Gynecological Cytology Analysis - Case Study Example

Follow up on a Gynecological Cytology Report Name: Institution: Follow up on a Gynecological Cytology Report Communication both to the patient and other health care related agencies is one of the most important aspect of clinical functioning. Regarding the results obtained from the pathology provider, a number of issues have to be discussed with Maria to build a better therapeutic doctor-patient relationship in order to deliver a high quality health care service. The important issues that need to be discussed with Maria include making her understand the test result by simplifying the doctor terms used in reporting of the results to what she can understand. She also needs to know what to do after the test; whether she requires immediate treatment or wait for another test, and why she may need the treatment. In addition, she needs to know the treatment options available for abnormal cervical cell growth. The treatment options basically aim in destroy or remove the abnormal cells. The doctor decides which treatment is suitable for the patient. The following issues have to be discussed with Maria. Interpretation of Diagnosis Test Results to Maria Squamous Intraepithelial Lesion means an abnormal squamous cell growths on the cervix surface. Low Grade Squamous Intraepithelial Lesion is a type of abnormal cell growths also known as cervical intraepithelial neoplasia type I (CIN 1) or mild dysplasia. In low-grade lesions, changes in cell size, shape and number on the cervix start to develop, with only a few cell abnormal characteristics and the cervix is not affected much. CIN 1 grade implies that about one third of the thickness of the cell lining that covers the surface of the cervix have an abnormal growth. A pap smear is performed to detect if abnormal growth of cells is occurring on the cervix. Human Papillomavirus (HPV) composes a group of viruses that are highly contiguous and affect the cervix. Infection with HPV can cause abnormal growth of tissues and other changes in cells in the cervix, with a possible lead to cervical cancer. LSIL is an indication of likely possibility of cervical dysplasia. It normally indicates cervical intraepithelial neoplasia type I (CIN 1), which is more likely to be caused by HPV infection diagnosed on a Pap smear (Nauth, 2011). Implication of the abnormal results Having been diagnosed with a low grade squamous intraepithelial lesion is not an indication that one is infected with cancer. The presence of cancer is normally detected by the presence of abnormal growth of tissues caused by uncontrolled growth of cells that are abnormally structured and in a primitive form. However, the detection of low grade squamous intraepithelial lesion is a change in cell growths prior cancer infection and is a likely indication that cervical cancer may occur later in life. The chances of existence of invasive cervical cancer after showing up of low grade intraepithelial lesion on a pap smear is 1 percent. Within a period of 24 months after a Pap smear test, only 1 percent of women with low grade intraepithelial lesion are invaded with cancer. LSIL or CIN 1 disappears on its own after sometime without developing into invasive cervical cancer. A re-test is supposed to be carried out after 12 months to confirm if the growth of the abnormal cervical cells will still persist. In order for cervical cancer to progress from CIN 1, it takes approximately ten years (Hasan, 2009). Why Maria may need treatment Test results show that Maria has low Grade Squamous Intraepithelial lesion, which is a mild change in cells. This abnormal cervical screening test result means that there are changes in the cells on the surface of her cervix that require treatment. Even though the chances of these abnormal cell growth turning into severe cervical cancer are minimal, there will be increased risk of these cells developing into a full blown cervical cancer in her future life. If this abnormal growth of cells is left untreated, then CIN 1 can progress to severe dysplasia, hence, the need for aggressively following the result by performing biopsy and colposcopy to establish the persistence of the abnormal growth of cervical cells. Follow-Up of test results There are various follow-up options for abnormal Pap test results depending on the severity of infection. In most cases, the abnormal cells grow back to the normal state on their own, but others may develop into cervical cancer if not treated earlier after detection. The following are the possible follow-ups for Maria’s abnormal Pap test results. Repeating the Pap test The Pap smear test will be repeated after 12 months to see if the problem still persists. There are high chances that the abnormal cell changes will not turn into cancer. Like most women, Maria will not require special treatment or surgery, but instead, she will follow the scheduled Pap test. The Pap test will monitor if there is any changes in cell growth after 12 months. Cervical cells normally change slowly and it is only after sometime that recommendation for treatment of the infected cervical cells can be verified. The treatment of