Abnormal Pap Smear Management

 

Sometimes, women may have an abnormal pap smear result which may cause a great deal of stress. Understanding pap smear results may help you decrease your stress and knowing is half the battle.

 

If your pap smear result is abnormal, you will receive a phone call from our office instructing you to schedule a visit to discuss your pap smear result and the follow-up treatment you will need. Results will not be given over the phone. Thank you so much for your understanding.

 

Understanding your
Pap Test Results

Your cervix is covered by a thin layer of tissue (feels like the tip of your nose and has the moist consistency similar to the inside of your cheek/mouth). This tissue is made of up cells. As they develop, they grow from the bottom layer up, slowly moving to the surface of the cervix. During this process, sometimes the cells become abnormal or damaged.

Abnormal Pap Smear Management

A normal healthy cervix would have a pap smear result stating Within Normal Limits (no evidence of malignancy or dysplasia).

The abnormal cells that show early precancerous changes called dysplasia or cervical intraepithelial neoplasia (CIN). Dysplasia and CIN are graded according to severity: Mild, Moderate or Severe. Mild dysplasia (CIN 1 ) usually resolves on its own. However, moderate (CIN 2) to severe dysplasia (CIN 3) may need further treatment.

 

Abnormal Pap Test results

Some examples of what your results may say are: (Remember, “precancer” is NOT CANCER!!! It means that IF you do not follow up, it MAY turn into something serious.)

ASC-US: Atypical Squamous Cells of Undetermined Significance which basically means that when the pathologist was looking at the cervical cells under a microscope, changes in the cervical cells have been found. The cells look “atypical” of “undetermined significance”. This is the most common abnormal Pap test result.

SIL: Squamous intraepithelial lesion means that there are abnormal changes seen in the cells that may be a sign of precancer. SIL may be low grade (LSIL) or high grade (HSIL).LSIL may indicate HPV infection. LSIL is very common and usually goes away without treatment. HSIL indicates more serious changes and definitely needs follow up treatment.

Atypical Squamous cells, cannot exclude HSIL (ASC-H): Changes in the cervical cells have been found, but the changes are not clearly HSIL. Further testing is needed.

AGC: Atypical Glandular Cells are cell changes that suggest precancer of the upper part of the cervix or uterus.

HPV
(Human Papilloma Virus)

Human Papilloma Viruses are a group of more than 100 different viruses. Abnormal Pap test results are often due to the detection of HPV.

  • More than 30 types are spread during sex.
  • Some types can cause cervical cancer when not treated.
  • HPV infection is one of the most common sexually transmitted infections (STIs).
  • About 75% of sexually active people will get HPV.
  • Some HPVs cause genital warts, but do not cause cervical cancer.

Some types have been linked to cancer of the cervix, vulva, and vagina. Some types have been linked to genital warts. These types are defined as high risk HPV viruses.

Pap tests and HPV tests are cervical cancer screening tests. At our practice, the Pap test we use simultaneously screens for HPV as well. Both tests help screen for cervical cancer, but they look for different things. The Pap test checks for cell changes in your cervix that could develop into cervical cancer. The HPV test specifically looks for HPV, the virus that can cause these cell changes.

There is no treatment for HPV, but most women’s bodies do eventually fight the virus off. However, there are treatments for the health problems that HPV causes such as genital warts (condyloma), cervical cell changes and cervical cancer.

 

Colposcopy: Diagnosis

So what happens when you have an abnormal pap result? What’s next? To further diagnose what the cause of your abnormal pap test, we have to do a colposcopy. A colposcopy is a procedure where we are able to look at your cervix more closely. A colposcope is like a large microscope. It magnifies your cervix. It can detect problems on your cervix that cannot be seen by the naked eye.

  • Before you come, you may want to take 1-2 tablets of Ibuprofen (Advil or Motrin) for any cramping you may feel during the exam.
  • You will be placed in “the position” with your legs in stirrups so the healthcare provider can easily access your cervix. A speculum will be placed in your vagina so she may visualize your cervix.
  • She may wipe/clean your cervix and then, she will apply acetic acid (vinegar) with a large Q-tip on your cervix. If there are cervical cellular changes occurring, the affected areas will become apparent and a biopsy may be taken.
  • One or more biopsies may be taken that will be sent to the pathologist for examination. You will feel a pinch and possibly some cramping. Each woman is different.
  • An endocervical sample (sample from your cervical canal) will also be taken and sent to the pathologist.

The entire procedure is less than 10 minutes from start to finish. The results should be back within a week or so and you will discuss these results with your healthcare provider.

Treatment

Possible treatment options may be the following:

  • Repeat pap smear in three to six months.
  • Freezing: Also called cryotherapy which is approximately 3 minutes of freezing the surface of your cervix. The abnormal tissue will later shed off in a watery vaginal discharge.
  • LEEP (Loop electrosurgical excision procedure) : A thin wire loop that carries an electric current is used to remove the abnormal areas of the cervix. This is done with anesthesia and it is done in the hospital. The area that is removed is sent to the pathologist for examination.
  • Cone biopsy: A cone-shape (like an ice cream cone) portion of the cervix is removed and also sent to the pathologist for examination. This procedure is done in the hospital under anesthesia. No overnight stay is needed.
After a few weeks, you will return for a follow- up visit to evaluate how your cervix is healing. Usually, another pap test will be scheduled for 3 months thereafter and subsequent pap tests will depend on the results post treatment. Please discuss any concerns you have with a nurse practitioner.