# Pap smear photos: Pap Smear Photos and Premium High Res Pictures

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## What Does A Cervix Look Like? 7 Cervix Pictures, Explained

Think of your cervix as the gatekeeper to your uterus. Lots of things—like tampons, fingers, penises, sex toys, and other germ-carrying items—can get to your cervix, but they aren’t getting past it. Your cervix, in its 24/7 role of keeping your uterus happy and healthy, won’t let that happen.

Likewise, there are things—like mucous, menstrual blood, and the occasional baby—that need to get out of your uterus. Your cervix is the bouncer, deciding what and when things go in and come out of the most vital piece of your reproductive system. Yet, despite benefiting from its work, day in and day out, chances are you don’t know much about it.

### So…what does a cervix even look like?

Great Q! Your cervix is the “neck” of your uterus, positioned at the top of your vaginal canal. Because of its location, seeing your cervix isn’t as easy as squatting over a hand mirror, like you would if you were examining your other lady bits, but it is possible with the right tools.

All you need is a flashlight, a mirror, a retractable speculum, and a little courage. If you don’t have a speculum just lying around your bathroom (and if you do, we want to hear that story!) you can buy a starter kit for \$22.95 from the Beautiful Cervix Project. It even comes with a handy map to guide you through your own nethers. Once there you can admire the beauty of your own, unique cervix and even snap some cervix pictures if you’re so inclined. (Use this handy video guide for tips on getting a good picture of your vaginal canal and cervix.)

The Beautiful Cervix Project is a movement to better understand and appreciate the awesomeness of the underrated cervix. O’Nell Starkey started it as a project for midwifery school, with her husband taking snaps of her cervix throughout her cycle. She quickly discovered, as she’s put it, “Cervices are amazing!”

After sharing her images with the world, she found that other women also wanted to see their own cervices (that’s plural for cervix!), leading her to start the Beautiful Cervix Project, as well as live workshops dedicated to helping women learn about and appreciate their bodies.

“What I have learned by creating this website is that people from all over the world are curious about their bodies, cervices, and the menstrual cycle—everyone from newly menstruating teens, pregnant people, medical students, people with abnormal Paps, to people trying to conceive, artists, educators, and the list goes on,” Starkey says. “Cervical self-exam is about educating and empowering people by contradicting some of the shame and under-education we have about our bodies and menstrual cycles.

The Beautiful Cervix Project is dedicated to people working to reclaim their entire bodies as beautiful and lovable. The more we know about ourselves, the more we feel confident to advocate and care for ourselves.”

While each cervix is slightly different (which is why we recommend checking out your own cervix!), they all go through similar changes during your monthly cycle, when you’re pregnant, during labor and delivery, and after giving birth. Curious? Starkey was kind enough to share some cervix pictures to help you see what your cervix is up to. ..right now.

### During the Follicular Phase

Beautiful Cervix Project

When your cervix is just hanging out, the visible part of the cervix protrudes into the vaginal canal and is covered by smooth, pink, squamous epithelium, says Kim Thornton, M.D., a reproductive endocrinologist at Boston IVF. In this picture, the cervix is preparing for ovulation by preparing more fluid.

### During Ovulation

Beautiful Cervix Project

The cervix looks a little bit like a donut. When it’s closed, the hole looks like a dimple, but it opens during ovulation to let sperm in, explains Ronald D. Blatt, M.D., gynecologist and chief surgeon and medical director of the Manhattan Center for Vaginal Surgery.

### During the Luteal Phase

Beautiful Cervix Project

After ovulation, the cervix prepares for menstruation. In this picture the cervix is just doing its thing, waiting for either a pregnancy or shark week to happen. The average cervix measures 3 to 5 centimeters in length and 2 to 3 centimeters in diameter, Thornton says.

### During Menstruation

Beautiful Cervix Project

When your flow comes to visit, you know the blood is coming from somewhere up in there, but this picture shows exactly how it comes out of your cervix. Again, the dimple in the center—called the os—is in the open position to release menstrual fluids, Blatt says.

### During Sex

Beautiful Cervix Project

This is a picture of the cervix just minutes after the woman had an orgasm during sex (you can even see the semen pooled around the bottom). Depending on the size of you and your partner’s anatomy, the penis can bump into the cervix during sex. Some women find the sensation enjoyable and may even orgasm from it, according to a study published in the journal Hormones and Behavior. Others find repeated thrusting into the cervix to be incredibly painful and it can cause bruising or even tearing of your cervical tissue.

### During Pregnancy

Beautiful Cervix Project

Your sex life and monthly cycle may keep your cervix busy, but the real work happens during pregnancy and delivery. In this picture, the woman is about two months pregnant. The white goo, called leukorrhea, is very common type of vaginal discharge that can occur during pregnancy and is nothing to worry about, Starkey says.

### During a Pap Smear

Beautiful Cervix Project

Getting swabbed for a Pap smear and HPV test isn’t anyone’s idea of a good time but it’s a necessary evil to catch cervical cancer and other diseases before they can cause more harm. But you don’t have to do them every year, says Devorah Daley, M.D., ob-gyn at Weill Cornell Medicine and NewYork-Presbyterian. “The recommendation is to have your first Pap smear at age 21—it does not matter when sexual activity has started,” she says. “After that, for younger women, every other year is sufficient. Starting at age 30, we recommend every three years if you’re doing just the Pap.”

If, however, you get co-tested—meaning your Pap and HPV tests are collected at the same time—Dr. Daley says you can stretch that time frame out to five years. “Even if you were to leave the office and come in contact with [HPV], it doesn’t cause initial problems for about five years,” she says.

It’s believed that more than 90 percent of cervical cancer cases are caused by HPV, according to the Centers for Disease Control and Prevention, with higher incidence rates among Black and Hispanic people. However, it’s hard to know whether that prevalence is due to socioeconomic factors (such as access to health care) or other variables.

## A Guide to Cervical Cancer, Symptoms, Causes, Prevention, and Treatments

IMAGES PROVIDED BY:

1) PIXOLOGICSTUDIO / Science Source

2) swisoot / Thinkstock

3) Kwangshin Kim / Science Source

4) Biophoto Associates / Science Source

5) Paul Bradbury / Getty Images

6) Martin Rotker / Medical Images

7) SDI Productions / Getty Images

8) John R. Foster / Science Source

10) Look at Sciences / Medical Images

11) Mauro Fermariello / Science Source

12) BSIP / JACOPIN / Medical Images

13) HRAUN / Getty Images

14) Mark Kostich / Getty Images

15) agrobacter / Getty Images

16) bdspn / Thinkstock

17) PHILIPPE PLAILLY / Science Source

18) vgajic / Getty Images

19) PeopleImages / Getty Images

20) Tassii / Getty Images

REFERENCES:

American Cancer Society.

Medline Plus.

National Cancer Institute.

CDC.

## Basic Information About Cervical Cancer

This diagram shows different parts of a woman’s reproductive system.

Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later. When cancer starts in the cervix, it is called cervical cancer. The cervix connects the vagina (birth canal) to the upper part of the uterus. The uterus (or womb) is where a baby grows when a woman is pregnant.

All women are at risk for cervical cancer. It occurs most often in women over age 30. Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common virus that is passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.

Screening tests and the HPV vaccine can help prevent cervical cancer. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.

Almost all cervical cancers are caused by HPV. Other things also can increase your risk of cervical cancer.

The most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21.

Early on, cervical cancer may not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you.

Two screening tests can help prevent cervical cancer or find it early: the Pap test (or Pap smear) and the HPV test.

Your Pap test will come back as “normal,” “unclear,” or “abnormal.” If you also have an HPV test, it will come back as either “positive” or “negative.”

Cervical cancer is treated in several ways. It depends on the kind of cervical cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation therapy.

## A pap-smear analysis tool (PAT) for detection of cervical cancer from pap-smear images | BioMedical Engineering OnLine

#### Image analysis

The image analysis pipeline for the development of a pap-smear analysis tool for the detection of cervical cancer from pap-smears presented in this paper is depicted in Fig.  1.

Fig. 1

The approach to achieve cervical cancer detection from pap-smear images

##### Image acquisition

The approach was assessed using three datasets. Dataset 1 consists of 917 single cells of Harlev pap-smear images prepared by Jantzen et al. [30]. The dataset contains pap-smear images taken with a resolution of 0.201 µm/pixel by skilled cytopathologists using a microscope connected to a frame grabber. The images were segmented using CHAMP commercial software and then classified into seven classes with distinct characteristics as shown in Table 2. Of these 200 images were used for training and 717 images for testing.

