Cellular changes of the cervix ASCUS (Atypical cells of unknown significance):
Here, some cellular changes are observed in the cervix, but the importance of these changes is not clear. There is no consensus on the approach in the presence of ASCUS. The PAP test can be repeated after 3-4 months. With an instrument called colposcopy, the cervix can be enlarged or HPV typing is performed and if there is a high-risk HPV (16, 18, 31, 33, 51) type, colposcopy is performed.
1.LSIL (Low grade intraepithelial lesion-low grade lesion)
PAP test has cellular changes suggestive of mild dysplasia. The PAP test should be repeated after 3-4 months and if the cells persist, colposcopy should be performed. Colposcopy allows for further guidance of therapy. If mild dysplasia (CIN-1) is found in the parts to be taken during colposcopy, it should be followed up with periodic PAP tests. If moderate or severe dysplasia (CIN-2 or CIN-3) is found on colposcopy, freezing, burning, laser vaporization or LEEP treatment of the transformation zone is considered. The most popular form of treatment in recent years is LEEP.
2.HSIL (High grade intraepithelial lesion-high grade lesion)
It usually occurs with high-risk HPV types and indicates moderate or severe dysplasia. After the piece is taken under colposcopy, one of the above-mentioned treatments should be applied according to the result.
3.ASCUS (Atypical glandular cells of unknown significance)
Here, atypical cells come from secretory cells behind the transformation zone. Along with colposcopy, the canal of the cervix should also be sampled. Treatment is carried out according to the pathology result.
Treatment of cervical dysplasias
Particularly mild lesions can be followed. P of these lesions disappear spontaneously without any intervention. Especially in low-risk women (monogamous, no history of sexually transmitted disease and non-smoker), the probability of disappearance of the lesion is very high. In patients with ASCUS lesion and high risk in HPV typing, LEEP can be performed following colposcopy. Colposcopy should be performed in patients with LSIL lesion who persist in repetitive PAP tests, and follow-up or LEEP treatment should be applied according to the results. LEEP should be performed following colposcopy in those with HSIL.
In patients with LSIL, the risk of recurrence after LEEP is around 2-3%. In HSIL, this probability varies between 5-10%. Especially if there is a lesion at the surgical margins in the pathological examination performed after LEEP, the probability of the disease continuing is high.
Monitoring of cervical dysplasias
Follow-up is done with the PAP test. After the treatment of HSIL lesions, if 3 PAP tests performed at three-month intervals are normal, annual follow-ups can be continued. After the treatment of LSIL lesions, if PAP tests performed at 3 and 6 month intervals are normal, annual follow-ups should be started.
What is colposcopy?
Colposcopy is the name given to the process of examining the cervix with a microscope. It is done without the patient sleeping. It is a painless procedure. The cervix is examined with special liquids and dyes and small pieces are taken from the necessary places. At the end of the procedure, the cervical canal should also be sampled (ECC). The transformation zone must be seen in colposcopy. If the transformation zone is pulled into the cervical canal, it cannot be seen in colposcopy and in this case, colposcopy is considered insufficient. In this case, LEEP is required. If the colposcopy is sufficient and pieces are taken from abnormal places, the next step of the treatment is determined by the result of the pathological examination of the pieces.
Today, it is the most commonly used method in both the diagnosis and treatment of cervical dysplasia. It is performed under local or general anesthesia. It is the procedure to take a cone-shaped piece from the cervix, including abnormal areas. It is a one-day intervention and the patient is sent home after the procedure. There may be a yellow-bloody discharge that lasts up to 3 weeks after the procedure. There should be no intercourse during this period. Bathing should be done in the form of a shower and should not go into the sea or the pool. Sometimes there may be delayed bleeding. Sometimes the amount of bleeding is excessive and hospital intervention may be required.
In recent years, a vaccine has been developed as a result of intensive studies against the HPV microbe, which is responsible for cellular deterioration in the cervix. The vaccine is for 4 of the high-risk HPV types. Vaccination is recommended for women who have not been exposed to HPV before and who are sexually active, and for young girls who have not yet had intercourse. Ask your doctor if you are eligible for the HPV vaccine.