Abnormal Pap Smears
A Pap test is a test performed to screen for cervical cancer. Sometimes testing for HPV (human papilloma virus) is also done, as infection with HPV is the main cause of cervical cancer. HPV has also been linked to cancers of the vulva, vagina, anus, penis, as well as some head and neck cancers. There are many types of abnormal Pap test results, some more worrisome than others:
– Atypical squamous cells of undetermined significance (ASC-US) is the most common abnormal result that we see. It usually means there are some minor changes in the cells of the cervix, signifying that there is infection with HPV. Typically, a repeat Pap and HPV test is required in 12 months.
– Low-grade lesion (LSIL) means that there are mild changes in the cells of the cervix that need to be monitored closely. Most of these lesions will resolve on their own. Typically, an office procedure called colposcopy is performed. During colposcopy, a magnifying camera is used to look at the cervix and biopsies of any abnormal-appearing areas can be performed.
– High-grade lesion (HSIL) means there may be more serious changes in the cells of the cervix. There is a greater risk of precancerous and cancer cells with this finding. Colposcopy and biopsies will need to be performed in this situation.
– Atypical squamous cells, cannot exclude HSIL (ASC-H) means there are abnormal cervical cells that raise suspicion for HSIL Colposcopy needs to be performed.
– Atypical glandular cells (AGC) means there are abnormal cells that raise concern for precancer or cancer of the glandular parts of the cervix and/or uterus. Glandular cells are found lining the inner canal of the cervix as well as lining the uterine cavity. Colposcopy and endometrial biopsy need to be performed.
Once a diagnosis is made, a treatment plan is determined. Many times an excisional procedure is performed to remove the abnormal tissue from the cervix. A laboratory examines the tissue further to ensure that all the abnormal cells have been removed and to look for any areas of cancer that may require more extensive treatment. There are two types of excisional procedures, both performed as outpatient surgeries and with anesthesia:
– Loop electrosurgical procedure (LEEP): a wire loop connected to electrical current is used to remove a segment of the cervix.
– Cold-knife conization: A cone-shaped segment of the cervix is removed using a knife.