Cervical cancer is one of the most common malignant tumours of a female reproductive system. Despite simple and accurate diagnostics, 320 women in Croatia are diseased from this illness every year and, unfortunately, 100 of them die.

Today we know for sure that one of the major causes of forming the cervical cancer is a long-term, chronic (untreated) inflammation of the vagina and cervix caused by human papilloma virus (HPV) which in cases of cervical infection is sexually transmitted. More than 100 types of HPV are known and 40 of them infect genital tract. We divide them into a low-risk and high-risk groups depending on whether a certain type of HPV has been found in samples of cervical cancer.

The most important risk factor for cervical cancer is sexually transmittable HPV infection, but most women infected with a high-risk type of virus will not develop changes. As other factors which serve chronic HPV infection to turn into a phase of cervical cancer precursors (CIN) are early beginning of sexual life (under the age of 18), changing sexual partners, smoking cigarettes, immune system, genetic sensitivity. The average life expectancy of women who develop malignant and premalignant cervical diseases, is lower today than a few decades ago.

The ways of preventing cervical cancer

Prevention procedures include protection measures against all risk factors leading to cervical cancer. By that, in the first place, we consider the protection from the main cause for cervical cancer- these are oncogenes sexually transmittable HPVs. Responsible sexual behaviour and adequate protection during sexual intercourse (preservative) are the most important factors for preventing this disease. Vaccines (Gardasil, Cervarix) are the most effective if they are applied before the exposure to HPV infection, which means before than the persons become sexually active. Today is current vaccination of persons being treated or already cured from the effects of HPV infection. It is important to point out that women who are vaccinated against HPV still have to regularly do gynaecological examinations and regularly take PAPPA test and necessary diagnostic processing for detecting cervical cancer and tumours of other female reproductive organs (ovary, the trunk of the uterus, vulva and vagina) have to be done.

Cervical cancer diagnostics

PAPA test. Detecting cervical cancer is possible by microscopic cytological examination – analysing the cells taken during gynaecological examination and are smeared on the glass. By cytological analysis, the cancer can be detected at the initial, asymptomatic stage or in the pre-stage which gynaecologist can not see with the naked eye. At the same time, numerous causative agents of sexually transmittable diseases can be recognized in PAPA test. If possible, it is recommended to do PAPA test several days after the end of menstrual bleeding in the first part of cycle. It is also recommended, 48 h before PAPA test, to avoid using intravaginal medicines, tampons, vagina’s toilette and to abstain from sexual intercourse. If there are suspicions, due to PAPA test, that this is the pre-stage of cervical cancer (CIN-LSIL, HSIL, ASC-H) or cervical cancer, then colposcopy is recommended. It is important to know that a further procedure, at the same abnormal result on PAPA test, depends on the patient’s age and parity.

Swabs of the cervix (Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hom., bacteriological) inflammation of the cervix helps transient, acute HPV infection into the chronic phase – phase of persistence and due to antibiotic treatment is recommended if some of the bacteria is isolated.

A colposcope is a device that, at a magnification of 8-25 times, is used for observing the cervix. The aim of this method is to localize abnormal epithelium and to point out on a suspicious place from which a part of tissue is going to be taken (biopsy) for pathohistological analysis HSIL (CIN II, CIN III) or cervical cancer. Coloscopy takes only about 15 minutes, and green filter of light for examination of cervical blood vessel and white light and cervical coating solutions – dilute acetic acid (3-5%) and Lugolov’s solution (iodine based) are being used.

HPV typing using DNA tests (PCR, Hybrid capture 2) is used for proving high-risk types of HPV (type 16, 18, 45...). It is recommended to conduct it as a diagnostic method at result ASC-US, AGC-NOS with all the patients, at follow-up after the surgical procedure and as a screening method for proving chronic persistent infection only above the age of 25. Therefore, patients with a proven high-risk HPV infection, have a risk of HSIL (CIN II, CIN III). For such patients, it is recommended taking PAPA-test more often, by a special algorithm.

Prevent cervical cancer by taking regular checks. Get a gynaecological examination and PAPA test up to 1 year after the first sexual intercourse and the latest at the age of 20. If the cytological finding is clean, the most appropriate controls are once a year. If any of pre-stages of cervical cancer are verified (CIN) or chronic HPV infection, further examinations- colposcopy or possibly HPV typing will help in further processing and decision on timely therapy (biopsy, LLETZ conization, conization or liquid nitrogen cryotherapy.)

All the listed diagnostic methods (PAPA, SWABS OF THE CERVIX, HPV TYPING, COLPOSCOPY) and therapy procedures it is possible to get done in the gynaecological infirmary of Polyclinic Arcadia. Gynaecological examination with taking PAPA test (result up to 14 days) and colposcopy do not take much time, methods are painless and can in due time prevent development of cervical cancer.

If you unsuccessfully treat CIN changes for more than 1-2 years in a conservative way (with pharmacological preparations or alternative methods), come to the Polyclinic and in just three visits solve the problem:

1. Colposcopy
2. PAPA result (within 2 weeks)
3. Minimally invasive surgical method LLETZ under the local anaesthesia for milder degrees of CIN and smaller changes in patients who are not prone to surgical treatment of CIN changes. It is possible to try to cure the change treating it by cryotherapy with liquid nitrogen (NO).

LLETZ 2000 kn + extra PHD (for the histopathological analysis, red referral may also be provided). It includes 2 hours of postoperative stay in the premises of day care at the Polyclinic.

CRYOGULATION OF THE CERVIX WITH LIQUID NITROGEN (NO) 400,00 KN

Sometimes, due to the involvement of the greater depth of the cervix, it is necessary to perform surgery of classical conization. That method is performed under the general anaesthesia.

CONIZATIO CERVICIS UTERI ET PLASTICA CERVICIS UTERI + GENERAL ANAESTHESIA 4500 KN+ extra PHD (for the histopathological analysis, red referral may also be provided) It includes 10 hours of postoperative stay in the premises of day care at the Polyclinic.

Success of the surgical method is estimated 4 months after the procedure according to PAPA swab and complete cure of HPV cervical infection is estimated 12 months after the procedure using a cervical swab and DNA typing of HPV.