Post Irradiation Cytopathology of Cervical Cancer Patients

Abstract

Introduction: Pap smear from uterine cervix or vaginal vault (in hysterectomised) patient is an important tool for follow up after completion of radiation therapy. It is quick, simple and cost effective. It can be used for monitoring and early detection of residual/recurrent neoplasm. In this study we report the cytopathological changes in patients undergoing radiation therapy for carcinoma cervix.Aim and Objectives: This study aims at awaring about cellular changes resulting from irradiation and varied composition of post irradiation smear which may lead to more accurate interpretation of cytological findings.Material and Methods: This is a descriptive study of 42 cases presented in cytological section of department of Pathology, PMCH, Patna from January 2020 to March 2021Pap-smear was collected from vaginal vault in hysterectomised patient and from endocervix/ectocervix in patient who retained uterus due to one or another reason Pap-smear was collected on three occasion i.e. on 1st follow up at one month of completion of radiotherapy, 2nd follow up at four month after completion of radiotherapy and 3rd follow up at ten month after completion of radiotherapy.Observations: Out of 42 carcinoma cervix patients participating in this study, youngest patient was a 26 years old married female coming from a rural area and was having well differentiated squamous cell carcinoma. Another female was 30 years old with a history of early marriage and having three children. Peak incidence in this study was observed in age group 41-50 years with all grades of squamous cell carcinoma i.e well, moderately and poorly differentiated SCC and one case of adenocarcinoma of endocervix. In age group greater than 61 years, five cases were seen of which one was diagnosed as poorly differentiated SCC. Rest four were well differentiated SCC. Conclusion: Cytology is a valuable tool for the detection of local recurrence of carcinoma cervix. It is simple and economical to perform at the time of follow up examination of the patients of carcinoma cervix after completion of radiotherapy. Awareness of cellular changes resulting from irradiation and varied composition of post irradiation smear led to more accurate interpretation of cytological finding. However cytological features of post irradiation dysplasia are difficult to distinguish from recurrent carcinoma cervix and owing to its higher progression rate of colposcopic examination and biopsy are recommended.