Abnormal Pap Smear

All about abnormal Pap smear

A Papanicolau smear (commonly known as Pap smear/Pap testing) serves as a cancer awareness tool for medical practitioners and female patients who try to conceive.

While an abnormal Pap smear result may indicate that infected cells are found in the cervix. This result suggests that further examination should be done.

Take note that getting an abnormal result does not necessarily mean that a woman is affected by cancer. In fact, the chance of having cancer is highly unlikely despite the abnormal result. Plus, it does not impose risks to the baby.

On the contrary, research show that about 80% women who have not took a Papanicolau smear test for 5 years are diagnosed with invasive cervical cancer.

Causes of an abnormal Pap smear result

Getting an abnormal Pap smear result is caused by the following factors:

  • Changes in the cervical cells
  • Various infections such as yeast, bacteria, and protozoan – trichomonas
  • Daughters from mothers who took the DES (diethylstilbestrol exposure) drug
  • Menopausal women
  • Genital herpes
  • Dysplasia (medical term for pre – cancerous abnormal cells)
  • HPV (human papilloma virus), a sexually transmitted disease. As a matter of fact, studies show that about 60% women carry HPV in their cervical and genital region
  • Damaged immune system due to chemotherapy, organ transplant, and corticosteroid therapy

Degrees of abnormal changes in the cervical cell

Laboratory specialists classify the abnormal cervical cell changes according to its degree via the Bethesda system (TBS), a uniform standardized analyzation system. With that being said, below are the different degrees of abnormal changes in the cervical cells:

Pregnancy week by week

Minor cell changes

Different types under minor cell changes are as follows:

  • Abnormal squamous cell of undecided significance (ASC – US) – changes may remain the same or return to its normal form
  • Abnormal squamous cell with possible high – status squamous intraepithelial laceration (ASC – HSIL) – minor changes but has higher chances of becoming severe
  • Low-slung squamous intraepithelial laceration (LSIL) – changes may become severe over time, if it does, these usually return to its normal form

Moderate – severe cell changes

Different types under moderate – severe cell change are as follows:

  • HSIL and Atypical glandular cells (AGC) – are highly likely to become cancer cells if untreated

Factors that increase the risk of getting an abnormal test result

The risk of getting an abnormal test result increases if a woman contributes to the following activities:

  • Having sex without protection (i.e. condoms) which may lead to genital warts
  • Polygamous sex life (or having a partner who has or had other partners) which may lead to genital warts
  • Smoking cigarettes / e – cigarettes and/or tobaccos

If a woman had a previous abnormal Pap smear result, she is highly likely to get another one in her future tests.

The Pap smear test

A Papanicolau smear test is a painless screening procedure that is done in conjunction with a pelvic exam. Pap testing is used to detect cancer or pre – cancerous conditions, minor tumors and cellular abnormalities in the uterine cervix.

Preparation prior to the test

To ensure the 100% accuracy of results, a female patient must do the following 2 days prior to the test:

  • Abstain from sexual intercourse
  • Avoid douching
  • Do not take vaginal medications
  • Do not use spermicidal creams, foams, and jellies
  • Reschedule if the menstrual period occurs

Types of Pap smear tests

Liquid – based Pap test

The collected cells are transferred from the cervix to a container. The container is filled with a specialized liquid which preserve the cells.

Conventional Pap smear

The collected cells are transferred from the cervix onto a glass slide.

Frequently asked questions for Pap smear testing

Who should take the Pap smear test?

  • Women age 21 – 65 years old
  • Have abstained sex for about 3 years

How often is Pap smear testing repeated?

  • Women age 21 – 29 are recommended to take the test every 3 years
  • Women age 30 – 65 can consider taking the test every 5 years

Is it safe to take Pap smear tests while pregnant?

It is safe to continue the routine. However, upcoming appointments will be delayed until after the baby is born. As a matter of fact, the birth of the baby of some women swabs away any abnormal cervical cells.

When to stop taking the Pap smear test?

