WHAT IS A PAP TEST?
A Pap test is a simple, effective screening for cervical cell abnormalities.
Developed in 1943, the original Pap test screened only for the presence of
cancer cells. Now, abnormalities can be identified before actual cancer cells
develop. With appropriate follow-up, many abnormal conditions can be treated
successfully.
WHO SHOULD HAVE A PAP TEST?
All women who are or have been sexually active should have a Pap test within
three years after the onset of sexual activity and/or by the age of 21 years.
An annual Pap test is recommended for most women. The Pap test may not be
performed if you have your period or if you have a vaginal infection. You
should not have sexual intercourse, use spermicidal jelly, vaginal
medications, douches or tampons for 24 hours prior to your Pap test, as they
can interfere with the accuracy of the test.
HOW IS A PAP TEST DONE?
The Pap test is part of the routine gynecological exam and is quick and
painless. During the exam, some cell samples are obtained from the cervix. The
cervix is the visible end of the uterus (womb) and can be seen when a speculum
is inserted into the vagina. A small broom or spatula and brush are used to
collect cells. The liquid from the spatula is then sent to a laboratory, where
specially trained technicians examine the slide under a microscope.
HOW ARE THE RESULTS OF A PAP
TEST REPORTED?
A Pap test is reported as normal (negative) when all the cells are of a
healthy size and shape. An abnormal (positive) test is reported if any cells
of different sizes or shapes are found. An abnormal Pap test does not usually
mean you have cancer. Special terminology is used to describe the degree of
abnormal cells. Since 2001, the categories used are: Benign Cellular or
Reactive Changes; ASC-US (atypical squamous cells of undetermined
significance); ASC-H (atypical squamous cells, cannot exclude high-grade),
low-grade SIL (squamous intraepithelial lesion – often referred to as mild
dysplasia), and high-grade SIL (often referred to as moderate or severe
dysplasia).
WHAT CAUSES AN ABNORMAL PAP
TEST?
The presence of an infection such as yeast, bacterial vaginosis, trichomonas,
chlamydia or gonorrhea may cause cervical cells to appear inflamed, resulting
in the finding described as benign cellular or reactive changes. Treatment
will be prescribed if necessary. The Pap test should be repeated in one year.
Inflammation without infection does not require treatment. ASC-US may be
caused by simple inflammation, which is benign, or may be caused by dysplasia.
Dysplasia is linked to the human papilloma virus (HPV). HPV is sexually transmitted and in a small number of those infected, genital warts can form. It has been estimated that up to 60% of sexually active college students may acquire HPV at some time during college. Fewer than 5% of women who are infected with the HPV virus will develop genital warts. The HPV virus can penetrate the cells of the cervix even if a woman has never had genital warts. The virus causes abnormal cell development which can develop into dysplasia. Recent studies show that HPV can spontaneously disappear with time. Mild dysplasia can also spontaneously go away with time. Smoking has been associated with an increased risk of progression to cervical carcinoma.
Cancerous cells are the most severe of the abnormal cells found on Pap tests. Carcinoma in situ involves only the surface cells of the cervix. Invasive cancer of the cervix means that the disease has progressed beyond the surface layer of cells. Although the risks of cervical cancer in college-age women are less than for women over 35, it is a risk that does exist.
HOW IS AN ABNORMAL PAP TEST
FOLLOWED UP?
Follow up depends on the degree of cell changes described by the technician.
Pap tests that indicate ASC-US will undergo further analysis. The results of
this testing will determine if colposcopy or repeating the Pap test in one
year will be recommended. Pap tests diagnosed as ASC-H, low-grade SIL, or
high-grade SIL should always be followed up with colposcopy.
WHAT IS COLPOSCOPY?
A colposcope is very similar to a microscope and allows doctors to examine the
external genital area (vulva), vagina, and cervix with magnification, so that
abnormal cells may be more easily identified. During the colposcopy, the
patient is in a similar position as for a Pap test and a speculum is inserted.
The doctor may apply a vinegar solution that makes the abnormal cells easier
to see. The colposcope itself does not touch the patient. Colposcopy usually
should not be performed during your period. You should try to avoid having
intercourse, using spermicidal jelly, vaginal medication, douches or tampons
for 24 hours prior to the colposcopy, as they can interfere with the accuracy
of the test.
WHAT IF ABNORMAL CELLS ARE
FOUND DURING THE COLPOSCOPY?
If abnormal cells are found, the physician may do a biopsy. A biopsy is the
removal of a small sample of tissue from the abnormal area. The woman may feel
a sharp pinch for a few seconds, and possibly some slight menstrual-like
cramps (some women don't feel anything). There may be light vaginal bleeding
or spotting for several days following a biopsy. The tissue sample is sent to
a laboratory where a pathologist will examine it. Ibuprofen, three
over-the-counter tablets (or 600 mg.), taken one hour before the exam, will
minimize any discomfort.
Legend |
|
| 1 | The tumor is still confined to the cervix. |
| 2 | The tumor has spread to vagina and neighboring tissue. |
| 3 | The tumor extends to the pelvic wall. |
| 4 | The tumor extends beyond the pelvis. |
WHAT TREATMENT CAN BE DONE
IF THE BIOPSY SHOWS SOMETHING WRONG?
The doctor will recommend management based on the pathologist's report. Your
Fronske Health Center health care provider can discuss the options with you. Continued
observation, with frequent repeat Pap tests and colposcopy, can be an
excellent option for many women with mild disease. Sometimes, a destructive
procedure using cryosurgery is indicated. Cryosurgery is a process that
destroys the abnormal cells by freezing them - to allow normal, healthy cells
to grow in their place. Sometimes, a removal procedure (loop electrosurgical
excision procedure, or LEEP) is recommended to take out the abnormal area.
These options can be discussed with your health care provider.
Reference:
- “Natural History of Cervicovaginal Papillomavirus Infection in Young Women”, New England Journal of Medicine, Volume 338 (February 12, 1998) 423-428. Authors: Ho, Gloria Y. F., Bierman, Robert.
Provided courtesy of McKinley Health Center, University of Illinois at Urbana-Champaign
If
you are a registered Northern Arizona University student and you have questions or concerns,
or need to make an appointment, please call: 928-523-2131.
If you are concerned about any difference in your treatment plan and the information in this handout, you are advised to contact your health care provider.
Visit the Fronske Health Center Web Site at: http://www.nau.edu/fronske
