Generality
Colposcopy is a screening test for the detection of cervical cancer.
It is performed to investigate the cases of patients with Pap smear having an abnormal outcome. Therefore, if the Pap test is the first level diagnostic test for the early identification of cervical cancer, colposcopy is the second level diagnostic test for the early recognition of the same malignant tumor.
During the examination, the doctor looks for possible pre-neoplastic lesions, thanks to the optical enlargement and to the help of specific solutions, such as acetic acid and / or Lugol's liquid.
In case of need, colposcopy also allows a small and targeted collection of tissue samples, to be subjected to a histological examination (ie a microscopic laboratory evaluation aimed at the cellular study and the search for possible abnormal cells).
If the suspicions related to a possible cervical cancer are well founded, the next step to colposcopy is to plan the most appropriate treatment.
Examination with low risk of adverse effects, colposcopy provides a specific preparation, which is however easy to follow.
Brief review of the Pap test
The Pap test is the first level screening test for the early detection of cervical cancer or cervical cancer in women.
We reiterate that a screening test is a test conducted on a section of the population considered to be at risk for a certain disease, in order to identify the disease in question at an early stage.
The Pap test is scheduled every 3 years in women aged between 20-25 and 64 years.
AN ANOMALOUS PAP-TEST ALWAYS MEANS PRESENCE OF TUMOR?
An abnormal Pap test does not necessarily mean the presence of cervical cancer; more than anything it is a "warning", which signals the need to undergo further and regular checks.
What is colposcopy?
Colposcopy is the second-level screening test for early detection of cervical cancer; as such, therefore, it is the diagnostic investigation that follows the anomalous Pap tests and which serves to confirm or deny what was highlighted by the latter.
Based on the use of a particular instrument - the so-called colposcope - colposcopy is, in practical terms, the gynecological exam that allows to visualize the tissue aspect of the inner walls of some organs of the female genital apparatus, specifically of the neck of the 'uterus, vagina and vulva, bringing to light any pre-cancerous lesions.
Cervical cancer: what is it?
The tumor (or cancer) of the uterine cervix is a malignant tumor that originates from a cell of the terminal part of the uterus, a part that precedes the opening of the latter in the vagina.
Preceded in general by pre-cancerous lesions which owe their formation to particular strains of Human Papilloma Virus ( HPV ), cervical cancer is one of the most widespread forms of cancer among women worldwide, second only to breast cancer .
For some years, young women can count on the availability of a vaccine against HPV, which is an excellent tool for preventing cervical cancer. However, since the aforementioned vaccine does not guarantee total coverage against all possible HPV strains, and since the effects of vaccination coverage at a distance of years remain unknown at present, it is good that women continue to undergo regular diagnostic tests, even after vaccination.
Fortunately, the ability to diagnose in advance (via Pap test and colposcopy) and treat, always in time, the pre-cancerous HPV lesions prevents these lesions from progressing to the actual cancer.
Recalling that many years before the transformation of pre-cancerous lesions into malignant neoplasms is necessary, when this happens, the hopes of a successful treatment are unfortunately considerably reduced.
The colposcope
The colposcope is a sort of binocular or monocular microscope, provided with light and endowed with a power of magnification of the object of investigation - that is the walls of the uterine cervix, the vagina and the vulva - which goes from a minimum of 6 to a maximum of 40 times.
During colposcopy, the colposcope remains outside the female genital apparatus, about 30 centimeters from the vagina.
- The smaller magnifying powers serve to visualize the general architecture of the anatomical sections under investigation, while
- The greater powers of enlargement serve to investigate in detail the tissues of the uterine cervix, vagina and vulva, and to highlight any pre-cancerous lesions.
What is the next step to colposcopy?
If the suspicions related to the presence of a cervical cancer become a certainty (ie when the diagnosis of cervical cancer is positive), the next step to colposcopy is to choose the most suitable treatment. This choice is made based on the severity of the lesions and the specific anatomical characteristics of the patient.