  • Women who underwent total hysterectomy – total hysterectomy is the surgical removal of the cervix and uterus. After the procedure, consult the medical practitioner if routine Pap testing needs to be continued; If hysterectomy was done for non – cancerous purposes (such that of uterine fibroids), discontinue the routine; If hysterectomy was done for both purposes, continue the routine
  • Women age 65 and older – Older women who had negative Pap testing results may discontinue the routine

If numerous risk factors are detected, a medical practitioner will request for more frequent Pap smear testing, regardless of the female patient’s age. Such risk factors are as follows:

  • If she has been diagnosed with cervical cancer
  • Pap smear test which detected pre – cancerous cells
  • HIV (human immunodeficiency virus) infection
  • Impaired immune system

Performing a Papanicolau smear test

A Papanicolau smear test is performed in the doctor’s office and obstetrician – gynecologist clinics. This routine testing only takes a few minutes by doing the quick step – by – step procedures below:

  1. The female patient is requested to lie flat on an examination table. The knees are bent while the heels rest on stirrups.
  2. The doctor will insert gently insert a speculum in the vagina. This medical instrument holds and widens the vaginal opening to see the cervix. Expect some pelvic pressure during the course of insertion.
  3. Then the doctor will use a spatula (flat scraping instrument) or a soft brush to collect cervical cells.
  4. The collected cells are transferred into the laboratory. The cells are examined using a microscope to look for suspicious cells, and pre – cancerous or cancer substances.

After the test, a female patient can go about a day without any restrictions.

Follow – up tests

Follow – up tests are necessary to ensure that no abnormal cells are left and the cervix has fully recovered. After the said procedure, here are the follow – up tests that are recommended to take:

HPV test

An HPV test (similar to a Pap testing) detects if there are any high – risks types of HPV in the reproductive system.

Cone biopsy

Cone biopsy is carefully removing a triangle of cervical tissues and abnormal cells. This procedure is either performed inside the doctor’s office, obstetrician – gynecologist’s clinic, or in the outpatients corner.

Expect vaginal bleeding and watery discharge after the treatment.

Tests for various infections

Take tests to look for various infections such as sexually transmitted diseases (STDs), yeast, and other bacteria.

The Pap smear testing results

A Papanicolau smear result helps women to prevent or cure the potential development of cervical cancer. In fact, this type of cancer is largely preventable and curable. Furthermore, below are the different types of Pap results:

Negative results

Negative results indicate that only normal cervical cells (also called a normal Pap) were present. No further treatment is required until a female patient is due for the next Pap and pelvic exam.

Positive results

Did you know that only about 1 out of 10 Pap smears result to positive? Positive results indicate the presence of abnormal, unusual, and suspicious cervical cells (also called an abnormal Pap).

A positive result does not equate to being affected by cervical cancer, this result depends on the type of cells that are detected in the test.

In line with this, here are some medical terms that the medical practitioner might use. Each medical term comes along with its succeeding test or treatment:

  • Abnormal squamous cells of uncertain significance – refers to the tinny, plane and slightly abnormal cells which grows on the outer part of the cervix. Take the liquid – based test for this case
  • Squamous intraepithelial lesion – refers to the collected cells via Pap testing may be pre – cancerous. If the changes equate to low grade, the development of pre – cancerous lesion is highly likely to be years away; If the changes equate to high grade, the pre – cancerous lesion may develop the soonest. Further diagnostic testing is required
  • Abnormal glandular cells – Glandular cells cultivate in the cervical opening and within the uterus. These are accountable for the making of mucus and the formation of mucus plug. Atypical glandular cells refer to the slightly abnormal cells and its uncertain if these are cancerous or not
  • Squamous cell sarcoma (also called as adenocarcinoma cells) – refers to the utterly abnormal cells which highly suggests that a patient is affected by cancer

False – negative results

A false – negative result indicate that there is no abnormality even though the cells are abnormal. In fact, this result does not equate to a testing mistake. There are contributing factors that causes the said result, this include:

  • Insufficient sample
  • Small amount of abnormal cells
  • Abnormal cells are tinged with blood
  • Abnormal cells are mixed with inflamed cells

Treatment options for Pap smear testing results

Each type of Pap smear testing results have succeeding treatment options. Enlisted are the following below:

For abnormal results

If abnormal Pap smears persisted, a female patient is considered to take the following further treatment options below:

Colposcopy

Colposcopy (similar to biopsy – tissue removal) is a close examination at the vagina and cervix. It involves inserting a speculum into the vaginal opening (to hold the walls), and the cervix is coated with a vinegar solution to make the abnormal tissues stand out.

The collected sample will be examined by a pathologist using a lighted telescopic tool. If an abnormal area is detected, a sample of the area will be taken for further diagnosis.

Cryosurgery

Cryosurgery is an examination which involves freezing the abnormal cells.

The LEEP procedure

LEEP stands for large – loop electrosurgical excision procedure. The LEEP procedure uses a loop – shaped tool to carefully remove the abnormal area. Expect vaginal bleeding and discharge during or after the process.

For moderate – severe cell changes results

Laser therapy

A laser therapy uses a laser beam to exterminate abnormal cells.

For menopausal stage

Women near or who are in their menopausal stage can treat minor cell changes using an estrogen cream.