Nature rewarded women with beauty, charm, sensuality, tenderness. She also created in their body an unusually complex system of genital organs, thanks to which life continues on our planet. For various reasons, dozens of diseases can occur in any part of these organs. Some of them are less serious, others more, but each needs to be treated. If this is not done, even a very simple ailment can develop into a big problem.
One of the most dangerous today is cancer. It is possible to defeat this deadly disease if malignant cells have not yet had time to spread throughout the body. Cancer can occur anywhere in the body, including the reproductive system. Timely diagnosis helps women avoid very unpleasant consequences of this and other diseases. One of the basic research methods in our time is a biopsy of the cervix.
If you've been prescribed it, you don't have to think you have cancer. This analysis is relevant for many problems that arise in the mucous membranes of a very small but important organ - the cervix. Whatdoes the biopsy show? How is it carried out? Does it require special preparation? What are the implications of this analysis? In our article you will find answers to your questions regarding the conduct of this study.
Cervix
Every woman has heard of the existence of such an organ, but not everyone knows what it is. The cervix, figuratively speaking, is a corridor along which spermatozoa move in a hurry to fertilize the eggs. It connects the vagina and the uterine cavity and is a short tube 2.9-4.2 cm long. Its width in nulliparous girls is 2.6-2.9 cm, and in those who have given birth, it is about 5 mm larger. From two ends of the cervix has the so-called pharynx. One opens into the vagina, the other into the uterus. In the normal position (menopause, there are no pathologies), they are closed.
In addition to two os, the cervix is divided into vaginal and supravaginal parts, as well as the cervical canal, which opens in the body of the uterus.
Inside, this small connecting tube is lined with several layers of cells. In the vaginal part, they are represented by non-keratinized epithelium, which has a superficial, spiny and basal layers. The epithelium is renewed every 5 days. It consists of several types of cells:
Cylindrical. They are located in one layer, bright red, have a papillary surface. These cells play an important role - they secrete a secret that moisturizes the genital tract.
Metaplastic. They are located under the cylindrical ones, formed from them by transformation. It is in them more oftenall cancers occur. That is, for a biopsy of the cervix, these cells are mainly taken.
Epithelial cells lie on a thin basement membrane that separates it from connective tissue.
The concept of a biopsy
This term means taking a biopsy (tissue or individual cells) from a living person. There is also an autopsy - the study of the tissues of the dead. Biopsy is the most accurate method for examining tissue cells. It is carried out using powerful microscopes. Research can be done in two ways:
- Histological. For this method, organ tissues are taken. They are first dehydrated with a special solution, then made fat-soluble, impregnated with paraffin, which, after solidification, is cut into layers about 3 microns wide. The samples prepared in this way are placed on a laboratory glass and, using different technologies, the presence or absence of pathological changes is detected.
- Cytological. This is a more gentle and less traumatic method of taking a biopsy, in which only cells, and not pieces of tissue, are taken from a suspicious area of \u200b\u200bthe body. It is a cytological examination that is most often performed with a biopsy of the cervix. The procedure consists in taking a smear-imprint from the mucous membrane of this organ. The morphologist performs the analysis. Cytoscopy is less informative and not as accurate as histology.
Indications for biopsy
Every woman is obliged to visit a gynecologist at least once a year. As a rule, the doctor conducts an instrumental examination (using mirrors and a colposcope), takes a smear. ATif necessary, he appoints the patient to take tests.
Cervical biopsy is an exceptional procedure. The indications for this study are such pathologies in the cervix:
- Ectopia (pathological changes in the cervical mucosa).
- Dysplasia (violation of the tissue and cellular structure). Considered a precancerous condition.
- Very often a biopsy of the cervix is prescribed for erosions. Suspicion should arise if they are crumbling or bleeding. However, for the purpose of reinsurance, doctors often prescribe a biopsy procedure for any type of erosion.
- Leukoplakia (keratinization, thickening of the epithelium).
- Polyps.
- Condylomas (genital warts).
- There are areas that do not stain with iodine (called iodine-negative).
- Changes in the epithelium, called coarse mosaic.
