Rus Articles Journal

Cytology - against cancer of

Why researches of a neck of a uterus

are necessary to

the Questions concerning pathology of women`s reproductive system were and remain a problem number one for mankind. Female diseases - it is really important! Why? Answer simple: some them them hardly will respond to treatment, are not easy diagnosed, and the infections extending sexually are responsible for many painful states. But the most terrible - that today the science defined an infection which bears responsibility for developing of oncological pathology and, unfortunately, has no the expressed clinical symptomatology and long remains in the “silent“ state. Delay in diagnosis of this infection can lead to the most serious consequences.

Statistically, over the last 10 years the quantity of oncological diseases in Russia increased by 25,5%. Only in Moscow annually 27 thousand people develop cancer, and 19 thousand die. In the list of diseases the breast cancer, a cancer of skin and a cancer of a neck of a uterus are in the lead. In 2002 in Russia 12 285 cases of cancer of neck of a uterus are registered. Annually more than 6 thousand patients in Russia die of this disease.

However owing to the fact that oncological pathology of a neck of a uterus does not arise from scratch, and develops gradually from the previous defeats, there is a real possibility of prevention of cancer by diagnostics and treatment of these defeats - predecessors. Today the cancer of a neck of a uterus is that pathology which development can really be prevented if the woman herself does not “run away“ from the program of oncological screening. For participation in this program it is necessary to visit the obstetrician at least once a year - the gynecologist.

From where cancer undertakes?

the Tumour are called by excess pathological growths of the fabrics consisting from qualitatively changed, lost ability to carry out certain functions of cages of an organism. Malignant tumors grow quickly enough, have no cover. Tumor cells get into surrounding fabrics, damaging them. Sprouting a lymphatic or blood vessel, they can be had by current of blood or a lymph to lymph nodes or the remote body and form there the secondary center of tumoral growth - - a metastasis.

Existence of the defeats preceding a cancer of a neck of a uterus was supposed scientists still at the end of 19 - go centuries. Later researchers put forward idea that certain oncogenic viruses are capable to influence genetic structures of normal cages and to turn them into tumoral. In the middle of 70 - x years 20 - go centuries for the first time reasonably were exorcized about a paramount role of the virus of papilloma of the person (VPP) in development of cancer of neck of a uterus. By 1999 already proved presence of this virus more than in 99% of the cases of tservikalny tumors of a neck of a uterus registered in the world.

according to world statistics, the genital human papillomavirus infection belongs to widespread infections, sexually transmitted. The possibility of infection with this virus at sexual contacts makes from 60 to 80%. The types of a virus of papilloma infecting a genital path are divided into types of high and low oncological risk depending on their ability to cause a serious illness of a neck of a uterus. Types of low risk cause all the known warts, or benign genital condylomas. Types of high risk - tservikalny cancer. Of course, in most cases this infection is temporary and passes within 24 months, sometimes even without treatment. However similar removal of a virus from a female organism happens not at all infected. At certain adverse factors (genetic predisposition, immunity violations, smoking, early sexual activity, neglect by barrier methods of contraception (condoms, vaginal caps), frequent change of sexual partners, existence of other genital infections or presence at the same time several onkogenny types of a virus of papilloma) the probability that the infection in an organism will remain for a long time increases. In this case often there is an introduction of a virus in cellular human genome (genes of a virus are built in a set of chromosomes), normal process of life of cages is broken. Cages begin to breed uncontrolledly, and tumoral growth begins.

If the woman has genital warts, then it demonstrates presence of at it clinical human papillomavirus infection forms. It is very infectious form of this disease which, certainly, represents the physician - a social, cosmetic problem and causes inconveniences. However doctors this form easily is found and is quite successfully treated by means of physical or chemical destruction (destruction of papillomatozny growths by means of physical impacts - nitrogen, electric current or by means of chemicals).

Two other forms of a human papillomavirus infection meet considerably more often clinical.

Latent the form (presence of a virus without changes of fabrics) often is temporary and can be defined only by special methods of research.

Subclinical the form (those dangerous defeats in more thickly fabric which can be transformed to a uterus neck cancer) demands

from doctors of special vigilance not to pass initial forms of pathology and in due time to begin treatment.

diagnostics Methods

in medicine are carried out Today by

various diagnostic actions directed to detection of a human papillomavirus infection and the related changes: cytologic, kolposkopichesky, histologic research and genetic testing for presence of viruses.

the Cytologic method and genetic detection of a virus are important researches by means of which primary diagnostics oncological of dangerous defeats can be carried out. If as a result of primary diagnostics signs of this defeat are found, the woman goes the doctor for the further, more difficult, confirming research and treatment.

Cytologic method . The cytologic method (Fathers - the test), that is research of cellular dabs from a uterus neck surface, was offered by the American scientist George Papanikolau and for many years continues to remain the main method of search of pathology of a neck of a uterus.

the doctor collects by

by means of the special pallet and a brush cages from a surface of a neck of a uterus and from the tservikalny channel, applies this material on subject glass, then in laboratories dab is painted and investigated under a microscope. Such “search“, or screening, the programs based on regular studying of tservikalny dabs led to considerable decline in mortality from a uterus neck cancer in those countries where they are actively carried out.

Cytologic research without serious consequences, is available to any woman, demands small financial expenses, and, the most important, allows the doctor to diagnose malignant process in an initial stage. However along with obvious “pluses“ cytologic research has also essential shortcomings which can complicate work of the doctor and detain timely treatment. Dab can turn out too thick or thin, can be polluted by blood elements, inflammation elements, spermitsidny (perniciously acting on spermatozoa) and antibacterial creams which the woman used soon. The doctor can badly paint dab or it is bad to distribute cellular material on glass. As a result of similar mistakes a certain part of women with tservikalny cancer has in the past “good“ dabs before development of oncological pathology.

