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| Along with antibiotics, insulin and the flu vaccine, the Pap test ranks
among the top success stories of modern medicine. Named after its developer, George
Papanicolaou, M.D., the Pap test can prevent cervical cancer by detecting abnormal
(atypical) cells on your cervix. If you get regular Pap tests, your chances of developing invasive cervical cancer are low. But even if you develop cervical cancer, the chances of a cure are as high as 90 percent — if discovered early. A Pap test, also called a Pap smear, is a simple procedure that collects cells from your cervix — the lower, narrow end of your uterus. It's a test that can detect the presence of infections, inflammation, precancerous cells or cancer.A Pap test is done in your doctor's office and takes only a few minutes. First you lie down on an exam table with your knees bent. Your heels rest in metal supports called stirrups. Your doctor will gently insert an instrument called a speculum into your vagina. Then, he or she will take a sample of your cervical cells and smear them onto a glass slide for examination.Your doctor sends the slide to a laboratory, where a cytotechnologist — a person trained to detect abnormal cervical cells — examines the sample under a microscope. These technicians work in cooperation with a pathologist, a doctor who specializes in cellular abnormalities. The pathologist is responsible for the final diagnosis.Usually your doctor performs a Pap test during your pelvic examination, a simple procedure that allows your doctor to examine your external genitals, uterus, ovaries and other reproductive organs. Although pelvic examinations can screen for reproductive problems or abnormalities, a Pap test will detect early cervical cancer or precancers. Your test results A negative result from your Pap test means that abnormal cells weren't detected. A positive result means that abnormal cells were found. However, a positive result doesn't necessarily mean that you have cancer or even a precancerous condition. The Pap test doesn't diagnose a disease but instead acts as a screening test to alert your doctor to look more carefully. The words used to describe abnormal cells are carefully chosen to send specific messages about risk to your doctor. Here are several abnormalities your doctor may find as a result of your Pap test and what your next course of action might be. * Inflammation. Common vaginal or cervical infections may appear on a Pap test. Your doctor will treat any infection and then repeat the Pap test a few months later. * Atypical squamous cells of undetermined significance (ASCUS). This term is applied when a Pap test shows slightly abnormal cells, but the cells don't clearly indicate a cervical problem. Many times this finding represents a viral infection, which can be treated. * Squamous intraepithelial lesion (SIL). This term is used to indicate that the cells seen on the Pap test are consistent with abnormalities in the cervix that may be precancerous (cervical intraepithelial neoplasia, or dysplasia). If the threat is low grade, the size, shape and other characteristics of the cells suggest that if a precancerous lesion is present, it's likely to be years away from becoming a cancer. If the threat is high grade, the certainty of something being wrong on the cervix is greatly enhanced, and the lesion is likely to be farther down the road to cancer. * Atypical glandular cells of undetermined significance. This term is used when glandular cells appear to be slightly abnormal. Compared with ASCUS, this finding is far more likely to be serious. And it always demands further testing. * Squamous cancer or adenocarcinoma cells. In either circumstance, the cells seen on the Pap test are so abnormal that the pathologist is almost certain a cancer will be found growing in the vagina, cervix or occasionally the uterus. Squamous refers to flat, skin-like cells. Adenocarcinoma refers to cancers arising in gland cells. If your doctor finds an abnormality other than inflammation, he or she may decide to examine the tissues through a special microscope in a procedure called colposcopy and take a tissue sample (biopsy). This test provides a definitive diagnosis in contrast to the Pap test, which is a screening test. Conditions that may be found after such procedures include: (see new Bethesda classification) * Cervical intraepithelial neoplasia (CIN). This is a term used to describe abnormal changes on the surface of the cervix after biopsy. CIN — along with a number (1, 2 or 3) — describes how much of the lining of the cervix contains an abnormal growth of cells. Another term for this condition is dysplasia. * Carcinoma in situ (CIS). This cancer involves cells on the surface of the cervix that haven't spread into deeper tissues. Treatment to remove the cancer is necessary and highly successful. * Cervical cancer. Abnormal cells will eventually invade deeper tissues and may spread into blood vessels and the lymphatic system, where they can be carried to distant sites. Both squamous and glandular cancers can arise in the cervix. Most of the time, abnormal Pap tests pick up precancerous tissue that can be treated before these more dangerous diseases arise. Treating abnormalities If your doctor confirms suspicious results with additional tests — such as with a colposcopy or biopsy — you need to seek treatment. For mild to moderate abnormalities or for carcinoma in situ, options include: * Conization. This is a procedure in which your doctor removes a cone-shaped piece of cervical tissue containing the abnormal area. * Laser surgery. In this procedure, your doctor uses a laser to kill precancerous cells. * Loop electrosurgical excision procedure (LEEP). This is a technique in which a wire loop with an electrical current running through it is used like a surgeon's knife to remove abnormalities. * Cryosurgery. Your doctor may use this technique to freeze and kill precancerous cells. * Hysterectomy. This is the surgical removal of precancerous areas, including the cervix and uterus. * Freezing the cervix * Hysterectomy: Benefits and alternatives All of these methods are highly effective in curing precancerous conditions of the cervix, but none is 100 percent foolproof. After treatment for these conditions, Pap test screening becomes even more important. If you have invasive cervical cancer, treatment will vary depending on the size of the tumor and how far it has spread. Treatments include hysterectomy, radiation and chemotherapy. |
