What is a Pap Test?
A Pap test (sometimes called a “Pap smear”) is a test that providers use to check the cervix for changes that can occur if a woman has been exposed to the Human Papillomavirus (HPV). The cervix is the part of a woman’s body where the uterus and the vagina meet. It is the bottom part of the uterus.
If a woman has untreated HPV for many years, it can progress to cervical cancer. Cervical cancer is extremely rare in women who get recommended screening pap tests.
When your results are abnormal
Don’t panic. An abnormal Pap test result can mean many things. It may be due to changes (inflammation) caused by normal cell repair or infection. Or, you may have cell changes that are due to a virus. If ignored, this problem might progress to cervical cancer. That’s why it’s so important to have Pap tests as often as directed. Pap tests can show cell changes in the cervix early on, when treatment is most effective.
What causes abnormal Pap test results?
The main cause of cervical cancer is infection with HPV. There are many types of HPV. Some types have been linked to cancer of the cervix, vulva, vagina, anus, and penis. Some also can cause cancer of the head and neck. These types of HPV are known as “high-risk” types. Most cases of cervical cancer are caused by just two high-risk types of HPV—type 16 and type 18. Cells that are infected with HPV appear different from normal cells under a microscope. Abnormal changes can be mild, or they can be more serious. The more serious changes can lead to cancer if not treated.
What are the different types of abnormal results?
Atypical squamous cells of undetermined significance (ASC-US)—changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. ASC-US is the most common abnormal Pap test result.
Low-grade squamous intraepithelial lesion (LSIL)—the cervical cells show changes than are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.
High-grade squamous intraepithelial lesion (HSIL)—suggests a more serious change in the cervix than LSIL. It is more likely than LSIL to be associated with precancer and cancer.
Atypical Squamous cells, cannot exclude HSIL (ASC-H)—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.
Atypical glandular cells (AGC)—Glandular cells are another type of cell that makes up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells are also present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of precancer or cancer.
What testing is needed after an abnormal Pap test result?
If you have an abnormal cervical cancer screening test result, you may need further testing. The following tests may be done depending on your age and your initial Pap test result:
Repeat Pap test or co-test (Pap test & a test for high-risk types of HPV)—recommended as a follow-up to some abnormal test results. These repeat tests may be done in 1 year or in 3 years depending on your initial test result, your age, and the results of previous tests.
HPV test—An HPV test looks for the presence of HPV types that have been linked to cervical cancer. An HPV test can be done on the same cells used for the initial Pap test. This is called reflex HPV testing. There is another kind of HPV test that looks specifically for HPV types 16 & 18. These two types cause the most cases of cervical cancer. This kind of HPV test is called HPV typing.
Colposcopy—an exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed.
Biopsy—a health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether pre-cancer cells are present.
Endocervical sampling—A small brush or other instrument is used to take a tissue sample from the cervical canal. This is done in our office. We recommend taking Ibuprofen prior to this procedure—Nitrous Oxide is offered for this procedure upon request.
Endometrial sampling—A sample of the endometrium (the lining of the uterus) is collected for study. Some women with an AGC (atypical glandular cells) result need to have this follow up test.
How are abnormal cervical cells treated?
In general, there are two ways to treat abnormal cervical cells:
Excisional treatment—tissue is removed from the cervix and is sent to a laboratory to be studied. Results can tell whether precancerous cells are present, if so, how severe the case is.
Ablative treatment—abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.
What types of excisional treatments are there?
Excisional treatments include the following:
LOOP Electrosurgical Excision Procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This is often done in the comfort of our office—we recommend taking Ibuprofen prior to this procedure. Nitrous Oxide is available upon request.
Conization—a cone shaped piece of the cervix that contains the abnormal cells is removed. This is often done in the operating room with sedation or Nitrous Oxide is available upon request.
What types of ablative treatments are there?
Cryotherapy—an instrument is used to freeze abnormal cervical tissue, which then sloughs off.
Laser Therapy—a focused beam of light is used to destroy abnormal cervical tissue.
Be sure to discuss your results with your healthcare provider. Find out about any follow-up tests you’ll need. You may be scheduled for another Pap test in a few months. You may be tested for the virus that can lead to cervical cancer (HPV), or you may be scheduled for a special exam so your healthcare provider can get a closer look at your cervix.
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