Table 2 Some of the characteristics of the cervical cells from the training dataset (N = nucleus, C = cytoplasm)

Dataset 2 consists of 497 full slide pap-smear images prepared by Norup et al. [31]. Of these 200 images were used for training and 297 images for testing. Furthermore, the performance of the classifier was evaluated on Dataset 3 of samples of 60 pap-smears (30 normal and 30 abnormal) obtained from Mbarara Regional Referral Hospital (MRRH). Specimens were imaged using an Olympus BX51 bright-field microscope equipped with a 40×, 0.95 NA lens and a Hamamatsu ORCA-05G 1.4 Mpx monochrome camera, giving a pixel size of 0.25 µm with 8-bit grey depth. Each image was then divided into 300 areas with each area containing between 200 and 400 cells. Based on the opinions of the cytopathologists, 10,000 objects in images derived from the 60 different pap-smear slides were selected of which 8000 were free lying cervical epithelial cells (3000 normal cells from normal smears and 5000 abnormal cells from abnormal smears) and the remaining 2000 were debris objects. This pap-smear segmentation was achieved using Trainable Weka Segmentation toolkit to construct a pixel level segmentation classifier.

##### Image enhancement

A contrast local adaptive histogram equalization (CLAHE) was applied to the grayscale image for image enhancement [32]. In CLAHE, the selection of clip-limit which specifies the desired shape of the histogram of the image is paramount, as it critically influences the quality of the enhanced image. The optimal value of the clip-limit was selected empirically using the method defined by Joseph et al. [33]. An optimum clip limit value of 2.0 was determined to be appropriate for providing adequate image enhancement while preserving the dark features for the datasets used. Conversion to grayscale was achieved using a grayscale technique implemented using Eq. 1 as defined in [34].

$$New \;Grayscale \;Image = \left( {\left( {0.3*R} \right) + \left( {0.59*G} \right) + \left( {0.11*B} \right)} \right),$$

(1)

where R = Red, G = Green and B = Blue colour contributions to the new image.

Application of CLAHE for image enhancement resulted in noticeable changes to the images by adjusting image intensities where the darkening of the nucleus, as well as the cytoplasm boundaries, became easily identifiable using a clip limit of 2.0.

##### Scene segmentation

To achieve scene segmentation, a pixel level classifier was developed using Trainable Weka Segmentation (TWS) toolkit. The majority of cells observed in a pap-smear are not surprisingly cervical epithelial cells [35]. In addition, varying numbers of leukocytes, erythrocytes and bacteria are usually evident, while small numbers of other contaminating cells and microorganisms are sometimes observed. However, the pap-smear contains four major types of squamous cervical cells—superficial, intermediate, parabasal and basal—of which superficial and intermediate cells represent the overwhelming majority in a conventional smear; hence these two types are usually used for a conventional pap-smear analysis [36]. A trainable Weka segmentation was used to identify and segment the different objects on the slide. At this stage, a pixel level classifier was trained on cell nuclei, cytoplasm, background and debris identification with the help of a skilled cytopathologist using Trainable Weka Segmentation (TWS) toolkit [27]. This was achieved by drawing lines/selection through the areas of interest and assigning them to a particular class. { \to }\) which was derived from the number of pixels belonging to each outline. The feature vector from each image (200 from Dataset 1 and 200 from Dataset 2) was defined by Eq. 2.

$$\vec{F} = \left[ {\begin{array}{*{20}c} {N_{i} } \\ {C_{i} } \\ {B_{i} } \\ {D_{i} } \\ \end{array} } \right],$$

(2)

where Ni, Ci, Bi and Di are the number of pixels from the nucleus, cytoplasm, background and debris of image $$i$$ as shown in Fig. 2.

Fig. 2

Generation of the feature vector from the training images

Each pixel extracted from the image represents not only its intensity but also a set of image features that contain a lot of information including texture, borders and colour within a pixel area of 0.201 µm2. Choosing an appropriate feature vector for training the classifier was a great challenge and a novel task in the proposed approach. The pixel level classifier was trained using a total of 226 training features from TWS. The classifier was trained using a set of TWS training features which included: (i) Noise Reduction: The Kuwahara [37] and Bilateral filters [38] in the TWS toolkit were used to train the classifier on noise removal. These have been reported to be excellent filters for removing noise whilst preserving the edges [38], (ii) Edge Detection: A Sobel filter [39], Hessian matrix [40] and Gabor filter [41] were used for training the classifier on boundary detection in an image, and (iii) Texture filtering: The mean, variance, median, maximum, minimum and entropy filters were used for texture filtering.

##### Debris removal

The main reason for the current limitations of many of the existing automated pap-smear analysis systems is that they struggle to overcome the complexity of the pap-smear structures, by trying to analyze the slide as a whole, which often contain multiple cells and debris. This has the potential to cause the failure of the algorithm and requires higher computational power [42]. Samples are covered in artefacts—such as blood cells, overlapping and folded cells, and bacteria—that hamper the segmentation processes and generate a large number of suspicious objects. It has been shown that classifiers designed to differentiate between normal cells and pre-cancerous cells usually produce unpredictable results when artefacts exist in the pap-smear [43]. In this tool, a technique to identify cervix cells using a three-phase sequential elimination scheme (depicted in Fig. 3) is used.

Fig. 3

Three-phase sequential elimination approach for debris rejection

The proposed three-phase elimination scheme sequentially removes debris from the pap-smear if deemed unlikely to be a cervix cell. This approach is beneficial as it allows a lower-dimensional decision to be made at each stage.

##### Size analysis

Size analysis is a set of procedures for determining a range of size measurements of particles [44]. The area is one of the most basic features used in the field of automated cytology to separate cells from debris. {2}\) derived from Table 2.

The objects in the background are regarded as debris and thus discarded from the image. Particles that fall between $$Area_{min}$$ and $$Area_{max}$$ are further analysed during the next stages of texture and shape analysis.

The shape of the objects in a pap-smear is a key feature in the differentiation between cells and debris [30]. There are a number of methods for shape description detection and these include region-based and contour-based approaches [46]. Region-based methods are less sensitive to noise but more computationally intensive, whereas contour-based methods are relatively efficient to calculate but more sensitive to noise [43]. In this paper, a region-based method (perimeter2/area (P2A)) has been used [47]. The P2A descriptor was chosen on the merit that it describes the similarity of an object to a circle. This makes it well suited as a cell nucleus descriptor since nuclei are generally circular in their appearance. {2} }}{A},$$(4) where c is the value of shape compactness, A is the area and p is the perimeter of the nucleus. Debris was assumed to be objects with a P2A value greater than 0.97 or less than 0.15 as per the training features (depicted in Table 2). ##### Texture analysis Texture is a very important characteristic feature that can differentiate between nuclei and debris. Image texture is a set of metrics designed to quantify the perceived texture of an image [48]. Within a pap-smear, the distribution of average nuclear stain intensity is much narrower than the stain intensity variation among debris objects [43]. This fact was used as the basis to remove debris based on their image intensities and colour information using Zernike moments (ZM) [49]. Zernike moments are used for a variety of pattern recognition applications and are known to be robust with regards to noise and to have a good reconstruction power. {*} \left( {r,\theta } \right)\) denotes the complex conjugate of the Zernike polynomial $$v_{nl} \left( {r,\theta } \right)$$. To produce a texture measure, magnitudes from $$A_{nl}$$ centered at each pixel in the texture image are averaged [43]. ##### Feature extraction The success of a classification algorithm greatly depends on the correctness of the features extracted from the image. The cells in the pap-smears in the dataset used are split into seven classes based on characteristics such as size, area, shape and brightness of the nucleus and cytoplasm. The features extracted from the images included morphology features previously used by others [30, 50]. In this paper three geometric features (solidity, compactness and eccentricity) and six textual features (mean, standard deviation, variance, smoothness, energy and entropy) were also extracted from the nucleus, resulting in 29 features in total as shown in Table 3. Table 3 Extracted features from the pap-smear images ##### Feature selection Feature selection is the process of selecting subsets of the extracted features that give the best classification results. Among those features extracted, some might contain noise while the chosen classifier may not utilize others. Hence, an optimum set of features has to be determined, possibly by trying all combinations. However, when there are many features, the possible combinations explode in number and this increases the computational complexity of the algorithm. Feature selection algorithms are broadly classified into the filter, wrapper and embedded methods [51]. The method used by the tool combines simulated annealing with a wrapper approach. This approach has been proposed in [28] but, in this paper, the performance of the feature selection is evaluated using a double-strategy random forest algorithm [52]. Simulated annealing is a probabilistic technique for approximating the global optimum of a given function. The approach is well suited for ensuring that the optimum set of features is selected. The search for the optimum set is guided by a fitness value [53]. When simulated annealing is finished, all the different subsets of features are compared and the fittest (that is, the one that performs the best) selected. {{2/\left( {q – 1} \right)}} }} ,$$

(6)

where $$m_{ik}$$ is the membership for data point k to cluster center i, $$d_{jk}$$ is the distance from cluster center j to data point k and q €[1…∞] is an exponent that decides how strong the memberships should be. The fuzzy C-means algorithm was implemented using the fuzzy toolbox in Matlab.

