Cervical Smears

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The womb which is only about 10cm ( 3 inches ) long in non pregnant women , has a narrow neck and opening to the outside world at the top of the vagina . Just inside the opening the tall dark red rectangular cells of the womb merge with the flat pink cells of the vagina . This area called the transformation zone , can become infected with the human papilloma virus and over many years , ten or more , gradually change to a cancer ie cells which multiply out of control . Cervical smears can spot those changes in their early stages.Those who do not want any cervical smears should sign a form.

The best time is two weeks after a period and after 48hrs without sex and do not use any douches . A little scrape is taken from this area with a pointed extended tip wooden spatula and spread evenly (smeared) on a glass slide , fixed with alcohol and then stained and examined with a dye and under the microscope to show early changes of cancer cells , ie the brain or nucleus of the cell becomes larger darker and misshaped .It is from this nucleus that instructions are given to make the cell multiply .If these changes are found , laser or surgical treatment can kill the affected area , done under a special examining microscope called a colposcope .

That is why it is important to have the cervical smear ie take a little scrape of this area as per schedule. Cervical cancer is more common in smokers , those with earlier age of onset of sex , and more partners . Current recommendations are to start at age 20 or three years after becoming sexually active , and every three years if the smear is clear till age 65 . If the smear is abnormal recall is earlier but usually these are minor changes which can often revert back to normal .The scrape looks for the abnormal large round cells with large nucleus which shouldnt be there.

Abormal smears
Normally the large round cells with large nucleuses of the basement membrane of the cervix as they move up to be shed change into small flat ones with small dense nuclei (squamous). If round cells are found in the inner third of the cervix epithelium its called mild dysplasia (CIN 1- or cervical intraepithelial neoplasia ) , if in the next third as well its moderate (CIN 2) and if its in most of the outer thrid too (CIN 3) , severe dysplasia . If the topmost layer of the cervix is affected its called carcinoma in situ and is a premalignant change and these cells can invade through the basement membrane ie cancer . It seems that the epithelium changes can sometimes reverse on their own for unknown reasons .

CIN 1 Mild dysplasia or koilocytic atypia . A repeat smear is done in 6 months , most return to normal but if this too is abnormal too then coloposcopy is advised within two months. Under this two eye stereo microscope the area of the cervix is stained by a dye , actually vinegar , which stains the abnormal large cells white as the large nucleus absorbs water and becomes opaque. Cancer cells also have good blood supply via vessels . If no abnormal staining occurs another smear is done 6 months later and if that too is normal , then as per schedule. If abnormal areas are seen a few punch biopsies are done and if these are normal then smear repeated in six months .

CIN2- Moderate dysplasia , colposcopy and biopsy and electrical , laser or excision of affected areas . This takes only a few minutes . Repeat follow up smears are done twice in the first year and once in the second year afterwards. If biopsies show abnormalities then a cone biopsy is done .

CIN 3 -marked dysplasia , higher risk of cancer . 20% of these will go on to develop cancer in the next ten years if not treated .

Warning signs are bleeding after intercourse .

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