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 you do not do this, even a very simple ailment can develop into a big problem.
One of the most dangerous today is cancer. This deadly disease can be defeated if malignant cells have not yet spread throughout the body. Cancer can occur anywhere in the body, including the reproductive system. Timely diagnosis helps women avoid the very unpleasant consequences of this and other diseases. One of the basic research methods in our time is a cervical biopsy.
If you are prescribed it, you don’t need to think that you definitely have cancer. This analysis is relevant for many problems that arise in the mucous membranes of a very small but important organ - the cervix. What does the biopsy show? How is it carried out? Does she need special training? 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 giving birth approximately 5 mm more. At both ends, the cervix has the so-called pharynx. One opens into the vagina, the other into the uterus. In a normal position (menopause, there are no pathologies) they are closed.
In addition to two pharynxes, the vaginal and supravaginal parts, as well as the cervical canal, which opens in the body of the uterus, are isolated in the cervix.
From the inside, this small connecting tube is lined with several layers of cells. In the vaginal part they are represented by non-keratinizing epithelium having a superficial, prickly and basal layers. The epithelium is updated every 5 days. It consists of several types of cells:
Cylindrical. Located in a single layer, bright red, have a papillary surface. These cells play an important role - secrete a secret that moisturizes the genital tract.
Metaplastic. Located under the cylindrical, formed from them by transformation. It is in them that oncological diseases most often 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 biopsy
This term means the collection of a biopsy (tissue or individual cells) from a living person. There is also an autopsy - an examination of the tissues of the dead. A biopsy is the most accurate method for examining tissue cells. It is carried out using powerful microscopes. Research can be performed 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 formations with a width of about 3 microns. Samples prepared in this way are placed on a laboratory glass and, by various technologies, detect the presence or absence of pathological changes.
- Cytological. This is a more gentle and less traumatic method of taking a biopsy, in which only cells, not pieces of tissue, are taken from a suspicious area of the 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. If necessary, he appoints the patient to be tested.
A cervical biopsy is a procedure that is performed in exceptional cases. Indications for this study are such pathologies in the cervix:
- Ectopia (changes in the pathological nature of the cervical mucosa).
- Dysplasia (a violation of the tissue and cell structure). It is considered a precancerous condition.
- A cervical biopsy is often prescribed for erosion. Suspicion should arise if they are crumbling or bleeding. However, for reinsurance purposes, doctors often prescribe the procedure for taking a biopsy specimen for any type of erosion.
- Leukoplakia (keratinization, thickening of the epithelium).
- Polyps.
- Condylomas (genital warts).
- There are areas that are not stained with iodine (called iodine-negative).
- Changes in the epithelium, referred to as rough mosaic.
- Atypical cells identified by smear on cytology.
- Coilocytes (cells in which the papilloma virus is detected.
- There are sections of the epithelium, clarified 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 should be taken:
- For HIV.
- On chlamydia, mycoplasma, ureaplasma.
- For hepatitis.
- On syphilis (RW).
- Blood is common.
- Blood coagulation.
- A smear on the microflora of the vagina and cervix.
- A smear for cytology (called PAP).
- Have 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 the doctor such information about her health:
- Whether or not there is an allergy to food, medications.
- Whether she or her family members experience periodic spontaneous bleeding.
- What were the previous surgical interventions.
- The presence of a history of hypertension, diabetes mellitus, heart failure.
- Transfer of previously vein thrombosis and / or pulmonary embolism.
The day before the upcoming biopsy, it is required to stop sexual contact, douching, the use of tampons and vaginal medications.
On the day of the analysis, you can not smoke, drink alcohol, use any means for personal hygiene.
If it is planned to carry out the procedure under anesthesia, it is forbidden to eat and drink any drinks, except water, 12 hours before.
When is a biopsy better?
Consider how the cervix behaves in different periods of the cycle?
On days 5-7, it is lowered down, firm and elastic, clogged with a mucous plug.
From the 7th and 12th days the neck gradually rises, becoming softer supple.
From the 13th to the 15th days, 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 from the 7th to the 12th day. You can capture the 13th. Then the external pharynx of the neck is ajar, which helps to reduce the pain of a woman when 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 days of the cycle.
To conduct a study, the doctor has to open the external pharynx (from the vagina) so that a colposcope can be inserted into the organ. That is why many women suffer from a cervical biopsy. In this case, when taking a biopsy sample, the patient feels unpleasant sensations, pulling, sometimes giving to the stomach, legs and ovaries. Only among women who have already given birth several times, there are many who do not experience any negative symptoms when instruments are introduced into the body.