##### The defuzzification

A fuzzy C-means algorithm does not tell us what information the clusters contain and how that information shall be used for classification. However, it defines how data points are assigned membership of the different clusters and this fuzzy membership is used to predict the class of a data point [54]. This is overcome through defuzzification. A number of defuzzification methods exist [55,56,57]. However, in this tool, each cluster has a fuzzy membership (0–1) of all classes in the image. Training data are assigned to the cluster nearest to it. The percentage of training data of each class belonging to cluster A gives the cluster’s membership, cluster A = [i, j] to the different classes, where i is the containment in cluster A and j in the other cluster. The intensity measure is added to the membership function for each cluster using a fuzzy clustering defuzzification algorithm. A popular approach for defuzzification of fuzzy partition is the application of the maximum membership degree principle where data point k is assigned to class m if, and only if, its membership degree $$m_{ik}$$ to cluster i, is the largest. Chuang et al. [58] proposed adjusting the membership status of every data point using the membership status of its neighbors.

In the proposed approach, a defuzzification method based on Bayesian probability is used to generate a probabilistic model of the membership function for each data point and apply the model to the image to produce the classification information. The probabilistic model [59] is calculated as below:

1. 1.

Convert the possibility distributions in the partition matrix (clusters) into probability distributions.

2. 2.

Construct a probabilistic model of the data distributions as in [59].

3. 3.

Apply the model to produce the classification information for every data point using Eq. 7.

$${\text{P}}\left( {A_{i} |B_{j} } \right) = \frac{{P\left( {B_{j} |A_{i} } \right)*P\left( {A_{i} } \right)}}{{B_{j} }} ,$$

(7)

where $$P\left( {A_{i} } \right),i = 0 \ldots .c$$ is the prior probability of $$A_{i}$$ which can be computed using the method in [59, 60] where the prior probability is always proportional to the mass of each class.

The number of clusters to use was determined to ensure that the built model can describe the data in the best possible way. If too many clusters are chosen, then there is a risk of overfitting the noise in the data. If too few clusters are chosen, then a poor classifier might be the result. Therefore, an analysis of the number of clusters against the cross-validation test error was performed. An optimal number of 25 clusters was attained and overtraining occurred above these number of clusters. A defuzzification exponent of 1.0930 was obtained with 25 clusters, tenfold cross-validation and 60 reruns and was used to calculate the fitness error for feature selection where a total of 18 features out of the 29 features were selected for construction of the classifier. The selected features were: nucleus area; nucleus gray level; nucleus shortest diameter; nucleus longest; nucleus perimeter; maxima in nucleus; minima in nucleus; cytoplasm area; cytoplasm gray level; cytoplasm perimeter; nucleus to cytoplasm ratio; nucleus eccentricity, nucleus standard deviation, nucleus gray level variance; nucleus gray level entropy; nucleus relative position; nucleus gray level mean and nucleus gray values energy.

##### Classification evaluation

In this paper, the hierarchical model of the efficacy of diagnostic imaging systems proposed by Fryback and Thornbury [29] was adopted as a guiding principle for the evaluation of the tool as shown in Table 4.

Table 4 Tool evaluation criteria

Sensitivity measures the proportion of actual positives that are correctly identified as such whereas specificity measures the proportion of actual negatives that are correctly identified as such. Sensitivity and specificity are described by Eq. 8.

$$Sensitivity \;\left( {TPR} \right) = \frac{TP}{TP + FN},\;Specificity\; \left( {TNR} \right) = \frac{TN}{TN + FP},$$

(8)

where TP = True positives, FN = False negatives, TN = True negatives and FP = False positives.

#### GUI design and integration

The image processing methods described above were implemented in Matlab and are executed via a Java graphical user interface (GUI) shown in Fig.  5. The tool has a panel where a pap-smear image is loaded and the cytotechnician selects an appropriate method for scene segmentation (based on TWS classifier), debris removal (based on the three sequential elimination approach) and boundary detection (if deemed necessary, using Canny edge detection method), after which features are extracted using the extract features button.

Fig. 5

PAT graphical user interface

The tool scans through the pap-smear to analyze all the objects that remained after debris removal. The 18 features described in feature selection are extracted from each object and used to classify each cell using the fuzzy C-means algorithm described in the classification method. Randomly, extracted features of one superficial cell and one intermediate cell are displayed in the image analysis results panel. Once the features have been extracted, the cytotechnician (user) presses the classify button and the tool emits a diagnosis (positive to malignity or negative to malignity) and classifies the diagnosis to one of the 7 classes/stages of cervical cancer as per the training dataset.

## Pap test: MedlinePlus Medical Encyclopedia

American College of Obstetricians and Gynecologists. Practice bulletin no. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. (Reaffirmed 2018) Obstet Gynecol. 2013;122(6):1338-1367. PMID: 24264713 pubmed.ncbi.nlm.nih.gov/24264713/.

American College of Obstetricians and Gynecologists. Practice bulletin no. 157: cervical cancer screening and prevention. Obstet Gynecol. 2016;127(1):e1-e20. PMID: 26695583 pubmed.ncbi.nlm.nih.gov/26695583/.

American College of Obstetricians and Gynecologists website. Practice advisory: cervical cancer screening (update). August 29, 2018. www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Cervical-Cancer-Screening-Update. Published August 29, 2018. Reaffirmed November 8, 2019. Accessed March 17, 2020.

Newkirk GR. Pap smear and related techniques for cervical cancer screening. In: Fowler GC, ed. Pfenninger and Fowler’s Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 120.

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. 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 website. Final recommendation statement. Cervical cancer: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening. Updated August 21, 2018. Accessed January 22, 2020.

## Cervical Cancer: Diagnosis | Cancer.Net

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of the medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing cervical cancer. Not all tests listed below will be used for every person. Some or all of these tests may be helpful for your doctor to plan the treatment of your cancer. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your age and general health

• The results of earlier medical tests

The following tests may be used to diagnose cervical cancer:

• Bimanual pelvic examination and sterile speculum examination. In this examination, the doctor will check for any unusual changes in the patient’s cervix, uterus, vagina, ovaries, and other nearby organs. To start, the doctor will look for any changes to the vulva outside the body and then, using an instrument called a speculum to keep the vaginal walls open, the doctor will look inside the vagina to visualize the cervix. A Pap test is often done at the same time. Some of the nearby organs are not visible during this exam, so the doctor will insert 2 fingers of 1 hand inside the vagina while the other hand gently presses on the lower abdomen to feel the uterus and ovaries. This exam typically takes a few minutes and is done in an examination room at the doctor’s office.

• Pap test. During a Pap test, the doctor gently scrapes the outside and inside of the cervix, taking samples of cells for testing.

Improved Pap test methods have made it easier for doctors to find cancerous cells. Traditional Pap tests can be hard to read because cells can be dried out, covered with mucus or blood, or may clump together on the slide.

• The liquid-based cytology test, often referred to as ThinPrep or SurePath, transfers a thin layer of cells onto a slide after removing blood or mucus from the sample. The sample is preserved so other tests can be done at the same time, such as the HPV test (see Screening and Prevention).

• Computer screening, often called AutoPap or FocalPoint, uses a computer to scan the sample for abnormal cells.

• HPV typing test. An HPV test is similar to a Pap test. The test is done on a sample of cells from the cervix. The doctor may test for HPV at the same time as a Pap test or after Pap test results show abnormal changes to the cervix. Certain types or strains of HPV, called high-risk HPV, such as HPV16 and HPV18, are seen more often in women with cervical cancer and may help confirm a diagnosis. If the doctor says the HPV test is “positive,” this means the test found the presence of high-risk HPV. Many women have HPV but do not have cervical cancer, so HPV testing alone is not enough for a diagnosis of cervical cancer.

• Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. Colposcopy can also be used to help guide a biopsy of the cervix. During a colposcopy, a special instrument called a colposcope is used. The colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the body, and the examination is similar to a speculum examination. It can be done in the doctor’s office and has no side effects. It can also be done on pregnant women.

