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What is Colposcopy?

Colposcopy is the examination by which we observe the cervix with the specialized machine-magnifying lens system- the colposcope. It is carried out with the woman in a standard gynecological examination position, it does not differ from the examination for the Pap test, but it takes 5-10 minutes. With this examination we have the possibility to have an enlarged image of the cervix, observing details about its texture and blood supply. The placement of non-caustic or toxic solutions such as 5% acetic acid and Lugol's solution in the region of the endocervical-extocervical transition zone shows the damaged areas with a whitish or yellowish shade, respectively. Then, painlessly for the patient, biopsies are taken from these points and sent for pathological examination.

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Cervical pathology

Cervical pathology is found at the border between the endocervix and the exocervix (transition zone). The main responsible for these changes is the human papilloma virus (HPV). The virus has 200 types but the most pathogenic are 16,18,31,33 and 45 whose ready antibodies are included in the two vaccines that are circulating and are vaccinated free of charge to all women aged 12-18. Initially, the test is done with the Papanicolaou test. There are three different systems for evaluating the test, but all agree if a test is negative or if abnormal cells are found that may indicate precancerous conditions. In the second case, the woman must undergo a colposcopy and biopsy, if the examination indicates it. The advantage of the biopsy is that the possible lesion is examined in its full thickness and categorized more precisely compared to the cytological examination (PAP test), which examines individual cells and gives only indications. 

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Staging

The classification of the pathology of the cervix is based on the pathological anatomical finding of the biopsy obtained during the colposcopy. Thus, cervical intraepithelial neoplasia or CIN has three categories according to the depth of infiltration of the lesion in the three normal layers of the cervix:

CIN I: Infiltration in basal layer only (1/3 of thickness).

CIN II: Infiltration in two of the three layers (2/3 of the thickness).

CIN III: Full thickness infiltration (3/3).

These categories are not indicative of cancer, but the next stage after CIN III is cervical cancer, so CIN III should be treated therapeutically as a precancerous condition  

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The prospects

CIN I: 65% chance of immune-mediated recovery in women <26 years of age who do not smoke within 1 year. If it persists, invasive treatment is needed.

CIN II: Immediate interventional treatment is needed.

CIN III: Immediate invasive treatment is needed.

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Interventional treatment

 

Excision of the transition zone (LLETZ)

It is performed painlessly for the womanwith local anesthesia in the doctor's office. With an electrodiathermy system, the front part of the cervix 3-5mm thick is removed and thus the damaged part of the cervix is renewed. The patient continues with antibiotic vaginal cream for one week. This treatment is indicated in:

•   CIN I not regressing to normal after one year of colposcopy follow-up (every 6 months).

•     CIN II

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Cone excision of the uterine cervix

It is performed under general anesthesia in the clinic. With a scalpel, electrocautery or LASER, the largest part of the cervix is excised in the form of a cone. The specimen is sent for pathologic examination and the posterior margins are checked to confirm resection of the entire lesion.