ABNORMAL PAP SMEARS

Types of Abnormal Pap Smears

• Normal (negative): There are no signs of cancer or precancer.
• Atypical squamous cells (ASCUS): Some abnormal cells are seen. These cells may be abnormal because of insignificant inflammation or be precancerous.
• LGSIL (low grade squamous intraepithelial lesion): Changes are seen in the cells that show early signs of precancer.
• HGSIL (high grade squamous intraepithelial lesion): changes are seen in the cells that show moderate or severe cell changes seen.
• Atypical glandular cells: Cell changes show that further testing is needed because of an increased risk of precancer or cancer of the cervix, uterus, or other female reproductive organs.
• Cancer: Abnormal cells have spread deeper into the cervix or to other tissues.

Squamous Intraepithelial Lesion

SIL is found in women of all ages. It can range from mild, moderate, and severe to carcinoma in situ (CIS). CIS is not yet cancer. However, if not treated, it is the type of SIL most likely to progress to cancer.

Human Papillomavirus Infection

Human papillomavirus infection (HPV) can cause abnormal Pap test results. However, most women infected with HPV have normal Pap test results. It is a very common infection that can be passed from person to person. There is no treatment for this type of infection. Many people have it and, in many cases, it does not cause problems. HPV can be spread through sexual contact.

Certain types of HPV are linked to cervical cancer. These are types referred to as High Risk HPV. Certain types of HPV also may be linked to cancer of the anus, vulva, vagina, and penis. However, these types of cancer are much less common that that of the cervix. If you have concerns about HPV infection, talk to your doctor.

In some cases, an HPV test can be done to help clarify the Pap test results. A negative HPV test result means that the ASC cell changes that were seen are not related to precancer. Most women with HPV do not develop precancer of the cervix. Women who have an abnormal Pap test result and a positive test result for High risk type of HPV will need further testing.

How do you evaluate an abnormal pap smear?

An abnormal Pap smear needs to be evaluated with a procedure called Colposcopy.

What is a colposcopy?

During a colposcopy your cervix is examined with the aid of a large microscope after moistening the cervix with a dilute solution of Vinegar. Abnormal cells appear white. Abnormal vessels may also be seen. If an abnormal area is identified a small biopsy is performed.

How uncomfortable is a biopsy?

The patient is usually pre-medicated with Motrin. During the biopsy a small pinch is perceived. Post the biopsy some bleeding is usually experienced less in amount that usual menstrual period.

When will the results be back?

Usually the results are back within one to two weeks.

Does my male partner need to be evaluated?

Unless your partner has visible warts on his penis, there is no need to evaluate him for HPV. While it is true that men are carriers of the virus, currently there is no commercially available test that can identify them as carriers.

What type of treatment is available for early grade dysplasia?

The most common treatment option available for early grade dysplasia is cryotherapy. Occasionally, for early grade dysplasia, only observation is appropriate. On the other hand, if early dysplasia persists for a significant amount of time or despite treatment with cryotherapy, it may be necessary to perform a LEEP.

What is cryotherapy?

Cryotherapy destroys abnormal cells on the cervix by freezing it. Cryotherapy destroys some normal tissue along with the abnormal tissue. During cryotherapy, liquid carbon dioxide (CO2), which is very cold, circulates through a probe placed next to the abnormal tissue. This freezes the tissue for 2 to 3 minutes. It may be allowed to thaw and then be refrozen for another 2 to 3 minutes. A single freeze treatment for 4 minutes may also be used.

Cryotherapy causes some discomfort. Most women feel a sensation of cold and a little cramping, and sometimes a sense of warmth spreads to the upper body and face.

Cryotherapy is not adequate treatment if abnormal cells are high in the cervical canal. In that case, another treatment, such as a LEEP or a cone biopsy will be recommended instead of cryotherapy.

What to expect after Cryotherapy?

Most women are able to return to their normal activity level after the cryotherapy procedure.

After Cryotherapy

A watery vaginal discharge will occur for about 2 to 3 weeks. Sanitary napkins should be used instead of tampons for 2 to 3 weeks. Sexual intercourse should be avoided for 2 to 3 weeks. Douching should not be done for 2 to 3 weeks.

What type of treatment is available for high grade dysplasia and carcinoma in situ?

For high grade dysplasia (CIN2 or CIN3), usually a LEEP or a Cold knife Cone is performed.

What is LEEP?

LEEP is an acronym for loop electrosurgical excision procedure. LEEP uses a thin, low-voltage electrified wire loop to cut out abnormal tissue

Where is LEEP done?

We can perform the procedure in specially equipped suite in our office. There is no need to go to the hospital.

How is LEEP performed?

LEEP can be performed with a cervical block or Iv sedation. With a cervical block medication is injected to numb the cervix (cervical block). With IV sedation pain medication is given into a vein (intravenous, or IV). In our office an anesthesiologist administers the medication and monitors the patient.

What can I expect After LEEP?

Mild cramping may occur for several hours after the procedure. Bleeding or discharge during the first week is normal. Vaginal discharge or spotting may occur for about 3 weeks. Sanitary napkins should be used instead of tampons for about 3 weeks. Sexual intercourse should be avoided for about 3 weeks. Usually it is resumed after the doctor makes sure that the cervix has adequately healed. Douching should not be done.

What type of follow up do I need after a treatment for an abnormal pap smear?

You will need more frequent Pap smears, every four to 6 months for a year or two.

Do you do second opinions?

At Women Center L.A., we are experienced gynecologists well versed in the latest techniques to diagnose and treat abnormal Pap smears. We would be happy to evaluate women with Pap smear abnormalities. Please bring a copy of your Pap smear results when you arrive for your first visit.