- Atypical cells identified by cytology smear.
- Koilocytes (cells in which papillomavirus is found.
- There are areas of the epithelium that are lightened with acetic acid.
- Epithelial changes detected during colposcopy.
- Atypical cells in the epithelium.
- Atypical vessels that do not react in any way to contact with acetic acid.
Preparation
It should be said that a cervical biopsy is preceded by a serious preparatory stage, during which the following tests must be taken:
- HIV.
- On chlamydia, mycoplasma,ureaplasma.
- Hepatitis.
- For syphilis (RW).
- Blood total.
- Blood clotting.
- Smear on the microflora of the vagina and cervix.
- Cytology smear (called PAP).
- Get a colposcopy.
If the examination reveals the presence of pathogenic microbes, the biopsy is postponed until the detected disease is cured.
A woman should tell her doctor the following information about her he alth:
- Is there or not allergic to food, medicines.
- Does she or her family members experience occasional spontaneous bleeding.
- What were the previous surgical interventions.
- History of hypertension, diabetes, heart failure.
- Experienced venous thrombosis and/or pulmonary embolism.
The day before the upcoming biopsy, it is required to stop sexual intercourse, douching, the use of tampons and vaginal medications.
On the day of the test, do not smoke, drink alcohol, use any personal hygiene products.
If the procedure is scheduled under anesthesia, it is forbidden to eat and drink any drinks other than water 12 hours before.
When is the best time to do a biopsy
Let's consider how the cervix behaves at different periods of the cycle?
On the 5-7th day, it is low down, hard and elastic, clogged with a mucous plug.
From the 7th to the 12th day of the neckgradually rises, becoming softer supple.
From the 13th to the 15th day, the cervix becomes loose, slippery and wet.
From the 16th day, it falls again, becomes firm and elastic.
Many gynecologists believe that the most successful time for a biopsy is the period from the 7th to the 12th day. You can capture the 13th. Then the external pharynx of the cervix is ajar, which helps to reduce the pain of the woman when the instruments are introduced into the organ.
Some doctors prescribe an analysis immediately after the end of menstruation, as well as from the 5th to the 8th day of the cycle.
To conduct a study, the doctor has to open the external pharynx (from the side of the vagina) so that a colposcope can be inserted into the organ. That is why many women experience pain during a cervical biopsy. In this case, when taking a biopsy, the patient feels pulling, sometimes radiating to the stomach, legs and ovaries, discomfort. Only among women who have already given birth several times, there are many who do not experience any negative symptoms when instruments are inserted into the organ.
This may depend on the pain threshold of each patient, on the professionalism of the gynecologist and on which day of the menstrual cycle the analysis is performed.
How a cervical biopsy is done
Standard process (without complications) takes about 30 minutes. In this case, the following actions are performed:
1. The patient sits comfortably on the gynecological chair.
2. The doctor provides access to the cervix byinserting a special medical speculum into the vagina.
3. Prepares the surface of the mucosa, for which it carries out some manipulations:
- cleans the area of the neck from mucus with a saline swab;
- applies iodine to this place (the problem area does not turn brown, characteristic of the substance);
- applies acetic acid (problem areas turn white);
- introduces the colposcope and carefully examines the surface (the device has a light bulb at the end, allows you to magnify 40 times).
These preparatory manipulations may cause discomfort to the patient, but they must be done.
4. A biopsy is taken. How a cervical biopsy is performed depends on the type of instrument. This issue will be discussed below. Now we note that a biopsy is taken from all problem areas (if several are found).
5. After the procedure, the cervix, vagina and genitals are treated with an antiseptic from the outside.
Results are being prepared for 2 weeks.
Biopsy Tools
In the arsenal of gynecologists there are several types of instrument used to take a biopsy. Which one to use depends on the equipment of the clinic and on the nature of the problem area to be examined.
1. biopsy needle. With this type of material sampling, anesthesia is not performed. The patient feels short-term pain, as with an injection. After a cervical biopsy performed in this way, the woman does not feel discomfort. Allocationsminimal.