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 to do a cervical biopsy
The standard process (without complications) takes about 30 minutes. In this case, the following actions are performed:
1. The patient is comfortable on a gynecological chair.
2. The doctor provides access to the cervix by introducing a special medical mirror into the vagina.
3. Prepares the surface of the mucosa, for which it carries out some manipulations:
- swab with saline cleans the neck area of mucus;
- Applies iodine to this place (the problem area is not painted in a brown color characteristic of the substance);
- applies acetic acid (problem areas turn white);
- introduces a colposcope and carefully inspects the surface (the device has a light at the end, allows you to make an increase of 40 times).
These preparatory manipulations can cause discomfort in the patient, but they must be done.
4. A biopsy sample is being taken. How a cervical biopsy is performed depends on the type of instrument. This issue will be considered below. Now we note that the biopsy is taken from all problem areas (if there are several of them).
5. After the procedure, the cervix, vagina and genitals are treated with an antiseptic.
Results are prepared 2 weeks.
Biopsy Instrumentation
In the arsenal of gynecologists there are several types of tools used to take a biopsy. Which one to use depends on the equipment of the clinic and on the nature of the problem area that needs to be investigated.
1. Biopsy needle. With this type of material sampling, anesthesia is not done. The patient feels a short-term pain, as when injected. After a biopsy of the cervix performed in this way, the woman does not feel discomfort. Allocations are minimal.
2. Conkhotom. Some women call this tool forceps because of their resemblance. How is a cervical biopsy performed with a conchotome? With this tool, pieces of flesh are simply nipped off. The procedure should be performed with an injection of anesthetic into the cervix, then it is almost painless. Without anesthesia, women feel pulling pains radiating to the lower abdomen. The doctor cauterizes the wounds after the procedure. If there is abundant blood discharge, a swab inserts. If it doesn’t bleed too much, women get along with the usual gasket. Discharge may occur 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. The biopsy specimen is taken on a gynecological chair. Before the procedure, grounding is required. Without anesthesia, the process is rather painful, since the surface of the mucous membrane is removed using high-frequency radio waves. Discharge after cervical biopsy by the radio wave method is always significant, lasting a week or more. Also, women feel pulling (as before menstruation) pain in the lower abdomen.
4. Electric knife. It is a wire heated by electric current. The procedure should also be performed under local anesthesia.
Types of biopsy performed under general anesthesia
Such procedures are carried out in cases where you need to take a large amount of material for research. As a rule, the patient is offered to go to hospital for a couple of days.
1. A wedge-shaped cervical biopsy. How is the procedure done in this way? It is performed with a scalpel. Anesthesia is spinal or epidural. The specialist cuts the biopsy in the form of a triangular fragment of the flesh. If the area of material intake is significant, the doctor sutures the wound surfaces of the cervix. The biopsy is taken from the areas most suspicious of pathology. The sensations after the procedure in many women were complicated by the recovery period after anesthesia. In the lower abdomen for 7-10 days, pulling pains can be felt. Discharge is observed up to two weeks.
2. The laser knife. The procedure is quick. The sensations after it are similar to those that are present after a wedge-shaped biopsy, but the way out of anesthesia is easier.
3. Circular biopsy. It differs in that it captures a very vast area for research (the mouth of the cervical canal, the vaginal and supravaginal areas). 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 up to three weeks.
4. Endocervical curettage. It involves curettage of the mucosa. The tools that perform the procedure are brushes (they are turned in the neck) and a curettage spoon. In some cases, this type of research is performed 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 released very abundantly, especially in the first hours. On gaskets it can be observed up to two weeks.
After the procedure
There are certain rules that a woman must follow after a cervical biopsy. The consequences in this case will be minimal.
What can not be done after the procedure:
- Use tampons.
- To have sex.
- Visit the sauna, pool, beach, solarium.
- Do douching.
- Use vaginal suppositories and other drugs.
- Actively play sports.
- Lift and carry weights.
- Take blood thinners. Their list also includes the familiar Aspirin.
What to do after the procedure:
- On the first day, ensure yourself peace. Ideal would be bed rest. In the future, a long sitting position should be avoided for several days.
- For pain, drink "Ibuprofen", "Paracetamol."