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If the lesion is small, the doctor may remove all of it during the biopsy.

There are several types of biopsies. Most are usually done in the doctor’s office, sometimes using a local anesthetic to numb the area. There may be some bleeding and other discharge after a biopsy. There may also be discomfort similar to menstrual cramps. One common biopsy method uses an instrument to pinch off small pieces of cervical tissue. Other types of biopsies include:

• Endocervical curettage (ECC). If the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy, they will use ECC. During this procedure, the doctor uses a small, spoon-shaped instrument called a curette to scrape a small amount of tissue from inside the cervical opening.

• Loop electrosurgical excision procedure (LEEP). LEEP uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove a precancer or an early-stage cancer.

• Conization (a cone biopsy). This removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove a precancer or an early-stage cancer. It is done under a general or local anesthetic and may be done in the doctor’s office or the hospital.

If the biopsy shows that cervical cancer is present, the doctor will refer you to a gynecologic oncologist, which is a doctor who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix.

• Pelvic examination under anesthesia. In cases where it is necessary for treatment planning, the specialist may re-examine the pelvic area while the patient is under anesthesia to see if the cancer has spread to any organs near the cervix, including the uterus, vagina, bladder, or rectum.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

• Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

If there are signs or symptoms of bladder or rectal problems, these procedures may be recommended and may be performed at the same time as a pelvic examination:

• Cystoscopy. A cystoscopy is a procedure that allows the doctor to view the inside of the bladder and urethra (the canal that carries urine from the bladder) with a thin, lighted tube called a cystoscope. The person may be sedated as the tube is inserted in the urethra. A cystoscopy is used to determine whether cancer has spread to the bladder.

• Sigmoidoscopy (also called a proctoscopy). A sigmoidoscopy is a procedure that allows the doctor to see the colon and rectum with a thin, lighted, flexible tube called a sigmoidoscope. The person may be sedated as the tube is inserted in the rectum. A sigmoidoscopy is used to see if the cancer has spread to the rectum.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cervical cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

## If You Have Cervical Cancer

### What is cervical cancer?

Cancer can start any place in the body. Cervical cancer starts in the cervix. It starts when cells in the cervix grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.

Cancer cells can spread to other parts of the body. Cancer cells in the cervix can sometimes travel to the lung and grow there. When cancer cells do this, it’s called metastasis. To doctors, the cancer cells in the new place look just like the ones from the cervix.

Cancer is always named for the place where it starts. So when cervical cancer spreads to the lung (or any other place), it’s still called cervical cancer. It’s not called lung cancer unless it starts from cells in the lung.

Ask your doctor to use this picture to show you where the cancer is.

##### The cervix

The cervix is the lower part of the uterus. It connects the uterus to the vagina (birth canal), which goes to the outside of the body.

### Are there different kinds of cervical cancer?

There are a few kinds of cervical cancer. Your doctor can tell you more about the kind you have.

The most common kind is called squamous cell carcinoma. This kind starts in the cells that cover the surface of the cervix.

#### Questions to ask the doctor

• Why do you think I have cancer?
• Is there a chance I don’t have cancer?
• Would you please write down the kind of cancer you think I might have?
• What will happen next?

### How does the doctor know I have cervical cancer?

Cervical cancer often doesn’t cause signs or symptoms until it has spread outside the cervix.

Some signs of cervical cancer are:

• Bleeding from the vagina that is not from your period,
• Spotting or discharge from the vagina,
• Pain during sex.

If signs are pointing to cervical cancer, more tests will be done. Here are some of the tests you may need:

Colposcopy: A close look at the inside of the vagina and the cervix using a lighted camera at the end of a thin tube called a colposcope.

Pap test: (or Pap smear) An exam used to scrape cells off the cervix so that they can be tested for cancer and pre-cancer.

Cervical biopsy: In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. There are many ways to do a cervical biopsy. Ask the doctor what kind of biopsy you need. A biopsy is the only way to tell for sure if you have cancer.

CT (computed tomography) scan: This is also called a “CAT scan.” It’s a special kind of x-ray that takes detailed pictures to see if the cancer has spread. CT scans can also be used to help do a biopsy (see below).

MRI (magnetic resonance imaging) scan: This test looks at the soft tissue parts of the body sometimes better than other imaging tests, like a CT scan. Your doctor will decide which imaging test is best.

Chest x-ray: An x-ray may be done to see if the cancer has spread to your lungs.

PET (positron emission tomography) scans: In this test, you are given a special kind of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if the cancer has spread.

Blood tests: Blood tests are not used to find cervical cancer, but they are done to tell the doctor more about your health.

#### Questions to ask the doctor

• What tests will I need to have?
• Who will do these tests?
• Where will they be done?
• Who can explain them to me?
• How and when will I get the results?
• Who will explain the results to me?
• What do I need to do next?

### How serious is my cancer?

If you have cervical cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the cancer through the cervix. It also tells if the cancer has spread to nearby organs or places farther away.

Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the cervix. Be sure to ask the doctor about the cancer stage and what it means for you.

#### Questions to ask the doctor

• Do you know the stage of the cancer?
• If not, how and when will you find out the stage of the cancer?
• Would you explain to me what the stage means in my case?
• Based on the stage of the cancer, how long do you think I’ll live?
• What will happen next?

### What kind of treatment will I need?

There are many ways to treat cervical cancer. The treatment plan that is best for you will depend on:

• The stage of the cancer
• The chance that a type if treatment will cure the cancer or help in some way.
• Other health problems you have
• Your feelings about the treatment and the side effects that come with it.

#### Surgery for cervical cancer

Most women with cervical cancer have some type of surgery.

##### Cryosurgery

This treatment kills the cancer cells by freezing them. It may be used to treat pre-cancers- abnormal cells that can turn into cancer if not treated
.

##### Laser surgery

This treatment uses a laser to burn off cancer cells. It may be used to treat pre-cancers.

##### Conization

Conization is also called a cone biopsy. To do this a small cone-shaped piece of the part of the cervix that has the cancer or pre-cancer is taken out.

##### Hysterectomy

A hysterectomy takes out the uterus and cervix. It’s the most common way to treat cervical cancer. There are many ways to do this surgery.

Sometimes the ovaries are taken out at the same time. Nearby lymph nodes may also be taken out to see if they have cancer cells.

Ask your doctor what type of surgery you will need. Each type has risks and benefits.

#### Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat women with cervical cancer should be able to help you with any problems that come up.

Radiation uses high-energy rays (like x-rays) to kill cancer cells.

Radiation can be aimed at the cervix from a machine outside the body. This is called external beam radiation. Or, a radioactive source can be put into the vagina near the cervix. This is called brachytherapy.

#### Side effects of radiation treatments

If your doctor suggests radiation treatment, ask what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:

• Skin changes where the radiation is given
• Feeling very tired

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

#### Chemo

Chemo is the short word for chemotherapy – the use of drugs to fight cancer. The drugs are often given into a vein. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

When chemo and radiation therapy are given at the same time, it’s called chemoradiation.

#### Side effects of chemo

Chemo can make you feel tired, sick to your stomach, and make your hair fall out. But these problems go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, be sure to tell your cancer care team so they can help.

#### Targeted therapy

Targeted therapy is not the same chemo because these drugs mainly affect cancer cells, not normal cells. They have different side effects from chemo.

#### Immunotherapy

Immunotherapy is treatment that either boosts your own immune system or uses man-made versions of parts of the immune system that attack the cervical cancer cells. These drugs are given into a vein.

#### Side effects of immunotherapy

Immunotherapy can cause many different side effects depending on which drug is used. These drugs may make you feel tired, sick to your stomach, or cause a rash. Most of these problems go away after treatment ends.

There are ways to treat most of the side effects caused by immunotherapy. If you have side effects, tell your cancer care team so they can help.

#### Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

#### Questions to ask the doctor

• What treatment do you think is best for me?
• What’s the goal of this treatment? Do you think it could cure the cancer?
• Will treatment include surgery? If so, who will do the surgery?
• What will the surgery be like?
• Will I be able to have children after surgery?
• Will I need other types of treatment, too?
• What’s the goal of these treatments?
• What side effects could I have from these treatments?
• Will the treatment put me into menopause early?
• Will my sex life change after treatment?
• What can I do about side effects that I might have?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• What’s the next step?

#### What will happen after treatment?

You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. Your doctors will ask about symptoms, do physical exams, and may do blood tests and maybe other tests to see if the cancer has come back. You will also need to keep getting Pap tests no matter what kind of treatment you had.

