Cervix is the lower part of the womb (uterus) that opens into the birth canal (vagina). The surface lining of the cervix is called the epithelium that has several layers of flat cells. Pap smears are examination of the scrapings of the epithelium obtained by a wooden spatula or a brush. Pap smears are screening tolls for timely detection of cancer of the cervix. Regular use of pap smears by more and more numbers of women has caused the numbers of cancers of cervix to reduce.
Abnormal Pap smear- What does it mean?
An abnormal pap smear can imply an infection, inflammation, or a dysplasia. Of these, dysplasia is most worrisome as it implies an erratic division of the cells lining the cervix. This can be a telltale sign of cancer and needs immediate medical attention. Inflammation and infection can be due to a number of infectious agents like fungus, the Herpes and Human Papilloma (HPV) viruses or a parasite called Trichomonas. An abnormal pap smear can be due a recent sexual activity, use of vaginal creams and douches, consumption of oral birth control pills, or even hormone changes in women nearing menopause.
All abnormal changes, i.e. changes in the size, shape, characters, division or numbers of cells, are not cancers and may not really change into one over time. If abnormal changes are found on your Pap smear, you may be advised for sustained follow up by repeating the Pap smear every few months or a colposcopy depending upon the grade of the abnormality.
ASC – Atypical squamous cells
ASCs on Pap smear imply that the thin flat cells on the surface of the cervix have an unusual appearance and do not appear completely normal. The abnormality may be mild when it is referred to as ASC of undetermined significance or may imply a higher chance of progressing to a cancer when it is called high-grade ASC. The abnormality needs to be investigated further as it may be a sign of an early cancer setting in.
AGC – Atypical glandular cells
A little higher up in the cervix, several glands open into its lumen. These glands produce mucus and fluids. AGC on a pap smear imply that the cells in the glands show abnormal changes which may be suggestive of a cancer high up in the cervix or in the uterus. These have to be investigated further.
LSIL – Low-grade squamous intraepithelial lesion
LSIL is a mild change in the size, shape or number of cells in the epithelium which is the lining of the surface of the cervix. This is a low grade change that isn’t normal, but isn’t also a cancer as yet. These changes can be due to warts caused by HPV. These can be an incidental finding in anybody irrespective of whether you have one or multiple sex partners. The abnormal cells may vanish over time but need to be followed up or investigated further.
HSIL – High-grade squamous intraepithelial lesion
HSIL implies that the cells in the surface lining of the cervix look significantly different from normal and have a higher probability of progressing to a cancer. You may need to undergo a colposcopy and biopsy.
CIN – Cervical intraepithelial neoplasia
CIN implies that a cancerous change is present on your pap smear but is confined to the most superficial external surface lining of the cervix. It is graded from 1 to 3 to imply the mild, moderate, and severe dysplastic changes depending upon the thickness of the lining of cervical surface that is involved. You should comply with follow up and regular examination of the abnormality to enable your doctor to understand how it is progressing. A colposcopy may need to be repeated often.
Squamous cancer cells
Squamous cancer cells on a Pap smear imply a clearly evident cancer. The cells of the surface lining show an erratic and aberrant cell division and can invade the underlying tissues and spread beyond via the blood stream depending upon the stage of the cancer. Squamous cell carcinoma (SCC) is the commonest type of cancer in the cervix. It usually occurs at the junction of the outwardly protruding (ectocervix) and inwardly located (endocervix) parts of the cervix.
Inflammation
Inflammation in a Pap smear implies an irritated cervix. Common causes for irritation can be sexual intercourse, douching, and use of tampons or oral birth control pills. It can be caused by an infection in the cervix. It subsides when the underlying cause is addressed.
Hyperkeratosis
Hyperkeratosis implies that dried skin like cells are seen on the Pap smear. It isn’t really worrisome. It can be caused by friction due to use of a tampon or a diaphragm or cervical cap. It subsides when the friction is withdrawn and may just need to be followed up by a repeat pap smear in another six months.
Colposcopy
If your pap smear was suggestive of dysplasia or a likely cancer, you may need to undergo a colposcopy. This procedure is simple and easy one where an instrument called a colposcope which is inserted into your vagina to have a closer and magnified view of the cervix. This will not hurt you. The cervix usually appears pink. It will be painted with vinegar and this can cause the abnormal regions to turn white. If you have one of those white patches, you may need a biopsy. In this a small piece of tissue will be snipped off the white area on the cervix. This may feel like a small pinch or prick. This tissue is then examined in detail in a laboratory to study the nature of the component cells. Colposcopy is short procedure lasting around 15 to 20 minutes.
Precautions for Pap smear
For the best results of your Pap smear examination, you should follow some precautions. This will avoid any false results. Do not use tampons, douches, or any vaginal medicines for 2 days before the Pap smear and avoid sexual intercourse for at least 1 day prior to the test. Do not get one done while you have your period. Tell your doctor or healthcare provider if you are on birth control pills or other medicines and if you have used a diaphragm or cervical cap during intercourse.
Screening with Pap smear
A Pap smear is not 100% reliable but it is a great screening tool. You should repeat one for yourself even if your results are normal and have your friends and family members to undergo one too.
It is good to get the first Pap test by the age of 21 or within 3 years of having the first sexual intercourse. Then it is best repeated every two years. Beyond the age of 30, it can be repeated every 3 years if there have been 3 consecutive negative tests. Beyond the age of 65 or 70, Pap smears can be discontinued if there have been 3 negative tests in past 10 years. However, the frequency of once in 2 years should be resumed at any age if you have a new sexual partner. No Pap smears are required if the uterus has been removed for any medical conditions. A regular Pap smear examination is the best you can do to safeguard yourself from cancer of the cervix.
