in your doctor’s office.  
• Cold knife cone biopsy: This method uses a surgical scalpel or a laser instead of a heated wire to remove tissue. You will receive anesthesia during the operation (either a general anesthesia, where you are asleep, or a spinal or epidural anesthesia, where an injection into the area around the spinal cord makes you numb below the waist) and it is done in a hospital.

Possible complications of cone biopsies include bleeding, infection and narrowing of the cervix.

Having any type of cone biopsy will not prevent most women from getting pregnant, but if a large amount of tissue has been removed, women may have a higher risk of giving birth prematurely.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Eifel P, Klopp AH, Berek JS, and Konstantinopoulos A. Chapter 74: Cancer of the Cervix, Vagina, and Vulva. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Fontham, ETH, Wolf, AMD, Church, TR, et al. Cervical Cancer Screening for Individuals at Average Risk: 2020 Guideline Update from the American Cancer Society. CA Cancer J Clin. 2020. https://doi.org/10.3322/caac.21628. 

Jhungran A, Russell AH, Seiden MV, Duska LR, Goodman A, Lee S, et al. Chapter 84: Cancers of the Cervix, Vulva, and Vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Cervical Cancer. Version 4.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/cervical. pdf on October 31, 2019.

Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525.

Last Revised: July 30, 2020

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

What is it, what happens, and results

Cervical cancer is a type of cancer that develops in the cells in the lower part of the uterus. This region is called the cervix.

The cervix is small and narrow, and it connects the uterus to the vagina. It provides an entry for sperm to pass into the uterus. The cervix also provides an exit from the uterus for monthly menstrual blood flow or a baby during delivery.

There are two parts to the cervix, and two different types of cells occur there:

Endocervix: This is the innermost part of the cervix. It lines the “tunnel” leading from the uterus into the vagina. It contains tall, column-like cells that are responsible for mucus secretion.

Ectocervix: This is the outer portion of the cervix, and it protrudes into the vagina. The ectocervix is home to squamous cells, which resemble fish scales under the microscope.

Where these two cell types meet is where most cervical cancers and precancerous cells form.

A Pap smear is a screening tool that can help doctors detect abnormal cells and cancer. It works by sampling cells from the cervix.

Cervical cancer screening is vital for getting an early diagnosis of cervical cancer. With an early diagnosis, effective treatment is usually possible.

Doctors recommend two tests for this purpose:

• The Pap smear, which checks for abnormal cells.
• The human papillomavirus (HPV) test, which detects DNA from HPV to reveal both its presence and type.

This information can help a doctor determine whether a person has cervical cancer, or if they have an increased risk of developing this disease.

These tests can detect:

• precancerous cell changes
• the presence of HPV
• the presence of cancer

If the tests lead to a diagnosis, a person can then seek treatment.

Routine screening does not always automatically include both tests at the same time, but a person can ask for an HPV test at the same time as a Pap smear.

According to the American Cancer Society (ACS), deaths from cervical cancer decreased dramatically after the introduction of the Pap smear.

A doctor usually carries out a Pap smear during a gynecological pelvic exam. They insert a tool called a speculum into the vagina so that they can examine the cervix. Then, they take a sample of cervical cells using a brush or spatula and send them for testing.

If possible, it is best to avoid having a Pap smear during a menstrual period, especially if the flow is heavy, as this can affect the results of the test. However, if a person only has the chance to have the test during menstruation, it is still better to attend than not.

A person should not douche or put anything in the vagina to clean it before the test. Doctors do not recommend douching at any time.

Recommendations on Pap smear frequency depend on several factors.

These include:

• age
• medical history
• exposure to diethylstilbestrol (DES) when in the womb
• HIV status
• whether or not the person has a weakened immune system, for example, due to HIV

The United States Preventive Services Task Force (USPSTF) recommend that:

• Women aged 21–29 years should have a Pap test every 3 years.
• Women aged 30–65 years should have a Pap test every 3 years, or an HPV test every 5 years, or a Pap and HPV co-test every 5 years.

The American Cancer Society recommend that people between the ages of 25 and 65 should have an HPV test every five years.

After the age of 65 years, most women will not need a Pap smear or HPV test. However, each person’s risk factors vary.

Those who have had abnormal test results in the past and those who are sexually active with more than one partner may need more frequent testing.

After a total hysterectomy, which is the surgical removal of the uterus and cervix, a Pap smear will no longer be necessary.

Anyone who has a hysterectomy because they had cancerous or precancerous cells should continue to have regular tests.