At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.

90,000 Pap test, take a smear for cytology from the cervix and cervical canal (Papanicolaou staining)

Method of determination
Microscopy

Study material
See description

Home visit available

Papanicolaou staining method is a specially developed method that allows detecting early precancerous diseases of the cervix with the highest degree of reliability.

Cervical cancer takes the third place in the structure of malignant neoplasms of the reproductive system. Until 1992, the incidence of cervical cancer was decreasing, but now there is again a tendency towards an increase in this pathology. The development of the tumor occurs gradually, over several years, therefore, preventive examinations of women using the cytological method of research are very important.

Currently, when conducting screening programs to detect cervical cancer, precancerous and background conditions, Papanicolaou staining of cellular material – the Pap test – is used.Papanicolaou staining method allows to assess the degree of cytoplasm maturation, stains nuclei with atypia well. The term “atypia” has different interpretations in different countries: in central Europe it is defined as malignancy, in the WHO nomenclature – “less than dysplastic intraepithelial changes.”

Carrying out the RAR test has a number of features. An important point is the correct taking of the material and its fixation. The cellular material is taken with special configuration brushes in the “mirrors” to avoid the ingress of foreign material.The transfer of material should be quick, without drying; quick fixation of a wet smear in 96% ethanol is required. Papanicolaou staining of smears goes through a number of stages, then the cellular material enclosed in the balm is subjected to cytological analysis.

Test material: scrapings from the endocervix, exocervix, as well as mixed scrapings applied to a glass slide.

### Literature

1. Kulakov V.I. et al. “Modern approaches to the diagnosis of papillomavirus infection of the genitalia of women and their importance for screening for cervical cancer.Gynecology”. 2000; 1 (2): 4 – 8.

## Cytological examination of smears (scrapings) from the surface of the cervix (external uterine pharynx) and cervical canal

Cytological examination using a special method of staining the material, which allows with high sensitivity to identify atypical cells in a smear and diagnose early precancerous changes in the epithelium and cervical cancer.

Synonyms Russian

Pap smear, Pap test, smear for oncocytology.

Synonyms English

Pap smear, Papanicolaou Smear; Cervical Smear; Cervical Oncocytology.

Research method

Microscopy.

Which biomaterial can be used for research?

A smear from the outer surface of the cervix, a smear from the inner surface of the cervix (from the cervical canal), a mixed smear from the cervical canal and from the surface of the cervix.

How to properly prepare for the study?

No preparation required.

Cervical cancer (CC) ranks third in prevalence among all malignant tumors in women (after breast cancer and colon cancer). The incidence of invasive cervical cancer worldwide is 15-25 per 100,000 women. Neoplasms of the cervix occur mainly in middle-aged women (35-55 years old), are rarely diagnosed under the age of 20, and in 20% of cases are detected at the age of over 65 years.

The 5-year survival rate for localized (local, in situ) cervical cancer is 88%, while the survival rate for advanced cancer does not exceed 13%.

Risk factors for developing cervical cancer include human papillomavirus infection (oncogenic serotypes HPV16, HPV18, HPV31, HPV33, HPV45, etc.), smoking, chlamydial or herpes infection, chronic inflammatory gynecological diseases, prolonged use of contraceptive drugs, repeated childbirth, cases of cervical cancer in the family, early onset of sexual activity, frequent change of sexual partners, insufficient intake of vitamins A and C with food, immunodeficiencies and HIV infection.

According to international recommendations, all women should be screened (pre-symptomatic examination) for cervical cancer 3 years after the onset of sexual activity, but no later than 21 years. From the age of 30, patients who have 3 consecutive negative cervical smear results can be screened every 2-3 years. Women with risk factors (human papillomavirus infection, immunodeficiency states) should continue to be screened annually.Women 65 years or older with 3 or more normal cervical smear results in the past 10 years may not be eligible for screening. Those who have had cervical cancer, have a papilloma virus infection or a weakened immune system, it is advisable to continue screening. Women who have undergone removal of the uterus and cervix may not have this test if the operation was not performed because of cancer or precancerous condition of the cervix. Those who had surgery only on the uterus, without removing the cervix, should continue to participate in the screening.

Cytological examination of material from the cervix and external uterine pharynx, stained according to the Papanicolaou method in compliance with the test procedure and conditions of preparation for analysis, allows with high sensitivity and reliability to identify atypical cells in the material, precancerous conditions (dysplasia, intraepithelial neoplasia of the cervix). Most often, a biomaterial obtained with a special cytobrush from two points (epithelium of the endocervix and exocervix) and fixed on a slide with 96% alcohol is examined.Material from the transformation zone should get into the smear, since about 90% of neoplastic conditions originate from the junction zone of the squamous and cylindrical epithelium and only 10% from the cylindrical. This study can also reveal signs of infection, pathology of the endocervix and endometrium.

Screening and early diagnosis of precancerous conditions and early stages of cervical cancer allow timely effective treatment and prevent dangerous consequences.

What is the research used for?

• For screening and diagnosis of precancerous diseases of the cervix.
• For screening and diagnosis of cervical cancer.

When is the study scheduled?

• With a periodic examination of girls and women 3 years after the onset of sexual activity, but no later than 21 years (it is recommended to take the analysis annually and at least every 3 years).
• Every 2 to 3 years from age 30 to 65 years with three consecutive negative results.
• Annually if you have human papillomavirus (HPV), if your immune system is weakened as a result of transplantation, chemotherapy, or prolonged use of steroid hormones.

What do the results mean?

Based on Bethesda classification The 2001 Bethesda System terminology

1. Amount of material

• Full-fledged material (adequate) – a good-quality smear containing a sufficient number of appropriate cell types is considered a full-fledged material.
• The material is insufficiently complete (insufficiently adequate) – there are no endocervical cells and / or metaplastic cells in the material, squamous epithelial cells are in sufficient quantity, or the cellular composition is poor.
• The material is defective (inadequate) – it is impossible to judge the presence or absence of pathological changes in the cervix by the material.

2. Interpretation of results:

• Negative Pap test – epithelial cells within normal limits, cytogram corresponds to age, normal.
• Benign changes – the presence of non-tumor cells, signs of inflammation (increased number of leukocytes), infection (a significant number of cocci, rods).It is possible to detect infectious agents (indicating the pathogen), for example Trichomonas, yeast.
• Changes in squamous epithelial cells (require increased attention, additional examination and if precancer or cancer is detected, treatment):
• Atypical squamous cells undertermined significance (ASC-US)
• Atypical squamous cells cannot exclude, HSIL ASC-H
• Squamous intraepitelial lesion.SIL)
• Low grade squamous intraepitelial lesion (LSIL)
• High grade squamous intraepitelial lesion (HSIL)
• Cervical intraepithelial neoplasia grade 1, 2 or 3, CIN 1, 2, 3)
• Carcinoma in situ (CIS)
• Squamous cell carcinoma – invasive carcinoma
• Changes in glandular cells (require increased attention, additional examination and if precancer or cancer is detected, treatment):
• Atypical glandular cells (AGC)
• Atypical glandular cells, favor neoplastic, AGC, favor neoplastic

If minimal changes or atypical cells of unclear significance are detected, it is recommended to conduct an examination for oncogenic serotypes of the human papillomavirus.

What can influence the result?

In girls under 20, false positive results are possible due to the presence of changes in the epithelium against the background of transient hormonal disorders.

A distorted result can be obtained if:

90 080 90 021 women are not properly prepared for the study:

• smears taken during menstruation and represented by a large number of endometrial cells, blood;
• spermatozoa are present in the preparations;
• smear contamination with spermicidal and antibacterial creams, lubricants from condoms, ultrasound gel;
• a bimanual study (contamination of the material with talc) was carried out before taking the cytological material.
• the conditions for taking the material have not been met;
• smear preparation was performed carelessly.
• Important Notes

• It is advisable to take smears no earlier than on the 5th day of the menstrual cycle and no later than 5 days before the expected start of menstruation.
• Do not receive smears within 24 hours after sexual intercourse, within 48-72 hours after using lubricants, vinegar or Lugol solution, tampons or spermicides, douching, introducing medications, suppositories, creams, including gels for performing ultrasound into the vagina …
• In acute infection, it is desirable to obtain material for the purpose of examination and identification of the etiological agent; after treatment, but not earlier than 2 months later, cytological control is required.
• There is a possibility of a negative test result with changes in the epithelium in the cervix, therefore it is important to regularly re-examine.