- Be sure to wash your genitals every day (outside).
- Change gaskets every 2 hours.
- Drink decoctions of chamomile, calendula, yarrow, Ivan tea.
- Consult a doctor if such phenomena are noticed:
- the discharge has an unpleasant odor;
-in them clots of blood, pus;
-the general condition worsened, the temperature rose, the pain intensified;
-after meager discharge, abundant starts again;
- the color of the discharge is scarlet, they are plentiful, similar to bleeding.
Therapy after biopsy
Some women ask if it is possible to take medication after a biopsy of the cervix to alleviate their condition.
This issue is decided only by the attending doctor. To prevent infection, prescribe:
- "Ornidazole" or analogues 5 days.
- Rectal suppositories "Genferon".
- After the abundant discharge is completed, the doctor may ascribe the Betadine vaginal suppository.
- 2 weeks after taking the biopsy specimen, vaginal suppositories “Depantol” are prescribed.
What shows a cervical biopsy
Again, the analysis is 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, if there is no good reason. We offer a decoding of a cervical biopsy:
1. The result is negative. This is the best that can be. Such a response means that the cells of the cervix are not changed or very little changed, which is often a consequence of trivial inflammation.
2. Background benign metamorphoses in the cells. This means that a woman has a pathology that is not life threatening, but requiring treatment. These include:
- Papilloma. It can be caused by hormonal disorders.
- Polypous growths. The reason for their appearance also lies in hormonal disruptions.
- Pseudo-erosion (ectopia). In adolescents, it is considered the norm. Without treatment, it disappears by the age of 25. In the future, the causes of ectopia are birth injuries (women in labor under 25 are also affected) and genital infections.
- Benign epithelial changes. They are considered as such if no cancer cells are found in the biopsy specimen.
- Endometriosis Means the proliferation of cells that make up the endometrium. A common cause of this is hormonal disruption.
- Endocirvicitis. Means that the cervical canal is inflamed.
- Chronic cirvicitis. Elevated leukocytes, degeneration of epithelial cells are found in the biopsy.
3. Precancerous condition. This is not fatal, but without treatment, about 65% turns into cancer. Name of pathologies:
- Adenomatosis
- Erythroplakia.
- Polyps.
- Leukoplakia.
- Candilomas.
- Cervical dysplasia.
All these indications in the decoding of the analysis mean that atypical cells are 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 are found in the biopsy. They have multiple changes in the structure, quickly divide, do not undergo apoptosis, are able to penetrate into neighboring structures. Possible diagnoses:
- Leukoplakia proliferating. With this diagnosis, the areas of the epithelium are thickened and keratinized.
- In the atypical epithelium there is a papillary zone.
- Atypical transformation in the area of cylindrical epithelial cells (more than 1/3 of the total).
- Plot of atypical vascularization. Abnormal proliferation of blood vessels. As a rule, they do not respond to irritants (vasoconstrictor drugs, acetic acid).
- Intraepithelial carcinoma. In another way, it is called pre-invasive cancer. There is no metastasis yet, malignant cells do not go beyond the edge of 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 in neighboring tissues, but so far they are small, up to 7 mm. During surgery, patients remove the uterus, a third of the vagina, regional lymph nodes.
- Invasive cancer. The cancer can be large or small, but metastases are always observed. During the operation, the uterus and all areas with metastases, regional lymph nodes, appendages are removed. Next, radiation and drug therapy is carried out.
Prices
If a cervical biopsy is prescribed, you need not be afraid. This procedure is performed daily by hundreds of women, and all after it remain alive. Remember: such an analysis is necessary first of all for you. You can perform the procedure in a regular antenatal clinic or in a private clinic. There is more likelihood that you will have it with anesthesia. This will not affect the results, but the process itself will be transferred more easily.
Prices for cervical biopsies in different medical institutions vary widely, depending on the complexity of the procedure and on the category of the clinic. If we talk about Moscow, then here is the lowest cost - 1225 rubles. At this price, this study is carried out in clinics of the IMMA network. The highest cost of this procedure in the capital is 12,000 rubles. In St. Petersburg, prices are more affordable and start at 600 rubles.
Finally
It is much easier to deal with any ailment if it is detected on time. Lost time sometimes costs patients life. Even if you have very adverse cervical biopsy results, you don’t need to panic and despair. The treatment of malignant tumors in the organs of the female reproductive system has good prognoses, especially in the early stages of their detection.