The PAP Smear
Cervical Cancer screening.
A PAP Smear is a screening test for precancerous cells of the cervix and cervical cancer.
The PAP smear has been very successful in decreasing the risk of developing cervical cancer in the United States.
There is a reason why we don’t hear a lot about cervical cancer, like we do about breast and ovarian cancer. That is because the PAP smear is an excellent screening test for cervical cancer.
It is recommended that you have your first PAP smear at the age of 21.
What is a PAP smear?
The cervix is the opening to the uterus and is located at the top of the vagina. It is covered by a thin layer of tissue made up of two types of cells: 1) “skin-like” cells called squamous cells and 2) glandular cells that produce the mucus in the cervix
The screening process is simple and fast. You lie on an exam table and a speculum is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina.
Cells are removed from the cervix with a brush or other sampling instrument. The cells are usually put into a special liquid and sent to a laboratory for testing.
The sample is examined to see if abnormal cells are present. We may also test for HPV.
ABNORMAL PAP
If your pap smear comes back abnormal don’t panic.
Many women have abnormal cervical cancer screening results.
An abnormal result does not mean that you have cancer.
If your pap smear comes back as abnormal, the most likely cause is cervical dysplasia or active Human Papilloma Virus (HPV).
Most cases of cervical precancer and cancer abnormalities are caused by infection with HPV. HPV is a virus.
Human papilloma virus (HPV) is transmitted during sexual intercourse with a person who’s already infected with HPV, even when an infected person has no signs or symptoms. Most people who become infected with HPV do not know they have it. Anyone who is sexually active can get HPV, even if you have had sex with only one person.
Because of the body’s natural ability to fight infection, most HPV infections go away on their own.
These short-term infections typically cause only mild, or “low-grade,” changes in cervical cells.
Usually, the body’s immune system gets rid of the HPV infection naturally within two years.
The cells go back to normal as the HPV infection clears.
When the body’s immune system can’t get rid of an HPV infection, it can linger over time expressing its DNA.
This is called a “persistent” infection. A persistent infection with HPV showing active on repeat PAP smears, increase the risk of developing a precancerous lesion.
Each cell in your body has its own DNA which tells your cells to function and grow like they are designed to.
HPV DNA, when active, tells your cells to do something different (like getting a virus in your computer). This causes the cells to grow abnormally, which then produces an abnormal pap smear or cervical dysplasia.
Cervical Dysplasia
“Dys” – is abnormal
“-plasia” is growth
Dysplasia means that there are abnormally growing cells found on your cervix cells picked up by the pap smear.
This is a Precancerous lesion.
Cervical dysplasia is usually asymptomatic, it’s important to diagnose and treat the condition to reduce the risk of cervical cancer.
Cervical dysplasia can range from mild to moderate to severe, and treatments vary depending on the case.
Mild Cervical Dysplasia (LSIL)
Most cases of mild cervical dysplasia, also known as Low Grade, will revert back to normal as your immune system clears the HPV infection.
Ninety percent (90%) of HPV infections causing mild dysplasia will clear the HPV infection and revert back to normal over the course of a year
Moderate and Severe Cervical Dysplasia (HSIL)
Ten percent of woman will go on to develop moderate dysplasia. Even then almost half of the time this will revert back to normal over 2-3 years.
About 10% of women with HPV infection on their cervix will develop long-lasting HPV infections or “persistent Infection” that puts them at risk for a higher-grade lesion. High-grade changes that persist for 1 or 2 years are more likely to become cancer if they are not treated.
Severe dysplasia is a different story. If left untreated this condition is likely to progress to cancer over the next 5 years.
It usually takes 3 to 7 years for high-grade changes in cervical cells to become cancer.
This is why the PAP smear is an important tool in detecting these changes before they become cancer.
It’s important to diagnose and treat the condition to reduce the risk of cervical cancer.
The PAP smear is the screening test and if your PAP smear is abnormal, we may recommended a more thorough evaluation of your cervix with a procedure called a colposcopy.
Colposcopy
Colposcopy is done when results of cervical cancer screening tests show abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells.
Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope.
The procedure is done in our office. This gives the us a better view of the cervix.
Like a pap smear, a speculum will be used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen.
The colposcope is placed just outside the opening of your vagina.
A mild solution of white vinegar will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. You may feel a slight burning.
A halogen light illuminates the vagina and the cervix. A colposcope can greatly enlarge the normal view. This exam allows us to find problems that cannot be seen by the eye alone.
During colposcopy if any abnormal areas are seen, a biopsy of these areas may be done. During a biopsy, a small piece of tissue is removed from the cervix and cells from the canal of the cervix will be taken. This will be sent to be examined by a pathologist.
To prepare for your colposcopy:
For at least 24 hours before the test, you should not
- douche
- use tampons
- be on your period
- use vaginal medications
- have sex
1-2 Hours prior to your procedure.
- Take an over-the-counter pain reliever about 30 minutes prior to your procedure. You can use either nonsteroidal anti-inflammatories (like ibuprofen, Advil, or Motrin) or acetaminophen (Tylenol).
After a colposcopy, it’s normal to experience some spotting or brownish discharge for the next few days. This is normal and can be managed with sanitary pads. While the cervix heals, you should limit your activity and avoid sex for 48 hours.
Call our office if you have any of these problems:
- Heavy vaginal bleeding (using more than one sanitary pad per hour)
- Severe lower abdominal pain
- Fever or chills
Sometimes colposcopy may need to be done more than once. It also can be used to check the result of a treatment.