The PAP smear is the test your doctor uses to detect any changes that occur in the cells of your cervix. If your PAP smear shows changes to your cervix, the test result will be called abnormal. In some cases, these abnormal cells may be precancerous and may lead to cancer. An annual or semi-annual PAP smear is one of the best ways you can ensure your gynecological health.
Most problems that cause abnormal PAP test results can be treated, especially when they are found early.
A PAP test result that is not normal is usually caused by an infection such as human papillomavirus (HPV) or by types of vaginal irritation. Abnormal results may also be caused by a change in cervical cells called squamous intraepithelial lesion (SIL); SIL may also be referred to as cervical intraepithelial neoplasia (CIN). Both SIL and CIN are referred to as dysplasia, or an abnormal development of body tissue, and are graded according to their severity.
SIL is found in women of all ages and can range from mild, moderate, and severe to carcinoma in situ (CIS). CIS is not yet cancer, but if not treated, it is the type of SIL most likely to progress to cancer.
Human papillomavirus is a very common infection that can be passed from person to person. Some types of HPV can be spread through sexual contact. Sometimes, an HPV infection causes an abnormal PAP test result. In this case, an HPV test can often be done to clarify the PAP test results. A negative HPV test result means that the cell changes that were detected in your PAP test are not related to precancer. If you have an abnormal PAP test result and a positive HPV test result, your doctor will recommend further testing.
There is no treatment for an HPV infection and most women with this type of infection do not develop precancer of the cervix. However, certain types of HPV are linked to cancer of the cervix; therefore, it is especially important to have annual PAP tests once you know you are infected with HPV.
If you have an abnormal PAP test result, you will need further testing to determine the cause of the abnormal result. Sometimes, you may only need a repeat PAP test because many cervical cell changes go away on their own and do not need to be treated. Other times, your doctor may recommend a colposcopy or a biopsy to help identify the reason for the abnormal test result and to determine if treatment is needed.
A colposcopy lets your doctor look at the cervix through a special device similar to a microscope. This device can detect problems of the cervix that cannot be seen with the eye alone. The colposcopy is used to help diagnose SIL and cervical cancer.
In this procedure, a speculum like the one used during a PAP test is placed in the vagina. The colposcope remains outside of the vagina, but is used to see the cervix. The cervix is painted with a mild vinegar solution that sometimes causes a slight burning. This liquid makes abnormal cells on the cervix easier to see.
If abnormal cells are seen during your colposcopy, your doctor may decide that a cervical biopsy is needed. For a biopsy, the doctor removes a small sample of cervical tissue and sends it to a lab to be studied. You may have a pinching or cramping feeling when the tissue is removed.
The treatment recommended by your doctor depends on the severity of the problem. For instance, low-grade SIL cell changes may not need to be treated; you may just need to have a repeat PAP test. High-grade SIL cell changes, on the other hand, have an increased risk of progressing to cancer and may need to be treated with surgery.
Electrosurgical excision is often used if high-grade SIL cell changes are detected. During this procedure, a thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This electric energy also is used to close off the blood vessels on the surface of the cervix. This lowers the risk of bleeding after the procedure.
Electrosurgical excision is often performed in the doctor's office. Because there is minor discomfort, a local anesthetic is given.
A cone biopsy is also used to obtain a tissue sample from your cervix. In this procedure, a cone-shaped wedge of the cervix is removed. The procedure is usually done in a hospital or outpatient surgery clinic. General or spinal anesthesia is used and you should be able to go home the same day.
With cryotherapy, or freezing and laser treatment, abnormal cervical tissue is frozen and later sheds. This procedure is relatively painless and is performed in your doctor's office.