Health Tips

Pap Tests

Developed by Dr. George Papanicolaou in the 1940s, the Pap test identifies cervical changes and disease. When detected early, precancerous and cancerous changes are treated easily and effectively.

The Normal Cervix

The cervix is the bottom portion of the uterus. It has an opening to the cervical canal that leads to the uterus. The normal cervix is covered with scalelike squamous cells and the canal is lined with tall, narrow, columnar cells. The zone where the two meet, the transformation zone (T-zone), is where the cells are constantly being replaced. The transformation zone is the most likely area for abnormal cells to develop.

The speculum allows the examiner to see the cervix and take cell samples. Cells are skimmed from the cervix, then smeared onto a glass slide, and sent to a laboratory for examination.

What the Pap Test Shows

Pap smears are read by pathologists and cytologists. The cells on the slide are treated with a stain that emphasizes abnormal cells. Pap smears have many classifications, from normal to cancerous:

• Normal cells have a small nucleus (central core) and a consistent shape.
• Possibly abnormal cells show minimal changes often related to hormonal changes, or vaginal or cervical infections.
• Abnormal cells or possibly pre-cancerous cells have more obvious changes. Nuclei are larger and more oddly shaped. Dysplasia, or Cervical Intraepithelial Neoplasia (CIN), is used to describe these findings. Often the Human Papilloma Virus (HPV) also called genital warts, is a precursor to cervical abnormalities.
• Cells that are more abnormal in appearance, with darker appearing nuclei may indicate severe dysplasia or a precancerous condition called carcinoma in situ.
• Mostly dysplastic cells or small cells that appear to be all nuclei, may indicate a cancerous condition.

Colposcopy

If your Pap is possibly abnormal you may only need to be evaluated for infection or you may need a colposcopy. All other abnormal Paps require a colposcopy. A colposcope magnifies and focuses an intense light on the cervix, allowing the examiner to observe the cervical anatomy.

Diagnosis and Treatment

Using the colposcope as guidence the examiner may take a tissue sample from the face of the cervix, and from the opening of the canal. These samples are evaluated by a pathologist, and then compared to the Pap smear results and the colposcopic evaluation.

If a precancerous condition exists a cryosurgery (freezing the abnormal cells) or a LEEP (Loop Electrical Excision Procedure) may be used as treatment. LEEP uses a high frequency alternating current (radio frequency). A small portion of the outer cervix is removed with a thin wire loop electrode. This procedure does not effect sexuality or except in rare cases future fertility. The advantage of the LEEP over cryosurgery is it preserves tissue for pathological evaluation. This helps the clinican determine if the disease portion of the tissue was completely removed. Cervical cancer is rarely diagnosed on women having regular Pap smears, as it grows slowly and is usally found in the precancerous stages.

What Happens After Treatment

Colposcopy and treatment for most types of abnormal Pap smears can be done in the office. After a cryosurgery or a LEEP, a women may return to most activities the next day. However heavy lifting, vaginal tampons, douching and intercourse should be avoided for about six weeks. A brownish discharge will be present for two to three weeks. Women who are treated for abnormal Pap smears can expect to have normal healthy lives with appropriate follow up care. Each situation is unique but, generaly speaking Pap smears are done every three months for one year after a LEEP or cryosurgery. Follow up is essential to guard against a reacurrence.

Reducing the Risk of Cervical Cancer

• A diet high in vitamins A,C,E, and Folic Acid may reduce cancer risk.
• Non-smokers have a lower incidence of cervical cancer.
• Limiting sexual partners and using condoms reduces the transmission of Human Papilloma Virus (HPV)/genital warts, which reduces the risk of some cervical cancers.