Pap Test

Pap test is the only commonly performed non-invasive medical test that can detect changes in an organ before it becomes cancerous. Since its introduction about 50 years ago this test has reduced the number of deaths from cancer of the cervix by 70%. The following is basic information on this test.

What is the cervix? Cervix is the lower part of the uterus which opens into the vagina.

What is Pap test? It is a lab test performed on the cervix.

How is it done? During the pelvic examination an instrument called speculum is inserted to gently open the vagina so that the cervix becomes visible. A small brush and a plastic spoon like instrument are used to painlessly scrape cells from the surface of the cervix. These cells are sent to the lab in a bottle containing a special fluid. In the lab these cells are put on a slide and studied under the microscope. Results become available approximately two weeks after the test is done.

Who should have the Pap test done? All women twenty-one years and older, and all who have started sexual activity with men regardless of age, should have the Pap test done yearly.

What are the possible results?

Normal: Only normal cells were found.
ASCUS (Atypical Squamous Cells of Undetermined Significance) or AGUS (Atypical Glandular Cells of Undetermined Significance): This indicates some mild abnormalities which are often not pre-cancerous.
Squamous Intra-epithelial Lesion (SIL): This indicates presence of possible pre-cancerous cells. The report specifies if these are Low Grade (LGSIL) or High Grade (HGSIL).
Cancer: This indicates cancer, where the cells have possibly spread to other tissues.

What causes the abnormalities? Most abnormalities are caused by a virus called Human Papilloma Virus or HPV. This virus can cause different kinds of genital warts, some of which are not readily visible. It can also cause cancer of the cervix. There are over a hundred different varieties of this virus and some have a higher propensity to cause cancer of the cervix.

What needs to be done if the test is abnormal? If the test shows ASCUS or AGUS we have instructed the lab to test the specimen for Human Papilloma Virus. If the virus is absent you only need to have the Pap test repeated after a few weeks.

All other abnormalities require an exam called Colposcopy. In this test, the cervix is inspected with a microscope like instrument. During this exam we will determine if a biopsy is needed.

Biopsy includes scraping the inner canal of the cervix and taking tiny (pinhead size) bits of tissue for further study. You may feel a little momentary discomfort during the biopsy.

What are the treatment options? Treatment depends on what the biopsy shows. In most instances eradication of a thin layer of the cervix is sufficient. This can be done by one of three methods.

Cryocautery: Freezing the superficial cells of the cervix.
Laser: Vaporization of a thin layer of the cervix with a laser beam.
LEEP: Removal of a thin layer of the cervix with an electric cautery.

If the biopsy shows more severe lesions or if the inner canal of the cervix is affected a procedure called cone-biopsy is needed.

Choice of treatment depends on a variety of circumstances and will be decided after counseling. Follow-up care is needed after these treatments. We will advice you on what to expect after the treatment. The cervix needs to be inspected two weeks after treatment to make sure that it is healed. After this, Pap smear needs to be repeated at frequent intervals for about two years.

If cancer is detected, however, more extensive treatment would be required.

Other Sources: Ameican College of Obstetricians and Gynecologists

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