Cervical cytology: Radiation and other therapy effects

Abstract

The different treatment options for carcinoma cervix include radiation, chemotherapy, and surgical treatments. Cytological analysis of smears is crucial for patient follow-up to determine response to therapy and to diagnose the persistence or recurrence of malignancy. Anatomical alterations and changes in cell morphology following radiation or chemotherapy make collecting and interpreting cervical cytology samples difficult. These issues can be mitigated by liquid-based cytology. Ionizing radiation is used in radiotherapy (RT) to kill cells. It is important that cytologists are aware of alterations in morphology of the cells. Radiation can cause cytoplasmic and nuclear changes. Cellular enlargement, vacuolation, granularity loss, and other changes linked with cell death are examples of cytoplasmic alterations. Nuclear enlargement and multinucleation are the most frequent nuclear alterations. These changes are determined by the amount of time that has passed since radiation. It should be emphasized that no one characteristic is pathognomonic. Post-irradiation dysplasia is a condition described as abnormal cellular changes in non-neoplastic epithelial cells after RT. Chemotherapy causes comparable alterations as radiation but impacts fewer cells. Busulfan and other chemotherapeutic treatments may produce morphological alterations, which cytologists must be aware of and able to identify. Immunosuppressive treatments, hormonal therapy, and tamoxifen are some of the other drugs that might cause changes in cervical morphology. Surgical methods used in the detection and treatment of cervical cancer may potentially cause alterations as a result of thermal damage and healing. For the treatment of cervical lesions, electrocautery and the loop electrosurgical excisional procedure are available. These procedures employ electric current ablation leading to ischemic changes in the cervical smear. Cytological analysis of smears following treatment with these modalities necessitates a comprehensive history, kind of therapy, and duration of treatment.

The utility of colposcopy in detecting relapse after treatment of gynaecological malignancies

“…5,6 Moreover, the Pap test is not reliable in case of active bleeding spots and after radiotherapy due to paucicellularity and radiation-induced atypia. 7 Most of the time a relapse is identified by clinical examination. In previous studies, around 10-15% of recurrence cases in the whole cohort and 15-20% in asymptomatic cases were identified by physical examination.…”

Pitfalls in Gynecological Cytology: Review of the Common and Less Frequent Entities in Pap Test

“…The cytoplasm is pale or amphophilic, sometimes with vacuolization (shown in Fig. 7a-c) [4,18,19]. The main differential diagnosis is dysplasia and SCC which have high N/C ratio, dark, irregular nuclei, and irregular, clumped chromatin (shown in Fig.…”

“…For correct interpretation, it is important to have information on the radiation therapy provided by the clinician or checked in the patient's electronic chart. After 4 to 6 months since radiation, morphological features of radiation changes gradually subside [18,19].…”