What is a Pap Smear?
Your doctor can perform this easy test for you. A speculum is placed in your vagina to allow the cervix to be seen. A small brush is then used to gently collect cells that are normally shed from the lining of the cervix into the surrounding mucus. The collected cells are then brushed into a liquid test medium that is sent to the lab to be examined under a microscope. The technologist examining these cells has been specially trained to identify changes that are associated with pre-cancerous transformation.
Pre-cancerous or dysplastic changes usually take place in the cells of the lining of the cervix before eventually becoming cancer of the cervix. 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.
There may be words or terms in your Pap Smear report that may be confusing to you. Your doctor will be able to explain these to you in greater detail, but we can start to help you understand some of these terms now.
- Normal results
Normal or negative for intraepithelial lesion or malignancy. This means that the cells that were examined on your Pap test appear normal and do not show precancerous changes.
- Abnormal results
Atypical 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) mean the same thing and both refer to pre-cancerous changes of the cervix. CIN1 and Low-grade SIL are less severe changes that often will not need treatment. Low-grade SIL or mild change is also often seen when there is infection of the cervix with the Human Papillomavirus or HPV. CIN2 or 3 and High-grade SIL are more severe changes in the cervix that are more likely to progress to cancer and will usually require treatment. The good news is that HSILs (high-grade squamous intraepithelial lesions) such as CIN2 or 3 can be completely treated with simple procedures that can often be carried out right in your doctor’s office or clinic.
Atypical Glandular Cells or AGC. This means that a type of cell present in the cervix, uterus, Fallopian tube, ovary or breast is present in the Pap smear and shows changes that may be the result of the pre-cancerous or cancerous change. This result will usually prompt your doctor to suggest prompt follow-up with a colposcopy.
Cancer or carcinoma. This means that there are abnormal cells on your Pap test that may have come from a cancer or a severe pre-cancerous lesion on the cervix. This result should always be followed up with an immediate colposcopy.
What if my result is abnormal and I need a Colposcopy?
A colposcopy allows your healthcare provider to examine the cervix in detail.
A speculum is placed in the vagina to allow the cervix to be seen clearly. The cervix is then examined in good light with a colposcope. A colposcope is a special microscope designed to magnify the cervix allowing a careful and detailed examination of the cervix for pre-cancerous or cancerous changes. Often a dilute solution of vinegar or acetic acid will be placed on the cervix to make cancerous or precancerous changes more obvious during the colposcopic examination.
A biopsy may then be taken of any cancerous or pre-cancerous lesions or changes on the cervix. A biopsy is a small sample of tissue. This is usually taken from an area of the cervix that appears abnormal when examined using a colposcope and acetic acid during colposcopy.
There may be some light bleeding associated with a biopsy of the cervix, certainly no more than the bleeding in a normal menstrual period. Although the procedure itself is painless, you may experience some discomfort similar to menstrual cramping after the procedure.
Most pre-cancerous lesions or changes of the cervix can be treated easily with simple procedures that are performed right in your healthcare doctor’s office or clinic. Your healthcare provider will be able to explain these options to you in greater detail, but we will start to introduce some of the more common treatments right now.
- LEEP (Loop Electrosurgical Excision Procedure)
This procedure is sometimes also referred to as a LLETZ (Large Loop Excision of the Transformation Zone). This simple procedure uses an electrically powered loop to remove abnormal portions of the cervix. An injection to numb the cervix and prevent bleeding is usually given before this simple procedure is performed. Hence, the procedure is usually painless and you can expect some light bleeding or spotting but no more than expected in a normal menstrual period.
- Cone Biopsy
This procedure involves the removal of a larger cone-shaped portion of the cervix. A cone biopsy 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. This simple procedure can be performed in the office under local anesthesia or more commonly in an operating suite under general anesthesia. Lasers or electrosurgical instruments are most commonly used to remove the abnormal portion of cervix. Although less than a menstrual period, more bleeding can be expected after a cone biopsy because a larger portion of the cervix is removed as compared to a LEEP. Mild cramping may be expected after a cone biopsy. Your healthcare provider will usually recommend that you avoid having sexual intercourse for about two weeks to allow your cervix to heal from the procedure. You will not need to be hospitalised after a cone biopsy.
- Cold Coagulation or Ablation