What is Pap Smear Test

Routine Gynecological Control and Evaluation of Abnormal Pap Smear Results:

What is Pap smear Test?

Pap smear is a screening test for healthy women for the prevention of cervical cancer. It can detect atypical cellular changes related to HPV in cervical cells at an early stage, so that they can be treated before they turn into cervical cancer.

How often should Pap smear test be done?

It is recommended to have a Pap smear test annually starting at the age of 21. For women between ages 21-29, if the Pap smear result is normal, it can be repeated every three years. For women over 30 years, HPV test is recommended in addition to Pap smear.

If HPV virus is not present, they should still have annual gynecological check-ups, but Pap smear test can be repeated every 5 years. If they can not have HPV testing, Pap smear test should be repeated every three years for women over 30 years of age.

How is Pap smear done?

Pap smear test can be done very easily. During a routine gynecological examination, a speculum is inserted into the vagina and a soft brush is used to collect cells from the cervix, just by swabbing, the collected cells will be sent to a Cytology laboratory to be examined under a microscope. A Pap smear result can be normal, unclear or abnormal and rarely unsatisfactory.

However more frequent testing may be required for women:

• Who are tested positive for HIV,
• Women who are known to have a weakened immune system,
• Women who were exposed before birth to a medicine called diethylstilbestrol, (DES) which was prescribed to some pregnant women through the mid 1970s,
• Women with a history of recent abnormal cervical screening test or biopsy result,
• Women who have had cervical cancer in the past.

What is HPV/Pap Cotest?

It is a test performed to check for both abnormal precancerous cellular changes on the cervix and for high risk HPV presence. The test only takes a few minutes. After speculum insertion into the vagina, sample is taken as a swab from the cervix.

Where to get cervical screening?

The screening tests (Pap smear and HPV) are performed by Obstetrics and Gynecology specialists in Doctor’s offices, private clinics and hospitals and community health centers.

What types of abnormal Pap smear results exist?

There are several possible Pap smear test results:

• Normal: It may also be named as negative for intraepithelial lesion or malignancy.
• ASC-US: Atypical squamous cells of undetermined significance.
• AGC: Atypical glandular cells.
• LSIL: Low grade squamous intraepithelial lesion.
• ASC-H: Atypical squamous cells, cannot exclude HSIL.
• HSIL: High grade squamous intraepithelial lesion.
• AIS: Adenocarcinoma in situ.
• Cervical Cancer.

Sometimes the Pap smear result may be ‘unsatisfactory’ , which means there were not enough cells for evaluation or the cells were hidden by blood or mucus.

What does an abnormal Pap smear indicate?

It does not indicate thet the patient has or will have cervical cancer. It just means that further evaluation will be necessary to diagnose any cellular abnormalities on the cervix and follow or traet them so that they do not progress to cervical cancer.

What causes an abnormal Pap smear other than HPV?

Irritation, vaginal infections, hormonal changes (menopause) or polyps may cause abnormal Pap smear test results such as ASC-US.

What is the next test after an abnormal Pap Smear?

Depending on the patient’s history and the risk of developing cervical cancer,it may be recommended to have:

Follow-up pap smear-Pap smear may be repeated in a certain time: For menopausal patients with ASC-US, vaginal estrogen may be used topically until the next Pap smear.

Colposcopy (with biopsy): It is a microscope with a light to visualise the surface of the cervix after speculum insertion. There is no discomfort during this test. Vinegar solution is applied to the cervical surface to show abnormal areas. If abnormal areas are seen, a biopsy forceps may be used to collect tissue samples for pathological examination.

Endocervical curettage (scraping): It is necessary if colposcopy cannot detect any abnormal areas or the transformation zone cannot be seen. A curette or brush may be used the scrape the inside of the endocervical canal for biopsy.

Conisation: It is a surgical procedure in which a cone of cervical tissue including the transformation zone is removed both for diagnostic and therapeutic purposes. It can either be performed by cold knife conisation or leep procedure.

Why would someone need a colposcopy?

For patients who have:

• Symptoms of cervical cancer,
• Abnormal pap smear results,
• Positive HPV test results,
• Colposcopy exmanination may be necessary.

What is ASC-US?

It is the most common abnormal Pap smear result. It means that the cells do not look completely normal but it is not certain if these changes are caused by HPV infection. If it is not caused by HPV infection, possible causes may be irritation, vaginal infections, hormonal changes (menopause) or polyps.

What should be done if the pap smear result is ASC-US?

HPV testing is recommended. If HPV testing is negative, medical treatment may be necessary if there is a vaginal infection (antibiotic or anti fungal medications) or menopause (vaginal estrogen). Repeat Pap smear is recommended in 3-6 months.

If HPV testing is positive, colposcopy is recommended.

What is LSIL?

It means low grade squamous intraepithelial lesion. The cytologist will diagnose LSIL when the cervical cells collected by Pap smear look slightly abnormal. It is usually caused by an infection with certain HPV types, mostly disappearing spontaneously without any treatment, very rarely it may become cancer.

LSIL may also be found on the vulva, vagina, anus and esophagus.

What should be done if the pap smear result is LSIL?

Most commonly, additional testing will be necessary to make sure that there are not more serious (high grade) changes. This may vary from follow-up pap smear or Pap smear/HPV cotest to colposcopy and biopsy depending on the patient’s individual risk of developing cervical cancer.

What is HSIL?

It means high grade squamous intraepithelial lesion. There are moderate to severe cellular changes on the cervix that could lead to cervical cancer if left untreated.

HSIL may also be found on the vulva, vagina, anus and esophagus.

What should be done if the pap smear result is HSIL?

For most patients colposcopy and biopsy will be recommended. Depending on the result, surgical treatment may be necessary.

What are the stages of CIN?

After colposcopy and biopsy, tisusue samples are sent to a pathology laboratory for examination. If the biopsy result is CIN (Cervical intraepithelial neoplasia) it is graded on a scale of 1 to 3.

• CIN1-mild low grade changes on the cervix that will usually disappear spontaneously.
• CIN2-Moderate changes on the cervix usually treated by removing the abnormal tissue but may rarely diasappear spontaneously.
• CIN3-severely abnormal changes on the cervix that should be treated right away unless the patient is pregnant. Treatment is usually by conisation.

Can CIN 2 be followed up without treatment?

Depending on the personal risk factors, for some patients follow up by colposcopy and biopsy every 6 months may be recommended. If CIN 2 does not disappear in 1-2 years or progresses to CIN 3, it must be surgically treated.

When does CIN become cancer?

In general it takes 10-20 years for CIN to progress to cancer. If HPV infection persists, progression may be detected by follow-up and treated before cellular changes turn into cancer.

What is the treatment for CIN?

Treatment is necessary when a woman has high-grade cervical celllular changes. There are mainly two types of treatment options:

• Excisional (conisation): Cold life conisation or leep procedure-is the method in which abnormal tissue is removed.
• Ablative (Cryotherapy, laser or coterisation)-is the method in which abnormal tissue is destructed.

Do you still need Pap Smear after HPV vaccination?

Since HPV vaccine cannot prevent HPV infection 100%, patients are recommended to have annual gynecological check up visits and Pap smear test as recommended.