2. Conchotom. Some women call this tool forceps because of their resemblance. How is a cervical biopsy performed with a conchotome? This tool simply pinches off pieces of flesh. The procedure must be performed with an injection of anesthetic into the cervix, then it is practically painless. Without anesthesia, women feel pulling pains radiating to the lower abdomen. The doctor cauterizes the wounds after the procedure. If there is heavy bleeding, insert a tampon. If the bleeding is not strong, women manage with a regular gasket. Discharge may last for several days.
3. Radio wave biopsy of the cervix. Most often, the Surgitron apparatus is used for this procedure. It should be performed under local anesthesia, but in the reviews, women report that not all clinics comply with this requirement. Biopsy sampling is performed on a gynecological chair. Before the procedure, it is imperative to perform grounding. Without anesthesia, the process is quite painful, since the surface of the mucosa is removed with the help of high-frequency radio waves. Allocations after a biopsy of the cervix by the radio wave method are always significant, lasting a week or more. Also, women feel pulling (as before menstruation) pain in the lower abdomen.
4. Electroknife It is a wire heated by electric current. The procedure must also be performed under local anesthesia.
Types of biopsies performed under general anesthesia
Such procedures are carried out in cases where it is required to take a large amount of material for research. Usually,the patient is offered to stay in the hospital for a couple of days.
1. Wedge biopsy of the cervix. How is the procedure done in this way? It is performed with a scalpel. Anesthesia spinal or epidural. The specialist cuts out the biopsy in the form of a triangular piece of flesh. If the material sampling area is significant, the doctor sutures the wound surfaces of the cervix. A biopsy is taken from the most suspicious areas in relation to the pathology. Feelings after the procedure in many women complicated the recovery period after anesthesia. Pulling pains can be felt in the lower abdomen for 7-10 days. Discharges are observed up to two weeks.
2. Laser knife. The procedure is fast. The sensations after it are similar to those present after a wedge biopsy, but the recovery from anesthesia is easier.
3. Round biopsy. It differs in that it captures a very extensive area for research (the mouth of the cervical canal, the vaginal and supravaginal regions). After such a biopsy of the cervix, the discharge in the form of blood is always significant, especially in the early days. In moderate amounts, discharge is observed for up to three weeks.
4. Endocervical curettage. It involves scraping the mucosa. The instruments used to perform the procedure are brushes (they are turned in the neck) and a curettage spoon. In some cases, this type of research is carried out on an outpatient basis under local anesthesia. However, more often endocervical curettage is performed in a hospital under general anesthesia. Blood after a biopsy of the cervix performed by this method is very abundant, especially in the first hours. On her padscan be observed for up to two weeks.
After treatment
There are certain rules that a woman must follow after a cervical biopsy. The consequences in this case will be minimal.
What not to do after the procedure:
- Use tampons.
- Having sex.
- Visit the sauna, swimming pool, beach, solarium.
- Douching.
- Use vaginal suppositories and other drugs.
- Get active in sports.
- Lifting and carrying weights.
- Take blood thinners. Their list also includes the well-known Aspirin.
What to do after the procedure:
- Get some peace on the first day. Bed rest would be ideal. In the future, a long sitting position should be avoided for several days.
- For pain, drink Ibuprofen, Paracetamol.
- Be sure to wash the genitals every day (outside).
- Change pads every 2 hours.
- Drink decoctions of chamomile, calendula, yarrow, Ivan-tea.
- See a doctor if you notice any of these:
-the discharge has an unpleasant odor;
-blood clots, pus are seen in them;
-the general condition worsened, the temperature rose, the pain intensified;
-after meager discharge, abundant again began;
- the color of the discharge is scarlet, they are plentiful, similar to bleeding.
Therapy after biopsy
Some women ask if aftercervical biopsy take medication to relieve his condition.
This issue is decided only by the attending doctor. To prevent infection, prescribe:
- "Ornidazole" or analogues for a course of 5 days.
- Genferon rectal suppositories.
- After the heavy discharge is over, the doctor may prescribe Betadine vaginal suppositories.
- 2 weeks after taking a biopsy, vaginal suppositories "Depantol" are prescribed.
