Abnormal Pap Smear Management

An abnormal Pap test shows that cells in the cervix have changed from a normal to an abnormal appearance. Only a small number of abnormal Pap test results are cell changes that may progress to cervical cancer. Abnormal cell changes of the cervix rarely cause symptoms, so it is important to have regular Pap tests to find cell changes.

A Pap test is done to look for changes in the cells of the cervix. During a Pap test, a small sample of cells from the surface of the cervix is collected by a doctor. The sample is then spread or smeared on a slide (Pap smear) or mixed in a liquid and sent to a lab to be examined under a microscope.

Many abnormal Pap tests are caused by an infection of human papillomavirus (HPV) that will go away on its own and will not lead to cancer.

There are several choices for managing minor cervical cell changes, which may include watchful waiting. Treatments for moderate to severe cell changes destroy or remove the abnormal tissue.

Abnormal Pap During Pregnancy

Abnormal pap during pregnancy does not seem to increase the progression of abnormal cervical cell changes. The presence of abnormal cervical cell changes or HPV does not affect the outcome of the pregnancy. Close monitoring is needed so that you and your health professional can make the best treatment decisions at each stage of the pregnancy.

An abnormal Pap test may be evaluated further with colposcopy. Colposcopy is a safe test during pregnancy.
If colposcopy shows normal tissue, then a repeat Pap test or colposcopy may be done later, depending on the type of abnormalities reported on the first Pap test.

If colposcopy confirms abnormal tissue areas, a cervical biopsy may be done to diagnose the abnormal tissue. This level of testing is also done to make surecervical cancer, which is rare, is not present. If a cervical biopsy is needed during pregnancy, it does not usually cause problems with the pregnancy though the risk of bleeding is greater after the first trimester. Minor cell changes should continue to be monitored during the pregnancy and after delivery. Many minor cell changes return to normal after delivery.

Moderate to severe cell changes shown on an abnormal Pap test are always evaluated by colposcopy, and possibly cervical biopsy, to diagnose the abnormal tissue and to make sure invasive cervical cancer is not present. Follow-up Pap tests and colposcopy may be done for the rest of the pregnancy to monitor the progression of the cell changes. Moderate to severe changes can be monitored closely, and treatment can wait until after delivery. In rare cases a procedure called a cone biopsy is needed to rule out cancer.

Treatment of invasive cervical cancer must be done as soon as possible. It is harder to manage because of the concern for the outcome of both the woman and her pregnancy. Treatment will be managed by a team of health professionals specializing in cancer and high-risk pregnancies.

Abnormal Pap – Surgery Options

If you have had an abnormal Pap test, surgery may be an option. Surgical treatment may be recommended if:

  • Your abnormal test results have been confirmed by colposcopy and a cervical biopsy.
  • The cervical biopsy shows you have minor, moderate, or severe cell changes.
  • The cervical biopsy shows that you have or may have cervical cancer.

Surgery may be done to destroy or remove the abnormal cells on your cervix, or confirm or rule out the possibility that you have cervical cancer.

Abnormal tissue that can be seen through the magnifying viewing instrument (colposcope) can often be destroyed or removed with cryotherapy, a cone biopsy, a carbon dioxide (CO2) laser, or the loop electrosurgical excision procedure (LEEP).

Abnormal cervical cells that are detected by a Pap test but cannot be seen by colposcopy may be high in the cervix (cervical canal). Before treatment is recommended, the location and type of cell change must be confirmed by a cervical biopsy. Depending on the results of the colposcopy and cervical biopsy, a cone biopsy may be done as the next step.

Surgical choices for abnormal cervical cell changes include the following:

Procedures that remove abnormal tissue

  • Cone biopsy (conization) removes a cone-shaped wedge of abnormal cells high in the cervical canal. A small amount of normal tissue around the cone-shaped wedge of abnormal tissue is also removed so that a margin free of abnormal cells is left in the cervix.
  • Loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal cervical cells. It can also be used to remove a cone-shaped wedge of tissue like a cone biopsy.

Procedures that destroy abnormal tissue

  • Cryotherapy destroys abnormal cervical cells by freezing them.
  • Carbon dioxide laser uses a laser beam to destroy (vaporize) abnormal cervical cells. It can also be used to remove a cone-shaped wedge of tissue like a cone biopsy.

If the results of a Pap test, colposcopy, and cervical or cone biopsy point to invasive cervical cancer, then surgery, radiation, chemotherapy, or a combination of treatments will be needed to destroy or remove the cancerous tissue.

What to Think About

Minor cell changes may not need to be treated with surgery. When deciding on treatment for minor cell changes, consider the following:

Infections may be cured with medicines for the specific cause of the infection.

Minor cell changes often go away without treatment. Your doctor may suggest a period of watchful waiting before further evaluation or a biopsy is recommended. Surgery may be needed if the cell changes are confirmed by biopsy to be progressing to more severe cell changes. Surgery may also be done if follow-up evaluation is not possible or immediate treatment is wanted.

Cell changes caused by human papillomavirus (HPV) infection may not progress beyond mild changes. The natural course of most types of HPV is for the cells to change back to normal within 18 months without treatment. Cervical cell changes caused by HPV may be treated because of their degree of abnormality, but treatment does not eliminate the virus. You may still have HPV inside your body’s cells.

Treatment choices for moderate to severe cell changes are more likely to include surgery to specifically destroy or remove the abnormal tissue

Pap Smear Facts

What is a pap smear?

A Pap smear is a screening test for cancer of the cervix. The procedure is usually not painful, although there may be some discomfort when the cervix is touched to collect the sample. The Pap smear is one of the tests that may be done during your annual well woman exam. Chlamydia and gonorrhea tests may be done also.

Who needs a pap smear?

The first Pap smear should be done when a woman is age 21. To help make your Pap smear more accurate, don’t douche, don’t use tampons, don’t use vaginal medications, or have intercourse for about two days prior to your exam. All women should have a well woman examination once a year.

When is the right time to schedule a pap smear?

You should not schedule a Pap smear during your monthly menstruation. And for at least 48 hours prior to the test, you should obstain from sex, using tampons, birth control jelly, foam, or any vaginal creams or medications.

I've heard of hpv testing, is this the same as a pap smear?

Its not the same test, but today both are typically done at the same time. Hpv (human papillomavirus) testing allows us to determine which women are at risk of developing cervical cancer down the road.  In short, the pap test tells us about your current risk, while the hpv test measures your current as well as your future risk of developing cervical cancer. The combined test is not recommended for woman under the age of 30.

What factors increase my risk for an abnormal pap result?

  • Smoking
  • If you have HPV.
  • If you are immune suppressed (HIV or organ transplant).
  • Women whose mothers took DES to prevent miscarriages from 1940-1971.
  • Having multiple sexual partners.
  • Prior history of a high grade abnormal Pap smear.

How is my pap smear read?

  • Normal/Negative – No abnormal cells were detected
  • Atypical – Atypical cells are not completely normal, but do not meet the criteria to be labeled abnormal.
  • Abnormal – The Pap smear report shows cells which are mild, moderate, or severely abnormal. A Pap smear in this category usually requires further evaluation. Your health care provider may recommend a colposcopy, which is a special way to examine the cervix (using magnification).

What do Ii do if my reading is abnormal?

  • First and foremost… Do not panic!!
  • Read your Pap letter carefully and follow your doctor’s recommendations.