Also recommended

• Cytological examination of smears (scrapings) from the surface of the cervix (external uterine pharynx) and cervical canal for atypia
• Squamous cell carcinoma antigen (SCCA)
• Human Papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types), DNA without type determination [real-time PCR]

Who orders the study?

Gynecologist, oncologist.

Literature

• Apgar BS, Zoschnick L, Wright TC (November 2003). “The 2001 Bethesda System terminology”. Am Fam Physician 68 (10): 1992-8.PMID 14655809.
• Arbyn M. et al. (2010). “European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition — Summary Document “. Annals of Oncology 21 (3): 448-458.
• American College of Obstetricians and Gynecologists, “ACOG Committee Opinion No. 483: Primary and Preventive Care: Periodic Assessments, “2011, Obstet Gynecol, 2011, 117 (4): 1008-15.PubMed 21422880
• Novik V.I. Epidemiology of cervical cancer, risk factors, screening.

## Cytological smear (Pap smear, Pap test)

In recent years, oncological diseases, including endometrial and cervical cancer, have become increasingly common. To diagnose them, a method such as a Pap smear test or a Pap test is used, which allows you to identify cancer cells in the secretion of the vagina. The technique is quite simple, painless for the patient and gives results with high accuracy, but in Perm, such a study is not carried out in every clinic.We are ready to offer our patients to have a Pap smear.

##### Pap smear at a glance

Analysis refers to a cytological procedure in which a sample is stained with special compounds. The material is taken by scraping from the upper layer of the cervix, and after staining it is examined under a microscope. In addition to endometrial cancer, with the help of the Pap test, oncology can be detected in other organs:

90 080 90 021 in the lungs;

90,021 in the stomach;

• For these purposes, other biological excretions are collected from patients – urine, feces or sputum. The Pap test can also be used to examine tissue samples taken with a biopsy.

Cervical cancer is more often diagnosed in women using this technique than other types of oncology. To obtain a biomaterial, the patient sits in a gynecological chair, then a scraping is taken from the transition zone of the cervix. The resulting sample is applied to a glass slide, fixed, stained and examined under a microscope.An experienced laboratory technician will immediately see cancer or abnormal cells if they are present in the material.

##### How to prepare for a cytological smear

The material is taken for research during a standard gynecological examination in cases when a woman does not take contraceptives and hormonal drugs. These drugs can alter the composition of the mucus and the upper layer of the cervix, making it more likely that the result is wrong.

Test preparation rules:

• to stop sexual intercourse in two days;
• stop injecting drugs into the vagina, and also do not douche or put cotton swabs two days before the appointed date;
• to be tested for cervicitis, if found – to cure it, if possible.

Taking a smear for subsequent cytological examination can be performed on any day, with the exception of menstruation. Also, the material is not taken if there is bleeding from the uterus. If necessary, a Pap test can be done during menstruation, but the effectiveness will be significantly reduced.

##### How often should the Pap test be done

Taking a smear for a Pap test can be carried out at the time of a routine examination, for this, the recommendations of doctors are taken into account, indicating the frequency of the study depending on the age range:

• 21-29 years old – every 3 years;
• 90,021 30-65 years old – every 5 years;

• upon reaching the age of 65, the last screening is done, if there were no previous positive test results.

Residents of the Perm Territory who are at risk or have reached the age of 21 can be tested for cervical cancer at our medical center. Make an appointment at a convenient time for you now, without postponing the examination until tomorrow. Remember that cancer can be successfully treated at an early stage.

## Medical center “CONSULTANT” – Cytological research

Cytological examination is a method of laboratory diagnosis of various diseases based on a microscopic assessment of the cell and changes in it.Under a microscope, the morphological change in the cell is assessed, after which a cytological conclusion is drawn up by a cytologist.

The main goal of cytological studies is the diagnosis and prevention of diseases, especially those associated with oncopathology.

For an accurate and complete interpretation of the cytological material, not only the professionalism of a cytologist is required, but also the correct technique for taking and applying biological material on the glass, according to the localization of the pathological process.

The success of cytological studies largely depends on whether the material is taken correctly: from the tumor or from the surrounding tissues, from its center or peripheral areas, from foci of necrosis or hemorrhage, and whether it is enough. In the absence of a sufficient amount of material, they resort to repeated, sometimes multiple studies. In addition, many tumors are characterized by the presence of areas with different structures and unequal cellular composition, therefore, accurate cytological diagnosis of such neoplasms is difficult.In our center, all methods are developed and standardized.

The advantages of the cytological research method include the technical simplicity of processing and taking the material, the possibility of its quick preparation, low invasiveness and low cost.

Material delivered for cytological examination is divided into puncture and exfoliative.
Puncture is a cytological examination of materials of the thyroid and mammary glands, lymph nodes and other neoplasms obtained by aspiration puncture with a thin needle under ultrasound control.

Exfoliative is a cytological examination of the discharge of various mucous membranes (bronchi, cervix, vagina, bladder, nose, etc.), secretions of glands (including milk ones), smears from the skin and the surface of wounds.

Cytological diagnostics includes verification of various pathophysiological conditions: inflammation, reactive changes, proliferation, stages of carcinogenesis.

Nevertheless, the main focus of clinical cytology is the early and timely diagnosis of neoplasms.
Cytological studies are currently used in many branches of medicine, but they are most widely used in gynecological practice, since they give an accurate diagnosis in the setting of diseases of the cervix.

### Cervix

Cervical cancer takes the third place in the structure of malignant neoplasms of the reproductive system. The development of the tumor occurs gradually, over several years, therefore, preventive examinations of women using the cytological method of research are very important.
With the help of a smear, it is possible to diagnose background diseases, dysplasias (CIN 1,2,3) and malignant processes. Currently, it is recommended that a cervical smear be taken from every woman over the age of 20. Often, early treatment at the stage of dysplasia can reliably protect against a formidable cancer diagnosis.

In a clinical assessment of the results of cytological examination of material from the cervix, it should be remembered that the absence of cancer cells in the test material does not exclude the presence of a malignant tumor in the patient.If there are no clinical signs of a malignant process, the cytological diagnosis should not be rejected without an in-depth clinical, colposcopic examination, hysteroscopy, targeted biopsy with the study, if necessary, of layer-by-layer sections.

The cervix, being a small area of ​​a small organ, is of great importance in a woman’s reproductive health. The cervix is ​​one of the most vulnerable parts of the body, so it should be under the close attention of not only a gynecologist, but also a cytologist.Thanks to this study, in many countries of the world, the incidence and mortality from cervical cancer has decreased tenfold. The cytological method in the diagnosis of cervical diseases remains one of the main ones.

For the diagnosis of pathological conditions of the cervix, our center uses traditional cytology. Unlike liquid cytology and Pap smears, it makes it possible to successfully carry out not only screening for cervical cancer, but also to diagnose inflammatory processes, which is also very important for the reproductive health of women.

### Thyroid

Recently, the number of thyroid diseases has been increasing everywhere, according to some data, covering up to 30% of the world’s population. The main task of a puncture of the thyroid gland is to determine the nature of the node, i.e. to distinguish non-neoplastic diseases of the thyroid gland (goiter, thyroiditis) from neoplastic ones. And if it is neoplastic, then assess the nature of the process: benign or malignant.

The incidence of cancer in the thyroid nodule is about 5% in the general population and about 20% in patients after surgery.Thus, the presence of a node in the thyroid gland obliges the clinician to carry out the necessary comprehensive diagnostic examination for the timely recognition of a tumor process, especially a malignant one. That is why a puncture biopsy of the thyroid gland is important for the correct tactics of further patient management. It is safe to say that without a high-quality fine-needle biopsy of the thyroid gland, it is impossible to treat patients with thyroid nodules of high quality either.Unfortunately, for a number of objective reasons, it is not always possible to obtain full-fledged material the first time. For an accurate and confident judgment about the pathological process, we perform repeated puncture for patients.

### Breast

Among diagnosed malignant tumors, breast cancer is 26%, followed by lung and bronchial cancer (15%). Outstanding advances in the treatment of this disease have contributed to a decrease in mortality despite an increase in morbidity.Qualitative clinical trials, one of which is cytological, have been the main factor behind more favorable breast cancer outcomes. Cytological diagnostics allows: to quickly determine the presence of a tumor, hyperplastic and inflammatory diseases, to diagnose some benign conditions in which surgery is required, as well as lesions in which surgery is not required, to monitor the effectiveness of treatment, to confirm the recurrence of cancer.These tasks are solved both with the help of a puncture biopsy with a thin needle, and in the study of discharge from the nipple of the mammary glands. The latter are especially relevant in the differential diagnosis of fibrocystic disease and intraductal papilloma.

