Abnormal Pap Smear

2024/05/16

What is a Pap Smear

A Pap Smear is a simple test performed by the doctor to detect cervical cancer. It involves the placing of a speculum in the vagina to reveal the cervix. A small brush is thenis used to gently collect cells that are normally shed from the lining of the cervix into the surrounding mucus. The collected cells will then be incorporated with into a liquid test medium for microscopy examination. A specially trained technologist will examine the sample to identify any changes associated with pre-cancerous transformation.

Pre-cancerous or dysplastic changes usually take place in the cells of the lining of the cervix before pregressing to cervical cancer. The more severe the dysplasia, the more likely it is to continue progressing and changing towards cancer. The less severe the dysplasia, the more likely it is to reverse and return to normal.

The Pap Smear report may contain unfamiliar words or terms; the doctor will be able to explain these in greater detail, but we can start to help you understand some of these terms now. Nonetheless, we included a list of these terms and their definition below.

Result Interpretation

Normal results

Normal or negative result for intraepithelial lesion or malignancy. This means that cells in the sample appear normal and do not show precancerous changes.

Abnormal results

A typical Squamous Cells or ASC. This means that there are cells in your Pap test that appear unusual but are not abnormal. These mild changes can be caused by infection or changes in a woman's hormones. Your healthcare provider will usually suggest treating an infection if you are found to have one, repeating a Pap smear in six months or follow-up with colposcopy.

CIN (cervical intraepithelial neoplasia) and SIL (squamous intraepithelial lesion) refer to the same condition of pre-cancerous changes of the cervix. CIN1 and low-grade SIL entail less severe changes typically not requiring any treatment. Low-grade SIL or mild change is also often seen in cervical infection due to Human Papillomavirus ( HPV). CIN2 or 3 and high-grade SIL entailmore severe changes in the cervix likely to progress to cancer Nonetheless, HSILs (high-grade squamous intraepithelial lesions) such as CIN2 or 3 can be completely treated with simple procedures performed in the examination room or clinic.

Atypical Glandular Cells ( AGC) are a type of cell present in the cervix, uterus, Fallopian tube, ovary or breast indicating the presence of pre-cancerous or cancerous change. The doctoris likely to recommend a prompt follow-up with colposcopy.

Cancer, or carcinoma means the presence of abnormal cells stemming from a cancer or a severe pre-cancerous lesion on the cervix. Such cases require an immediate colposcopy.

What if my result is abnormal and I need a Colposcopy?

A colposcopy allows the examination of the cervix in detail. It involves

the placing a speculum in the vagina to reveal the cervix, which will be examined light with a colposcope. A colposcope is a type of microscope designed to magnify the cervix for detailed examination to identify pre-cancerous or cancerous changes. A diluted solution of vinegar or acetic acid is usually applied on the cervix to render cancerous or precancerous changes more obvious for colposcopic examination.

A biopsy may be taken for investigation of potential cancerous or pre-cancerous lesions, and changes on the cervix. A biopsy involves obtaining tissue samples of an area in the cervix that appears abnormal under a colposcopy.

There may be light bleeding associated with a biopsy of the cervix, akin to the amount of bleeding during a normal menstrual period. The procedure is painless, but discomfort similar to that of menstrual cramping may be experienced after the procedure.

Treatment Options

Most pre-cancerous lesions and changes of the cervix can be treated through simple procedures that are performed in the doctor's office or clinic. Your doctor provider will explain the options in greater detail. Some common treatments are described below.

LEEP (Loop Electrosurgical Excision Procedure)

This procedure, is sometimes also referred to as a LLETZ (Large Loop Excision of the Transformation Zone). This), is a simple procedure that involves the use ofs an electrically powered loop to remove abnormal portions of the cervix. An injection is usually administered to numb the cervix and prevent bleeding. While the procedure is painless, there may be some light bleeding akin to the amount of bleeding during a normal menstrual period.

Cone Biopsy

This procedure is usually recommended when pre-cancerous or cancerous changes are found in the canal or tunnel-like portion of the internal part of the cervix. It involves the removal of a larger cone-shaped portion of the cervix. . This simple procedure can be performed in the doctor’s office under local anaesthesia or in an operating suite under general anaesthesia. Lasers or electrosurgical instruments are most commonly used to remove the abnormal portion of cervix. Slight bleeding is likely to occur after a cone biopsy because a larger portion of the cervix is removed as compared to in a LEEP. Mild cramping may also be experienced. Refraining from sexual intercourse for about two weeks is recommended to allow healing. No hospitalisation is required following a cone biopsy.

Cold Coagulation or Ablation

Depending on the location of the abnormal lesions, cold coagulation or other treatment options may be offered. These treatment options harness heat, freezing temperatures or laser energy to destroy the abnormal tissues of pre-cancerous lesions on the cervix. These procedures are painless with only mild discomfort expected. Minimal bleeding may also occur. Increase amount of watery or thick yellow vaginal discharge in the ensuing seven days is usually observed during the healing process.

Summary

Most abnormalities shown on a Pap Smear do not require treatment. 

A colposcopy is usually recommended to determine the cause.

Most severe pre-cancerous changes or lesions of the cervix can be easily treated with procedures performed in a clinic or as a day surgery procedure.