Everyone has different needs, so it is important that people speak to their doctor about their risk factors for developing cervical cancer and their need for screening.

The test results usually take 1–3 weeks to come back. Most test results are negative, but they can sometimes be positive. A positive result does not confirm that a person has cancer, but it indicates that more investigation is necessary.

Normal

In most Pap smears, the result is normal and does not reveal any abnormal cells.

Unclear

Sometimes the result is ambiguous. The doctor may ask the person to have more tests to monitor for any changes. These additional tests are likely to take place either soon after the first test or about 6 months later.

Abnormal

Sometimes the result is “abnormal.” The doctor may recommend more tests straight away or after 6 months depending on the extent of the cell changes.

Common cell abnormalities include:

Atypical squamous cells of undetermined significance (ASCUS): These are mildly abnormal cells that do not meet the criteria for precancerous cells. If HPV is present, the doctor may recommend additional testing.

Squamous intraepithelial lesion: These lesions indicate possible precancerous cellular changes that are likely to need further testing.

A doctor will usually recommend following up with a colposcopy, with or without a biopsy.

During a colposcopy, the doctor uses a colposcope to magnify the view of the cervix, vulva, and vagina for examination. They may take a biopsy sample for evaluation in a laboratory.

They are divided into two categories:

• Low grade: A low-grade lesion has a low risk of progressing to cancer in the near future.
• High grade: A high-grade lesion has a high risk of progressing to cancer sooner rather than later.
• Atypical glandular cells: This diagnosis is indicative of abnormal cells in the endocervix. These will require further testing.
• Squamous cell cancer or adenocarcinoma: This diagnosis signals the likelihood of cancer and depends on the cell type that is atypical. Further testing is required.

What does an abnormal result mean?

It is possible to classify the cell changes as follows:

Low-grade lesion: The risk of a low-grade lesion imminently progressing to cancer is minimal.

High-grade lesion: A high-grade lesion has a high likelihood of becoming cancerous sooner rather than later.

Atypical glandular cells: There are abnormal cells in the endocervix that will need further testing.

Squamous cell cancer or adenocarcinoma: There is a likelihood of cancer, depending on the type of cell that is atypical. Further testing is necessary.

In 2019, the ACS estimate that there will be around 13,170 new diagnoses of invasive cervical cancer in the United States and approximately 4,250 deaths.

Screening and other types of prevention can reduce this risk dramatically.

There are often no symptoms until the later stages, when there may be bleeding or discharge from the vagina. This is why it is important to attend screening.

Risk factors for developing cervical cancer include:

• not having the HPV vaccine
• not attending routine screenings
• having an HPV infection
• smoking
• having sex without using a condom
• having several sexual partners
• having a chlamydia infection
• having a weakened immune system, for example, due to HIV
• not including enough fruit and vegetables in the diet
• being overweight
• using birth control pills for an extended period
• using an intrauterine device (IUD) for birth control
• having several full-term pregnancies
• being under 18 years of age for the first full-term pregnancy
• taking the hormonal drug DES or having a mother who used it

Doctors also do not recommend douching, as this can increase the likelihood of exposing the vagina to bacterial infection.

What is human papillomavirus?

HPV is a virus that can lead to cervical cancer in some cases. There are over 150 types of HPV. Some types, for example, type 16 and 19, can lead to cervical cancer.

Other types can lead to different complications, such as noncancerous warts or papillomas.

HPV can pass from one person to another during vaginal, anal, or oral sex when there is skin-to-skin contact.

There is no cure, but the infection often resolves in time. However, if HPV becomes a long-term infection, the risk of cancer increases.

Treatment is available for HPV-related warts and cell changes.

Vaccination is available to protect against HPV infection. Until recently, the Centers for Disease Control and Prevention (CDC) have recommended that young women have the vaccine up to the age of 26 years and young men up to 21 years.

In 2018, however, the Food and Drug Administration (FDA) recommended a form of the vaccine called Gardasil 9, which protects against HPV, for men and women aged 27–45 years.

Cervical cancer is a type of cancer that develops in the cervix. Before developing into cancer, cervical cells undergo abnormal changes that a Pap test can detect.

With early diagnosis and appropriate treatment, the chances of surviving cervical cancer are good.

If a doctor diagnoses cervical cancer in its earliest stage, the person has a 93-percent chance of surviving for at least 5 more years. However, if diagnosis occurs when cervical cancer is at the latest stage, the likelihood of survival falls to 15 percent.

