Q. The results of my last Pap test are
abnormal. I'm worried. What does
this mean?
A. Abnormal results on a Papanicolaou (Pap) test
mean that there are changes in the cells of the cervix-the opening of the uterus
(womb). Cervical cell changes are most often caused by inflammation. Infiammation
may be the result of infections, such as gonorrhea; herpes; human papillomavirus
(HPV), which causes genital warts; bacterial vaginosis; chlamydia; Trichomonas; and
yeast infections. Cervical cell changes can also signal cancerous or precancerous
conditions that need to be examined further by your physician.
Q. Does an abnormal Pap test mean that I
have cancer?
A. No. For the vast majority of women, an abnormal Pap test result does not lead
ultimately to a diagnosis of cancer Early treatment of precancerous conditions can
prevent cancer from ever occurring. Yearly Pap tests and complete follow-up care
ensure that even if cervical cancer is present, it will be detected early enough that it
can usually be treated successfully. That is why it is so important to return to your
doctor for follow-up care.
Q. How do I know whether I have an
infection or a more serious condition?
A. You should consult your physician for an explanation of your test results, but here
are some common classifications of Pap smears that help interpret any changes seen
in the cervical cells:
-ASCUS (atypical squamous cells of undetermined significance): cells may not be
normal, but it is hard to tell exactly what is wrong with them.
- SIL (squamous intraepithelial lesion): cells show certain distinct changes, known as
dysplasia. SIL is either low grade or high grade
- Dysplasia, also called cervical intraepithelial neoplasia (CIN), means that abnormal
cells have replaced normal ones and could develop into cancer over a period of years.
CIN is not itself cancer and is usually 100% curable by treatment.
It is divided
into three grades:
- CIN 1: mild dysplasia or HPV-linked changes
- CIN 2: moderate dysplasia
- CIN 3: severe dysplasia and carcinoma in situ (CIS), a precancer, not true invasive
cancer.
- Invasive cancer: unhealthy, cancerous cells are seen; cancer has spread into the
cervix and possibly to other organs. Even invasive cancer has a cure rate of 80% to
90% if it is found early enough!
Q. is the Pap test always accurate?
A. Although the Pap test is very effective in detecting changes in the cervix, like any
test it is not 100% accurate. Sometimes there are problems with the sample or its
interpretation. There may be too few or too many cells in the sample to allow an
accurate reading, or an infection may temporarily be "covering up" abnormal
cells.
Although no test is perfect, remember that because the Pap test can find cell changes
at an early stage when treatment is more successful-it helps prevent cancer of the
cervix. Since the Pap test was introduced 50 years ago, the number of deaths from
cervical cancer has decreased by 70%.
Q. If my Pap test indicates that there are atypical or inflammatory cells, what happens
next?
A. Your doctor will prescribe a treatment for the inflammation or infection, and you will
probably be asked to have a repeat Pap test following treatment. Wait 3 months
before repeating the test to give the cervical cells a chance to recover. If cell changes
are detected again on a repeat Pap test further diagnostic tests may be needed.
Q. What are these tests?
A. Colposcopy, which is performed in the doctor's office, allows direct viewing of the
cervix through a special magnifying microscope (colposcope). Any abnormal cells
seen by colposcopy may be removed (biopsy) to accurately diagnose the problem.
Biopsy is usually done in the doctor's office. It may cause slight discomfort for a few
seconds.
Q. I have dysplasia. How will it be treated?
A. Because abnormal cells are removed in biopsy, the procedure can also serve as a
method of treatment. There are several @s of biopsies:
Punch biopsy: takes a small sample of cervix;
Endocervical curve: samples
inside of cervix;
Endometrial biopsy: samples a small amount of tissue of the
uterus;
Loop electrode excision procedure: removes abnormal areas of the cervix with a thin
electrode; and
Cone biopsy: removes a larger sample of tissue.
Minor surgery may be used to treat genital warts, dysplasia, and early stages of
cancer. The affected tissue is removed, and new tissue gradually grows and heals
the cervix. Several methods are used:
cryosurgery, which freezes the affected
tissue;
electrosurgery, which destroys affected tissue with heat; and
laser treatment,
which removes abnormal tissue with high-intensity light.
Q. Who is at increased risk of developing cervical cancer?
A. Women who have had many sexual partners or whose partners have had multiple
partners, women who have had many pregnancies or who became pregnant in their
teenage years, and women with a history of genital warts are at increased risk.
Women who smoke also increase their risk.
You may not be able to change your risk factors, but you can prevent cervical cancer
by having yearly Pap tests and returning for follow-up treatment if the results are
abnormal.
For more information on the web visit this site
SUGGESTED READING
American College of Obstetricians and Gynecologists.
Disorders of the Cervix. Washington, DC: 1992. Pamphlet.
American College of Obstetricians and Gynecologists. The Pap Test. Washington,
DC: 1994. Pamphlet.