What a cervical biopsy shows
Repeat, the analysis is being prepared for at least two weeks. Many women are waiting for him with impatience and great excitement, because a biopsy is a serious study that is not prescribed unless there are good reasons for it. We offer a transcript of a cervical biopsy:
1. The result is negative. It's the best it can be. This response means that the cells of the cervix are not changed or very little changed, which is often the result of a trivial inflammation.
2. Background benign metamorphoses in cells. This means that a woman has a pathology that is not life-threatening, but requires treatment. These include:
- Papilloma. May be due to hormonal imbalances.
- Polypous growths. The reason for their appearance also lies in hormonal disruptions.
- Pseudo-erosion (ectopia). Teens are considered normal. Without treatment, it disappears by the age of 25. In the future, the causes of ectopia are birth trauma (this also applies to women in labor under the age of 25) and genital infections.
- Benignepithelial changes. They are considered as such if cancer cells are not found in the biopsy.
- Endometriosis. Means the proliferation of cells that make up the endometrium. A common reason for this is hormonal disruptions.
- Endocirvicitis. Means that the cervical canal is inflamed.
- Chronic cirrhosis. The biopsy reveals elevated leukocytes, degeneration of epithelial cells.
3. precancerous condition. It is not yet fatal, but without treatment in about 65% it turns into cancer. Name of pathologies:
- Adenomatosis.
- Erythroplakia.
- Polyps.
- Leukoplakia.
- Kandiloma.
- Cervical Dysplasia.
All these indications in the transcript of the analysis mean that atypical cells were found in the biopsy. They can be in large or small quantities, affect one or more layers of the epithelium, proliferate or not, but in any case, apoptosis is still relevant for them.
4. Cancer. This means that cancer cells were found in the biopsy. They have multiple changes in the structure, rapidly divide, do not undergo apoptosis, and are able to penetrate into neighboring structures. Possible diagnoses:
- Proliferating leukoplakia. With this diagnosis, sections of the epithelium are thickened and keratinized.
- There is a papillary zone in the atypical epithelium.
- Atypical transformation in the area of cylindrical epithelial cells (more than 1/3 of the total).
- Site of atypical vascularization. Abnormal proliferation of blood vessels. As a rule, they do not respond to stimuli (vasoconstrictordrugs, acetic acid).
- Intraepithelial carcinoma. In another way, it is called preinvasive cancer. There is no metastasis yet, malignant cells do not go beyond the basement membrane. Such a diagnosis means the first stage of uterine cancer. Treatment includes removal of only the pathological site and drug therapy.
- Microcarcinoma. This means non-aggressive cancer. With this diagnosis, there are invasions of malignant cells into neighboring tissues, but so far they are small, up to 7 mm. During a surgical operation, the uterus, a third of the vagina, and regional lymph nodes are removed for patients.
- Invasive cancer. A cancerous tumor can be large or small, but metastases are always observed. During the operation, the uterus and all areas with metastases, regional lymph nodes, and appendages are removed. Next, radiation and drug therapy are carried out.
Prices
If you are scheduled for a cervical biopsy, there is no need to be afraid. Hundreds of women undergo this procedure every day, and all remain alive after it. Remember: such an analysis is needed primarily by yourself. You can perform the procedure in a regular antenatal clinic or in a private clinic. There is a higher chance that you will have it with anesthesia. This will not affect the results, but the process itself will be transferred more easily.
Prices for a cervical biopsy in different medical institutions vary widely, depending on the complexity of the procedure and the category of the clinic. If we talk about Moscow, then here the lowest cost is 1225 rubles. At this price, this study is carried out in clinics of the IMMA network. The highest cost of thisprocedures in the capital - 12,000 rubles. In St. Petersburg, prices are more democratic and start at 600 rubles.
In closing
It is much easier to fight any disease if it is detected in time. Lost time sometimes costs patients their lives. Even if you have very unfavorable cervical biopsy results, there is no need to panic and despair. Treatment of malignant tumors in the organs of the female reproductive system has good prognosis, especially in the early stages of their detection.