The Office for Women’s Health note that cervical cancer is the “easiest gynelogical cancer to prevent,” as long as a person attends screening sessions and has the HPV vaccination.

price, take an analysis in Moscow and Moscow Region – SmartLab MEDSI

Cytological examination is carried out in order to detect atypical cells and early diagnosis of precancerous conditions of the female reproductive system.

Biological material: material from the cervix and cervical canal (smear).

Malignant neoplasms of the cervix occupy one of the leading places in the oncological incidence of women. The most significant is cervical cancer.

As a rule, the cause of its development is the human papillomavirus (HPV) of oncogenic types 16, 18. There are other risk factors: frequent change of sexual partners, smoking, early onset of sexual activity.

There are more than 20 HPV types in total, which are divided into 3 groups:

• low oncogenic risk (HPV 3, 6, 11, 13, 32, 34, 40, 41, 42, 43, 44, 51, 61, 72 , 73)
• medium risk (HPV 30, 35, 45, 52, 53, 56, 58)
• high oncogenic risk (HPV 16, 18, 31, 33, 39, 50, 59, 64, 68, 70)

The diseases caused depend on the type of virus. For example, type 1 can cause the development of plantar warts, and type 5 can cause genital warts.

What can affect the result?

It should be understood that in girls (under 20 years old) due to changes in the epithelium with transient (passing, temporary) hormonal disorders, a false positive result may be obtained.

Important! The interpretation of the results of the analysis is carried out only by a doctor. If necessary, the patient is referred for other examinations (including instrumental and functional).

We recommend that you consult with a specialist and go through a check.

Additional tests

In addition, the patient can be referred for:

• detection of carcinoma antigen
• high-risk HPV detection (PCR method)
• screening study of the microflora of the urogenital tract

Which doctors are referred for analysis?

A referral for an examination is usually issued by a gynecologist. An oncologist can also advise you to undergo a diagnosis.

MEDSI takes care of its patients

• Experienced professionals. They professionally carry out the taking of biological material and its analysis, which allows us to guarantee the accuracy of the diagnosis
• The shortest processing times for materials. They are provided with modern equipment and experienced specialists. This reduces the time interval between the first visit of the patient, the diagnosis and the start of treatment, which in the case of precancerous and cancerous conditions increases overall survival rates
• Comfortable conditions for the examination. You can take the test throughout the day. The results will be available in your personal account
• Modern laboratory equipment. It corresponds to European and global levels. The laboratory uses equipment from leading manufacturers such as Beckman Coulter, Siemens, Ortho Clinical Diagnostics, Thermo Fisher, Sysmex, BD
• Regular maintenance of equipment and automation of research processes. All analytical units are serviced and meet quality standards. All processes are automated as much as possible and are built in accordance with LEAN-management
• Automation of the biomaterial sorting process. All biomaterial is identified with the patient and scanned upon admission to the laboratory. This makes it easy to track the location of the tubes
• Opportunity to undergo a comprehensive examination. If necessary, you can take all the necessary tests

Training requirements are determined by the attending physician.

Testing is recommended:

• In order to detect precancerous conditions of the cervix
• For the diagnosis of cervical cancer

It is important to take the test in the following cases:

• If you have HPV (human papillomavirus) – annually
• For a weakened immune system – annually
• Women aged 30 to 65

Service: Examination of gynecological material by liquid cytology using an automated system, Papanicolaou staining

Price: 564

Oncocytology – what does a smear for oncocytology of the cervix show: preparation for analysis, interpretation of the results

A smear for oncocytology is a screening method for cervical cancer. It is recommended to be performed by all women over 18 at least once every 3 years.

With the help of this study, it is possible to determine the presence of malignant transformation of cervical epithelial cells even at the stage of preclinical manifestation. In addition, morphological changes characteristic of non-tumor diseases of the cervix, for example, inflammatory processes, can be detected.

If the oncocytology showed signs of atypia, the patient is recommended an additional, more in-depth examination for diagnosis, in particular, a biopsy.

Pap test or liquid cytology

There are two techniques for performing an oncocytology test – Pap smear and liquid cytology.

Papanicolaou smear or PAP test

In Papanicolaou oncocytology, the material is taken separately from the cervical canal and separately from the surface of the cervix and applied to pre-marked slides (material from the endocervix on one slide, and from the surface of the cervix on the second). Then these glasses are fixed in rectified alcohol for 5 minutes and packed in individual packaging. The resulting material is sent to the laboratory, where it is examined by a cytologist who has undergone special training. The advantages of this method are:

• Relatively low cost.
• The ability to examine all cells, along with detritus, blood impurities, etc. This may be important to determine the causes of atypia, for example, in inflammatory processes.