### Leather

In terms of frequency, skin tumors are classified as the leading pathology. A significant increase in the number of skin cancers has led to an increase in the volume of cytological studies, according to which the plan for further treatment of the patient is determined.In the process of examining a patient, a cytological examination allows you to quickly get an answer about the benign or malignant nature of the pathological process.

Most often, in smears-prints from the surface of the skin, a cytologist can see a pigmented nevus, basal cell carcinoma, squamous cell carcinoma and melanoma.

### Rhinocytology (general clinical examination of mucus from the nose)

The nasal secretion has important protective functions.Normally and with banal inflammation, eosinophilic leukocytes in the secretion from the nasal cavity are absent, or the ratio of eosinophils to neutrophils is 1:10. The detection of a large number of eosinophils in the secretion from the nasal cavity reflects the body’s allergic reaction to the introduction of allergens into the upper respiratory tract. The frequency of symptoms of allergic rhinitis in the Russian Federation reaches 38%; the prevalence of the disease among the child population reaches 40%. Effective therapy is impossible without accurate diagnosis.
For research, a swab is taken from the nasal cavity, stained using the Romanovsky-Giemsa method. In the course of the microscopy, the characteristics of the cellular composition are given. The presence of eosinophils more than 10% most often indicates the allergic nature of rhinitis.

Photographs of cytological images were taken at the Consultant medical center using a built-in camera in a Leica DM 1000 LED microscope from Leica Microsystems. A modern microscope makes it possible to archive a microscopic image in electronic form, personalized for each patient.
You can ask a question to a specialist at the following email addresses: [email protected], [email protected]

## Cytological examination of a smear from the cervix PAP test on a liquid cytology apparatus

Liquid oncocytology (PAP test) is a screening method for examining women to identify potentially dangerous precancerous and cancerous processes in the cervical canal and cervix. The test has replaced the routine Pap smear, as it has a number of significant advantages.

The test is intended for annual prophylactic screening of women in order to prevent cervical cancer. According to the European Guidelines for Quality Assurance in Cervical Cancer Screening (2010), a PAP test combined with a regular screening program can reduce cervical cancer mortality by up to 80%!

On the territory of the CIS, a routine method of microscopy of cervical scraping is widespread, which, in comparison with liquid oncocytology, has a number of disadvantages.These two methods are united by the fact that the result of the study is based on the study of scraping from the cervix under a microscope. The advantage of the PAP test lies in the technology of preparing biomaterial for research :

1. Unlike the routine method, the biomaterial is not “smeared” on the glass immediately after scraping, but is placed in a special liquid medium.
2. Next, the process of centrifugation of the liquid and separation of cells from each other takes place, as well as the removal of other contents (mucus)
3. The resulting cellular material is applied in an even layer on a glass slide, after which it is microscoped.

The last, third point is fundamentally important, since it is he who provides the most accurate result: when directly applying a scraping on a glass slide, up to 80% of cells are lost (* Hutchinson ML et al., Homogeneous sampling accounts for the increased diagnotstic accuracy using the ThinPrep® Processor, Am J Clin Pathol).

In the OLIMP CDL, the study is performed on the automatic system EASY PREP ® , which eliminates the possibility of errors associated with the process of creating a preparation for microscopy.The device independently prepares the material, after which the assessment of the research results is carried out by a cytologist. The equipment allows you to display a high-precision image of the smear on the monitor.

 Conventional method Liquid Oncocytology Manual creation of biomaterial for microscopy (human factor) Automatic creation of biomaterial (no human factor) About 80% of cells * do not reach the stage of study Almost 100% of biomaterial is available for study Clumping and layering of cells Uniform distribution of cells Material contaminated with non-cellular biological elements (mucus) Minimum waste biomaterial High probability of false negative Minimum probability of a false negative result Ability to detect cells infected with human papillomavirus (HPV)

Attention! It is not recommended to take a smear in the following cases:

• Before 48 hours after intercourse
• During menstruation
• During treatment for another genital infection
• Before 48 hours after using lubricants, vinegar or Lugol solution, tampons or spermicides
• After vaginal examination or douching

Figure 1.Routine method

Figure 2. Liquid oncocytology

## Medical Council

 Code Item Price 02-001 Analysis of feces for occult blood 200 02-002 Urine analysis according to Nechiporenko 198 02-003 Microscopic examination of the discharge of the genitourinary organs of women (microflora) 280 02-004 Microscopic examination of the secretion of the prostate gland (microflora) 236 02-005 Clinical blood test (with leukocyte count) 230 02-006 General urine analysis with sediment microscopy 180 02-007 Erythrocyte sedimentation rate (ESR) 112 02-009 Coprogram 360 02-010 Analysis of feces for helminth eggs 160 02-013 Enterobiasis 180 02-014 Complete blood count (without leukocyte count and ESR) 140 02-015 Microscopic examination of the discharge of the genitourinary organs of men (microflora) 140 02-021 General sputum analysis 520 02-027 Reticulocytes 210 02-029 Clinical blood test with leukocyte count and ESR 320 02-031 The content of carbohydrates in feces 440 02-032 Sulkovich’s test 130 02-033 Microscopic examination of a smear from the nasal mucosa 330 02-056 Analysis of feces for eggs and larvae of helminths, protozoa and their cysts 550 03-002 Antithrombin III 580 03-003 Activated partial thromboplastin time (APTT) 180 03-004 Lupus anticoagulant 780 03-005 Blood group ABO 260 03-007 Coagulogram No. 1 (prothrombin (according to Quick), INR) 190 03-008 Rh factor 236 03-010 Thrombin time 180 03-011 Fibrinogen 180 03-015 Coagulogram No. 2 (prothrombin (according to Quick), INR, fibrinogen) 370 06-003 Alanine aminotransferase (ALT) 90 06-004 Serum albumin 80 06-005 Amylase total in serum 110 06-006 Amylase pancreatic 200 06-010 Aspartate aminotransferase (AST) 90 06-011 Protein fractions in whey 240 06-012 Vitamin B12 (cyanocobalamin) 570 06-013 Gamma-glutamyl transpeptidase (gamma-GT) 120 06-014 Glycated hemoglobin (HbA 1c) 420 06-015 Plasma glucose 90 06-017 Iron in serum 100 06-018 Iron binding capacity of serum 180 06-019 Potassium, sodium, chlorine in serum 360 06-020 Calcium in serum 90 06-021 Serum creatinine (with GFR determination) 90 06-022 Creatine kinase total 140 06-023 Creatine kinase MB 290 06-027 Lipase 240 06-028 Cholesterol – High density lipoprotein (HDL) 100 06-029 Cholesterol – Low density lipoprotein (LDL) 140 06-031 Magnesium in serum 100 06-033 Uric acid in serum 90 06-034 Urea in whey 90 06-035 Total whey protein 90 06-036 Total bilirubin 90 06-037 Bilirubin direct 80 06-038 Total protein in urine 100 06-039 C-peptide in serum 420 06-040 Transferrin 340 06-041 Triglycerides 90 06-042 Ferritin 360 06-043 Vitamin B9 (folic acid) 600 06-045 Phosphatase alkaline total 90 06-046 Phosphorus in serum 90 06-048 Total cholesterol 90 06-049 Serum cholinesterase 160 06-050 C-reactive protein, quantitative (highly sensitive method) 260 06-051 Calcium ionized 260 06-053 Amylase total in daily urine 120 06-054 Calcium in daily urine 80 06-055 Magnesium in daily urine 150 06-056 Phosphorus in daily urine 110 06-057 Creatinine in daily urine 150 06-058 Urea in daily urine 150 06-059 Uric acid in daily urine 150 06-060 Total protein in cerebrospinal fluid 90 06-061 Glucose in cerebrospinal fluid 90 06-062 Potassium, sodium, chlorine in daily urine 360 06-064 Potassium in serum 360 06-065 Sodium in serum 360 06-066 Chlorine in serum 360 06-067 Potassium in daily urine 240 06-068 Sodium in daily urine 240 06-069 Chlorine in daily urine 240 06-071 Glucose tolerance test (extended) 360 06-115 Glucose in urine 90 06-180 General acid phosphatase 380 06-182 C-reactive protein, quantitative (method with normal sensitivity) 250 07-025 HBsAg 440 07-027 Helicobacter pylori, IgA (quantitative) 540 07-028 Helicobacter pylori, IgG (quantitative) 360 07-030 Herpes Simplex Virus 1/2, IgG 350 07-031 Herpes Simplex Virus 1/2, IgM 360 07-032 HIV 1,2 Ag / Ab Combo (determination of antibodies to HIV types 1 and 2 and antigen p24) 660 07-056 Syphilis RPR (anticardiolipin test / micro-precipitation reaction), titer 150 07-113 Screening examination for helminthiases (Opisthorchis IgG, Toxocara IgG, Trichinella IgG, Echinococcus IgG) 460 08-004 CA 125 II 600 08-005 CA 15-3 640 08-006 CA 19-9 640 08-007 CA 72-4 840 08-008 Fragments of cytokeratin 19 CYFRA 21-1 1100 08-020 The beta subunit of human chorionic gonadotropin (beta-hCG) 310 08-042 Cancer embryonic antigen (CEA) 500 08-111 Luteinizing hormone (LH) 340 08-112 Progesterone 360 08-113 Total triiodothyronine (T3) 280 08-114 Free triiodothyronine (T3 free) 280 08-115 Total thyroxine (T4) 280 08-116 Free thyroxine (T4 free) 280 08-117 Testosterone 350 08-118 Thyroid stimulating hormone (TSH) 300 08-119 Follicle stimulating hormone (FSH) 320 08-120 Estradiol 360 08-121 Macroprolactin 560 08-122 Prolactin 320 09-001 Candida albicans, DNA [real-time PCR] 120 09-002 Chlamydia trachomatis, DNA [real-time PCR] 120 09-003 Cytomegalovirus, DNA [real-time PCR] 160 09-006 Epstein Barr Virus, DNA [real-time PCR] 230 09-007 Gardnerella vaginalis, DNA [real-time PCR] 120 09-025 Mycoplasma genitalium, DNA [real-time PCR] 120 09-026 Mycoplasma hominis, DNA [real-time PCR] 120 09-027 Neisseria gonorrhoeae, DNA [real-time PCR] 120 09-030 Trichomonas vaginalis, DNA [real-time PCR] 120 09-031 Ureaplasma parvum, DNA [real-time PCR] 120 09-032 Ureaplasma urealyticum, DNA [real-time PCR] 120 09-036 Anaplasma phagocytophilum, DNA [real-time PCR] 340 09-038 Bordetella pertussis, DNA [real-time PCR] 240 09-039 Borrelia burgdorferi s.l., DNA [real-time PCR] 180 09-040 Ehrlichia chaffeensis, DNA [real-time PCR] 280 09-105 Human Papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types), DNA without type determination [real-time PCR] 520 09-106 Human Papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types), DNA genotyping [real-time PCR] 600 09-115 Human Papillomavirus of high carcinogenic risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types), DNA quantitatively, without type determination [real-time PCR] 760 10-035 Culture on Staphylococcus aureus (S.aureus) 540 10-036 Culture for Staphylococcus aureus (S. aureus) with antibiotic susceptibility testing 700 10-037 Sowing for flora without antibiotic susceptibility testing 560 12-001 Cytological examination of smears (scrapings) from the surface of the cervix (external uterine pharynx) and cervical canal for atypia 330 12-003 Cytological examination of the hormonal background (with the threat of termination of pregnancy, irregularities in the cycle) 170 12-005 Cytological examination of material obtained during surgery 200 12-006 Cytological examination of punctates, scrapings of other organs and tissues 200 12-008 Histological examination of the operating material 850 12-012 Cytological examination of material obtained during endoscopy (FGDS, bronchoscopy, laryngoscopy, cystoscopy, sigmoidoscopy, colonoscopy) 200 12-048 Cytological examination of smears (scrapings) from the surface of the cervix (external uterine pharynx) and cervical canal – Papanicolaou staining (Rar test) (mixed smear) 790