cervical cancer may not be comfortable, has risks and can be associated with some side effects, and for this reasons, it has to be established that Maria will need the treatment. Minor cell changes that occur like in the case of LSIL rarely become severe, and would possibly disappear on its own after some time. More testing required HPV type test Even though this test has been carried out, it is important to known if the HPV type of high risk is present. The test will check for the DNA or genetic material of the HPV virus. There are a several types of HPV viruses; some cause warts or some may not even show any symptoms. The high risk types of HPV include type 16, 18, 31 and 45. These types of HPV cause abnormal changes in the cells on the surface of the cervix. To protect Maria against development of cervical cancer as a result of HPV infection, a HPV vaccine can be issued. If the patient is infected by high risk HPV, then further tests such as colposcopy and cervical biopsy will be recommended (Borruto & Ridder, 2012). Colposcopy and Cone biopsy When the Pap test concludes that there is abnormal growth of cells in the cervix, colposcopy test is recommended. The test should be done to check the cervix using a special kind of magnifying device and see if a problem exists. If a problem is found during colposcopy, a sample of biopsy will be taken from endocervical canal of the cervix. Colposcopy will also reveal if other problems such as sore and genital warts exist around the cervix or the vagina. Before carrying out colposcopy and biopsy, a urine or blood test should be done to Maria to know if she might be pregnant. In addition, information on any other medication, allergy to some medicines, bleeding problems or treatment against vaginal or pelvic infection has to be provided by Maria. This will help in making important decisions regarding any further treatments. Test for presence of other infections Other tests will have to be carried out to establish the presence of other infections such as bacterial infection, sexually transmitted infections or yeast infection. Further treatment options available Cryosurgery This is the where a doctor uses very extreme cold temperatures to destroy the abnormal precancerous cells on the cervix by freezing. The freezing temperature is introduced into the lower part of the uterus through a probe. The probe has a liquid nitrogen cooled below a temperature of -20oC. Other procedures that are meant to control bleeding or pain are cooled to a temperature above -20oC to protect other tissues from damage. The risks of these surgery are rare but may include: infection, bleeding and sometimes, cervical stenosis, which may cause increased cramping during menstrual periods of difficulty in getting pregnant. Although sometimes bleeding and/or cramping can occur, this procedure is relatively painless and does not scare the patient. For optimal treatment, the “ice ball” is placed on the surface of the cervix for three minutes, to kill all the superficial layer of abnormal cells. The patient can immediately resume almost all the normal activities after the surgery has been performed. However, avoidance of having sexual intercourse and douching can be recommended for the next several weeks. A patient will also experience some watery virginal discharge as a result of the dead cervical tissues being shaded. Sometimes, she may feel light-headed, which may lead to fainting immediately after performing the procedure. In case this happens, the patient is laid down flat to remove the sensation of fainting after the surgery. Laser Surgery (Laser therapy/Laser ablation) In this treatment procedure, a CO2 laser beam to burn off the abnormal cells. The vagina is held open and a laser beam is directed at the abnormal areas. The laser beam, being strong and hot, it burns off the abnormal cells. A patient may notice a burning smell as the treatment proceeds. Most women will resume their normal activities after 2-3 days after the surgery, and should expect virginal discharge as a result of the dead abnormal cervical cells. Sexual intercourse and douching should be avoided, until after 2-3 weeks (Spencer, 2009). Conclusion Cervical cancer in women is as a result of cervical intraepithelial neoplasia, which is caused by human papillomavirus (HPV) infections of high risk. A Pap smear test done on Maria shows abnormal growth of cells in her cervix. Sometimes, this abnormal growth of cells if left untreated, CIN 1 can progress to severe dysplasia. A follow-up will ensure that biopsy and colposcopy is performed to provide the required precancerous treatment. Another Pap smear test done after 12 months will check if the abnormal growth of cervical cells is persistent and if it could develop into full-blown cancer. This results should not worry Marry because this is not yet cervical cancer. The changes in cell growth are minor and most of the time, these minor changes will be back to normal just by their own. The follow-up treatment can be done to prevent these minor growths from developing in to serious changes, which are called pre-cancer and they are not yet cancer as well. References Read More