However, there are also disadvantages:

• High dependence on the quality of material sampling. Ideally, it should cover the glass with a thin layer. Heaps of cells, impurities of blood and detritus can interfere with a qualitative study.
• About 10% of all smears are recognized as non-informative due to errors in the collection of material, its fixation or transportation.
• If a pathology is detected, it is not possible to conduct additional testing of the same material, it is necessary to take it again, i.e., call the patient for additional examination.

However, this test is still highly informative and is widely used for the early detection of cervical cancer and other cervical pathologies.

Liquid Cytology

In liquid cytology, the obtained material is immediately placed in a special liquid medium that stabilizes the cells. You can store them in this state for up to 6 months. After delivery to the laboratory, the resulting material is centrifuged, “washed” from detritus, blood cells, and preparations are made from them according to standardized protocols. At the same time, all cells are arranged in a monolayer, without piling up on top of each other, which allows them to be studied in detail.

Liquid-based cytology is currently the gold standard for screening due to the following advantages:

• High sensitivity, up to 98%.
• The method is standardized, which reduces the dependence of the result on the preanalytical stage.
• The material is stored for a long time, so if necessary, you can prepare a duplicate preparation and conduct additional studies, for example, using immunohistochemistry. This allows you to increase the information content of testing and more accurately determine the presence of pathology.
• In addition, the same material can be used to test for the presence of HPV or the P16ink4a protein, which allows you to differentiate changes with a high risk of malignant transformation.

And all these studies are performed “from one tube”, the patient does not need to come for a second appointment. Additional tests are ordered directly from the laboratory. Among the disadvantages of liquid cytology, one can note its higher cost compared to a Pap smear.

Biomaterial sampling technique

A smear for oncocytology is taken during a gynecological examination. To minimize the possibility of obtaining an unreliable result, it is recommended to adhere to the following rules before visiting a doctor:

• Do not use vaginal sex for 1-2 days.
• Do not use vaginal medications, douche or use tampons.
• The analysis is not taken during menstruation. At the same time, intermenstrual bleeding and spotting are just the indications for a smear.
• Do not perform any medical procedures on the cervix, such as colposcopy, bimanual examination, or vaginal ultrasound, for 48 hours.

The patient is positioned in the gynecological chair. The cervix is ​​exposed in mirrors and is processed from mucus. Material from the cervical canal is taken with a special brush, and from the surface of the neck with a spatula.

When performing a Papanicolaou examination, 1 to 3 slides are used. They are marked in advance with an indelible marker or pencil. Material from the cervical canal is applied to a separate glass, and material from the surface of the cervix is ​​applied to another glass. In liquid cytology, the tip of the cytobrush is broken off and left directly in the test tube with the transport medium and sent to the laboratory in this form.

Other gynecological examinations, such as colposcopy, ultrasound, etc., can be performed after the smear is taken. The first criterion for evaluation is the quality of the smear. It may be satisfactory or unsatisfactory. A satisfactory smear for oncocytology, the decoding of which is possible, meets the following criteria:

• For the PAP test – 8000-12000 squamous cells.
• For liquid cytology – 5000 squamous cells.
• For both tests, at least 10 cells of columnar or metaplastic epithelium.

There are cases when the amount of columnar or metaplastic epithelium is not enough, but according to the criterion of the amount of squamous epithelium, everything is fine. This may be due to the peculiarities of the structure of the cervix, for example, when the transformation zone is too deep in the cervical canal. Then the smear is classified as satisfactory, but to assess intracervical changes, it is necessary to repeat the analysis or look for other research methods.

The criteria for a failed smear are:

• Low squamous cell count.
• Smear overlap of 75% or more with inflammatory elements, detritus, or blood cells.

Next, the smear itself is evaluated. Depending on the results obtained, there may be the following options:

• NILM – a normal smear, there are no signs of neoplasia, but there may be other changes of a non-tumor nature, for example, inflammation, the presence of microorganisms, etc.
• ASC-US – there are cells with signs of atypia, more pronounced than those characteristic of reactive processes. But due to the fact that there are not enough cells, or their quality is low, it is not possible to establish a diagnosis of LSIL. It is recommended to repeat the analysis no later than 3 months later.
• LSIL – there are mild changes in the epithelium, which, among other things, can be with papillomavirus infection. As a rule, these are changes with low malignant potential, which are prone to self-regression within a few years. They are classified as mild dysplasia. Such patients are recommended simply dynamic observation.
• ASC-H – there are squamous epithelial cells with atypia, but their number does not allow to exclude a high degree of HSIL dysplasia.