Genetic testing . Other method of testing which is actively used in modern medicine is sent to search for genetic material of a virus (virus DNA). The DNA most sensitive method - diagnostics is the polimerazny chain reaction (PCR) . Until recently this method of diagnostics had an essential shortcoming - he allowed to find limited number of onkogenny virus types, especially from one biological test. However now efforts of scientists developed special PTsR the test - system which is capable to check biological material at the same time for 14 types of a virus. This system is called “multipraymerny PTsR“ . It is already introduced in practical work of many laboratories of the country.

Can understand discontent of women when they are offered “to pass“ through two tests. These are two manipulations on a material intake for researches, these are repeated visits to the doctor in case of unsuccessful / doubtful initial dabs or at ambiguous results of genetic testing... As a result - there are a lot of difficulties, uncertainty and the spent time! Besides, each of these tests which is carried out separately “passes“ part of those women who have infectious pathological changes of a neck of a uterus.

Modern technologies of screening

the Aspiration to increase efficiency of screening inspections led

to development of new techniques, including alternative ways of preparation of dab.

Moreover, now there was an opportunity to unite two important screening methods (cytologic and a method of genetic detection) and by that to increase diagnostic sensitivity of tservikalny screening in general. The new technology - liquid thin layer cytology - was developed and approved for clinical use in 1996 in the USA. From now on researchers of the whole world conduct its active studying, comparison with traditional cytologic research, an efficiency assessment.

In our country the liquid cytology appeared rather recently, however it is already approved in some lechebno - diagnostic establishments. Results of large-scale researches of new technology abroad, and also allow to note researches in our country with confidence that the liquid cytology is a strong contender in respect of replacement of traditional cytologic research and, undoubtedly, big achievement for applied medicine.

What is liquid cytology? The main idea of this new technology is that the cellular material received from a surface of a neck of a uterus and from the tservikalny channel by means of a brush is not transferred to glass at once, and together with a removable brush plunges into a special bottle with special solution.

This solution “preserves“ the cellular material collected by the doctor, interferes with damage of cages, allows to overcome bacterial “contamination“ and gives the chance in optimum conditions to transport collected cages in laboratory. Both for the doctor, and for his patients advantages when using liquid are its resistance to fluctuations of temperature, a possibility of storage of cellular material within several years and a possibility of carrying out additional or necessary analyses on a full range of genital infections including genetic testing for a virus of papilloma of the person.

can conduct All researches from one bottle with liquid cytologic material; from the patient additional visits to the doctor are not required, and it means that implementation of simultaneous or consecutive carrying out cytology and genetic detection of a virus, and, therefore, full screening of damages of a neck of a uterus in this case is most facilitated.

Use of a liquid way of collecting material for inspection of women on infectious pathology of a neck of a uterus is the most logical and economically reasonable approach. But the most important is that this new technology allows to increase efficiency of tservikalny screening and not to “pass“ those women from whom defeats on a neck already acquired the status of “precancer“.

by

during studying of a new technique of research carried out the comparative analysis of a traditional technique and liquid cytology. As a result of the analysis more than 100 traditional tservikalny dabs “suspicious“, or so-called “atypical“, cells of a neck of a uterus were found only in every fifth woman, and as a result of new liquid cytologic research - in every second.

Sensitivity - a special indicator which is used in medicine. It designates a share of all patients who can be revealed by means of a diagnostic method. The indicator of sensitivity of new liquid cytology in diagnostics of all range of papillomavirusny potentially oncological damages of a neck of a uterus more than twice exceeded the corresponding indicator of a traditional technique. Sensitivity of liquid cytology in diagnosis of true tservikalny “precancer“ also authentically exceeded a similar indicator of a traditional technique.

However, unfortunately, and the new cytologic method does not possess absolute sensitivity and passes small part (7%) of crushing tservikalny defeats.

the Combined diagnostics (cytologic dab together with PTsR - testing for a papilloma virus) which with ease can be carried out further from a uniform liquid sample, that is from the same bottle, showed how this combination of methods improves efficiency of “search“ of damages of a neck of a uterus. In our research sensitivity of the combined screening for all range of papillomavirusny potentially oncological damages of a neck of a uterus made 83%, for true “precancer“ - 100%.

Thus, only at simultaneous absence of pathology and in cytologic dab, and at PTsR - testing the probability to miss damages of a neck of a uterus of high severity is practically absent and is minimum for easier defeats.

How often to carry out screening and when to begin it? It is important to note that the greatest number of tservikalny defeats including heavy, it is the share of early reproductive age. Therefore it is more expedient to begin carrying out screening of tservikalny pathology as soon as possible after the beginning of sex life. Tservikalny cytologic screening should be carried out from 18 years or from age of the beginning of sex life. Only thanks to such approach the number of women at whom the disease comes to light late is reduced.

Taking into account the fact that development of tservikalny cancer happens in a predictable form (defeats laboratory doctors define it at research) and during the long period, practically in one of the leading countries of the world cytologic research of women on existence of “suspicious“ tservikalny cages is not carried out annually. Women who had 3 consecutive normal tservikalny cytologic dabs after consultation with the attending physician are allowed to reduce inspection frequency from 1 time in 2 years to 1 time in 3 years. Three years - the maximum interval between cytologic researches of dabs from a uterus neck. Women at the age of 70 years on condition of negative tests within the previous 10 years can stop further regular cytologic research.

in conclusion wants to emphasize that the tservikalny screening directed to detection oncological of a dangerous human papillomavirus infection and the related damages of a neck of a uterus continues to remain a necessary component of health care and each woman has to remember need of its “passing“. We hope that our experience will help you to increase the knowledge, to keep the health, and to your attending physician to increase efficiency of diagnostic activity.