## Cervical cancer – screening and prevention

Cervical cancer is a malignant tumor of the female genital organs.This is one of the rare lesions that can be prevented. In most cases, the disease occurs against the background of long-standing precancerous processes, which are quite easy to identify during screening examinations of the population. Doctors massively examine patients for the presence of altered cells. Thanks to this approach, in most cases, it is possible to recognize the disease in the early stages, when it can be completely cured.
Recently, there has been an increase in the incidence of cervical cancer among young women under the age of 40.

Symptoms of cervical cancer
At the initial stages, the disease does not manifest itself in any way and the woman does not feel anything unusual. But then the tumor grows into the deeper layers of the uterus. This causes the following symptoms:
1. Menstruation becomes longer, heavy or painful
2. Heavy intermenstrual bleeding or spotting in the middle of the cycle appears
3. Bloody vaginal discharge after douching, physical exertion and visiting a gynecologist
4.Abundant mucous discharge, sometimes mixed with blood
5. Pain during intercourse
6. Aching pain in the lower abdomen
7. In women during menopause, bleeding from the vagina may begin
Although these symptoms can appear with other gynecological diseases, they should alert the woman. This is a reason to see a doctor.
Increase the risk of a malignant tumor: early pregnancy, a large number of sexual partners, sexually transmitted diseases, inflammation of the genital organs, smoking and long-term use of hormonal contraceptives.
Gynecological examination
Cervical cancer is one of the few cancers that can be prevented. A regular visit to a gynecologist will help protect you. First of all, the doctor collects an anamnesis. This means that the gynecologist asks about the signs of the disease that bother the woman. Finds out if there were any cases of genital cancer among her relatives.
After that, the doctor conducts diagnostic procedures:
1. Vaginal examination using gynecological mirrors.At the same time, he assesses the condition of the cervix, arches and walls of the vagina. In about 95% of women who are sick, signs of cancer can be found during a routine examination.
2. Two-handed gynecological examination. One hand of the doctor probes the uterus through the vagina, and the other through the front wall of the abdomen. In cancer, the uterus is enlarged, painful, and denser. If metastases have occurred, then it does not move well to the sides.
3. Smear for oncocytology (Pap test, Pap test). This is a smear of glandular epithelium (surface cells).To do this, a smear is taken from the cervical canal with a special brush. Then it is carried out on a slide and an imprint is obtained. In the laboratory, the structure of cells is examined under a microscope. If a deviation is found in the structure of their nuclei or cytoplasm, it is suspected that a woman may develop a tumor. A positive test result does not prove the presence of cancer, but serves as a reason for a more thorough examination. If atypical cells are detected, the doctor advises to do an analysis to identify the DNA of the human papillomavirus.

4. Colposcopy is performed if there are atypical cells or signs of human papillomavirus. The coloscope allows you to greatly increase the image of the vaginal mucosa and cervix. In order for the changes to become more noticeable, the mucous membrane is treated with a solution of acetic acid and Lugol’s solution. During the examination, the doctor can notice even the smallest changes and the slightest swelling. May be alerted by ulcers, areas that rise above the rest of the mucous membrane, warts.
5. A biopsy is the taking of a tissue sample for histological examination.
6. Feeling of the lymph nodes. The doctor checks the lymph nodes by touch, determines their size and density. This is done to detect metastases.
7. Additional research. The doctor may prescribe an ultrasound of the pelvic organs, x-rays, computed and magnetic resonance imaging. If the tumor is confirmed, then methods such as cystoscopy, excretory urography, radioisotope renography, and sigmoidoscopy can be used to clarify its size and search for metastases.
Prevention of cervical cancer
1. Treatment of precancerous conditions. First of all, it is cervical dysplasia, as well as erosion, papillomas and warts in this area. Such defects can become the basis for a tumor, since their cells can degenerate into cancerous ones.
2. Prevention of infection with human papillomavirus and genital herpes. These infections are sexually transmitted. Condoms can help protect against them – an effective remedy for other sexually transmitted diseases that increase the risk of cancer.
3. Refusal from promiscuous sex life. Studies have shown that if a woman has more than 10 sexual partners in her life, the risk of developing cervical cancer increases 3 times.
5. It is necessary to educate girls about the dangers of early sexual intercourse and early first pregnancy (up to 16 years). At this age, the mucous membrane of the genital organs has not yet fully formed, and its cells are actively growing and dividing. If you injure them, then there is a high probability that they will begin to mutate.
6. If there is a need for gynecological manipulations: abortion, curettage, setting of the spiral, then contact a qualified gynecologist. Poor performance of these procedures leads to scarring. And they can serve as the basis for a tumor.
7. When choosing hormonal contraceptive pills, you should contact your gynecologist. Self-administration of these drugs can cause hormonal disorders that lead to the appearance of hormone-dependent tumors. Failure in the production of hormones can occur for another reason.Therefore, if you notice that your periods have become irregular, then inform your doctor about it. He will prescribe the necessary tests, and then he will write out the treatment.
8. Quitting smoking helps to reduce the number of carcinogens that affect the female body.