Among the possible treatments of cervical cancer include surgical and non-surgical therapeutic interventions, classified respectively in excisional methods (conization with scalpel, conization with laser, conization with diathermic handle and coning with radiofrequency needle) and destructive methods (diathermocoagulation, cryotherapy, thermocoagulation and laser vaporization).
The aforementioned treatments are all very simple, largely conclusive and usually executable on an outpatient basis.
Their success rate is very high, confirming that the entire preventive pathway, from the initial diagnosis through to the final treatment, is able to really prevent the development of cervical cancer.
Origin of the name colposcopy
The term colposcopy derives from the union of two Greek words, which are: kolpos ( κόλπος ) and skopeo ( σκοπέω ). The word " kolpos " means "vagina", while the word " skopeo " means "to observe".
Therefore, the literal meaning of colposcopy is "observation of the vagina".
Indications
Considering the extreme importance of early treatment of cervical cancer, colposcopy is indicated both to women whose pap smear showed modest alterations, and to women in whom there is an important indication of neoplasia.
The diagnostic importance of colposcopy results not only from its visualization capacity, but also from the fact that it allows the gynecologist to take some suspicious tissue samples, to be submitted, in second place, to specific histological laboratory evaluations ( cervical biopsy ).
Remember...
The main indication of colposcopy is to investigate the abnormal results of a Pap test, in a context of possible cervical cancer.
Other uses of colposcopy
Colposcopy is also used to monitor the efficacy of possible therapies, undertaken in order to give the uterine cervix its normal character (NB: they can also be therapies for the treatment of a pre-cancerous lesion), as well as in the diagnosis of transmission infections sexual (also Human Papilloma Virus infections), genital warts and abnormal blood loss.
Preparation
Colposcopy involves a particular preparation, which can be summarized as follows:
- Women who are still menstruating must agree with the doctor on the date of the examination based on the menstrual cycle. In fact, colposcopy must take place outside menstruation, preferably two weeks after the latter (ie halfway through the menstrual cycle);
- Two days after the exam date, every patient must refrain from sexual intercourse and from the use of lavages, eggs, vaginal creams and / or tampons, as they are all elements and circumstances that could, in some way, alter or mask the cells of the cervical surface (thus jeopardizing the success of the examination);
- If the patient suspects she is pregnant (for example due to a delay in menstruation), she must inform the doctor who will carry out the aforementioned examination.
Pregnancy is not a contraindication to colposcopy, even if the latter involves cervical biopsy; however, it is good that the doctor is in any case aware of the situation, to better deal with the greater risk of bleeding that the exam in question entails for pregnant women, when associated with the taking of a tissue sample;
- If the patient is aware of suffering from drug allergies, she must communicate the aforementioned medicines to the gynecologist;
- If the patient regularly takes one or more medications, she must report to the gynecologist what these drugs are. This is extremely important when the medicines in question have the power to dilute the blood (eg: warfarin, aspirin, etc.), because pharmacological preparations with such properties promote blood loss;
- If the patient has recently suffered from any vaginal, cervical or pelvic infection, she must report this to the gynecologist;
- To cope with the blood loss that could occur at the end of colposcopy with tissue extraction, it would be appropriate for the patient to carry a panty liner with her, to wear after the procedure.
Curiosity: how to manage colposcopy anxiety?
Several women who are planning a colposcopy develop a sense of anxiety, mixed with panic, partly unjustified; all this is simply linked to the fear of the diagnostic examination and what it might highlight.
In light of this, in order to face colposcopy more serenely, gynecologists invite patients to request information from them or from the general practitioner regarding the various steps of the diagnostic examination in question, without fear. They also advise asking friends or acquaintances for clarifications, who have already done colposcopy in the past, as they are excellent witnesses. Finally, to further ease the tension, some patients are allowed to carry a portable music device with them on the day of the exam and listen to their favorite music during the diagnostic procedure.
