Abnormal Pap Smear
A Pap smear is simply a screening tool to find abnormal cells (or dysplasia) in your cervix. It doesn’t mean you have cervical cancer or an STD.
An abnormal Pap smear simply means you might have an infection or abnormal cells and further testing is needed to verify whether or not there is a problem.
The purpose of a Pap smear is to screen for abnormal cells that could develop into cancer. It is the best way to prevent cervical cancer, which is why it is a routine gynecological procedure.
What Does An Abnormal Pap Smear Mean?
Before jumping to any conclusions you should know that about 1 in 10 Pap tests come back abnormal and most are not serious.
- You could have a bacterial infection or inflammation
- You could have a yeast infection
- You could have Herpes
- You could have recently been sexually active
- You could have the Human Papillomavirus (60% off women carry this virus)
- You could have Trichomoniasis
- You could have abnormal cell growth or dysplasia (a precancerous condition)
*The image to the right is the Cytology smear of pleural effusion showing candidate (fungi) organism mixed with white blood cells. Fungal hyphae are present in the smear along with leukocytes and protein.
How To Read Pap Smear Results
If you are trying to read your Pap test results, deciphering all that medical lingo can be confusing. Most labs use The Bethesda System for reporting the results of a Pap. For the average person, the terms are not easy to understand.
Here’s a little guide to help you through it. First off, the term “squamous” simply refers to the cells that cover your cervix.
- Normal – Means there are no signs of cancer or precancerous cell growth
- Atypical squamous cells of undetermined significance (ASC-US) – Changes to the cervical cells are present. This is the most common Pap test result.
- Squamous intraepithelial lesion (SIL) – Abnormal changes to the cervical cells are present and may be precancerous. Changes (SIL) can be low grade (LSIL) or high grade (HSIL). The grades are related to the levels of dysplasia. LSIL is very common and usually goes away on its own without treatment. HSIL indicates more serious changes.
- Carcinoma in situ (CIS) – A severe form of high-grade changes or HSIL which is the result most likely to progress to cancer.
- Atypical squamous cells, cannot exclude HSIL (ASC-H) – Changes in the cervical cells have been found. These changes are not clearly HSIL but they could be, further testing is needed.
- Atypical glandular cells (AGC) – Cell changes are seen that suggest pre-cancer of the upper part of the cervix or uterus.
- Cancer – Abnormal cells may have spread deeper into the cervix or to other tissues.
Gynecologist Follow Up Appointment
An abnormal Pap smear indicates the presence of abnormal cells which require further evaluation before diagnosis.
If you have an abnormal Pap, your gynecologist will want to see you again for a follow-up.
During the follow-up, your gynecologist will perform a minor procedure called a colposcopy and cervical biopsy. He or she will examine your cervix using a speculum or special microscope, swab your cervix with a vinegar solution to make the abnormal areas stand out. Then a small amount of tissue will be removed from your cervix, this is called a biopsy. The procedure is quick and painless. The biopsy will be sent off to a lab where a pathologist will provide you with an accurate diagnosis. If the abnormal cells are persisting, you may need further treatment to remove abnormal cell growth like cryosurgery, cone biopsy or LEEP procedure to remove the abnormal areas.
You gynecologist will discuss all of the treatment options available to you and determine the best course of action based on the results of your biopsy.
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You are probably familiar with the pap smear procedure, but many women may not know it is a screening for cervical cancer. Regular Pap smears help prevent the most common types of cervical cancer by detecting early cellular changes, also knowns as dysplasia or cervical intraepithelial neoplasia (CIN). If your pap comes back irregular, your gynecologist will likely issue a subsequent test called an HPV test.
Approximately 85% of the population has or has had HPV, also known as the Human Papillomavirus. There are 100’s of strains of HPV, but what the HPV test is checking for is those high-risk strains which cause dysplasia and cervical cancer.
Cervical dysplasia is a precancerous situation and is often easily treated in-office. It becomes a problem when it goes untreated. Untreated dysplasia can lead to cervical cancer.
If your pap comes back with LGSIL (low-grade squamous intraepithelial lesions) or HGSIL (high grade squamous intraepithelial lesions), the next step would be to perform a colposcopy which is a visual examination of the vagina and cervix using a magnifying device known as a colposcope. If abnormal cells are found your gynecologist will take a small sample of tissue or LEEP cone biopsy to carve out abnormal cells and send to pathology. A colposcopy and cervical biopsy can be done in-office, within 15 minutes.
There are 3 Types of Dysplasia:
- CIN I – mild dysplasia
- CIN II – moderate to marked dysplasia
- CIN III – severe dysplasia to carcinoma in situ
Mild dysplasia typically requires no treatment, but follow-up visits are strongly recommended to make sure it doesn’t develop into a more severe case of dysplasia. A LEEP cone biopsy is required for moderate, severe cases of dysplasia. It isn’t fun, but for the most part, the Pap test, HPV test, colposcopy and LEEP cone biopsy are pretty painless. And 100% necessary for your health and wellness.