Is it possible to eat before colposcopy?
Colposcopy does not involve any anesthesia, therefore it does not impose fasting or limitations on eating and drinking.
How to do it
Once the patient has worn a hospital gown specially prepared for her, the gynecologist invites her to sit on a special bed, equipped with leg supports, and makes her assume the so-called gynecological position, with a favorable inclination to the introduction of an instrument called a speculum.
Figure: plastic speculum
The speculum serves to "open" the vagina and to make visible, through the colposcope, the inner walls of the vagina itself and of the cervix.
Very often, to better appreciate the various details of the aforementioned organs, the gynecologist applies specific solutions, such as acetic acid or the so-called Lugol liquid .
The eventual biopsy takes place at this point in the procedure: the collection of the tissue sample to be analyzed in the laboratory takes place by means of a special surgical instrument, previously disinfected.
Once the visualization and the eventual tissue removal have been completed, the colposcopy can be considered concluded; at this point, therefore, the gynecologist extracts the speculum from the vagina and invites the patient to recompose.
Is colposcopy painful?
Colposcopy is a generally painless exam, especially if it does not include the collection of a tissue sample for a subsequent cervical biopsy; in fact, this last operation can cause a painful / annoying sensation, accompanied by a sort of pinch or slight cramps at the time of sampling.
Other possible circumstances that can be a source of discomfort or discomfort during colposcopy are:
- The moment when the gynecologist inserts the speculum, but only in the presence of irritation, poor lubrication or narrowness of the cervical canal.
- The moment when the gynecologist applies acetic acid or Lugol's liquid. These solutions can lead to a temporary burning sensation.
Duration of colposcopy
Generally, colposcopy lasts as long as a gynecological examination, ie 10 to 20 minutes .
The most prolonged procedures are those in which the gynecologist collects a sample of tissue to be subjected to laboratory analysis.
When is the return home expected?
A woman subjected to colposcopy can return home and return to her normal daily activities (eg driving, working, etc.) immediately after completing the diagnostic procedure.
Gynecologists tend to recommend a day of rest only in the case in which colposcopy has provided for the taking of a tissue sample (for cervical biopsy) and this sampling was responsible for a more conspicuous blood loss than usual.
Curiosity: colposcopy and sport activity
In general, doctors advise women undergoing colposcopy with tissue withdrawal to abstain for at least one day from sports activities.
risks
Colposcopy is a safe diagnostic test for most women. In fact, it is very rare that it can give rise to adverse effects and other problems.
Adverse effects: what are they?
Exclusive procedures for collecting a sample of cervical tissue, the possible adverse effects of colposcopy consist of:
- Blood loss from where the gynecologist took the tissue sample, and subsequent episodes of vaginal bleeding . Generally, vaginal bleeding episodes last up to 5 days and are exhausted on their own without special treatment; as long as these episodes take place, gynecologists advise abstention from sexual activity and the application of a vaginal swab;
- Persistent sensation of discomfort or vaginal burning . Generally, it resolves within a week. In such circumstances, gynecologists advise avoiding sexual intercourse and hot baths;
- Development of an infection . Access to pathogens in the organism is the lesion left by tissue sample collection. If at the first symptoms of infection (eg fever, leakage of smelly fluid from the vagina, conspicuous bleeding, pelvic pain) the person concerned contacts his gynecologist, there is a good chance of overcoming the problem in question, without complications.
When should a doctor be contacted immediately after a colposcopy?
After a colposcopy, a woman should immediately contact her gynecologist if she is a victim of: marked vaginal bleeding, high fever accompanied by chills and severe pelvic pain.
Contraindications
They represent a contraindication to colposcopy: ongoing menstruation and any other blood loss, acute cervicitis, severe vaginitis and the intake of anticoagulant and antiplatelet drugs.
For women who have just given birth, there is the possibility of performing a colposcopy only after 6 months from the happy event.
