Disclaimer: this page is provided
for informational purposes only and is not to be considered medical advice
of any kind. The author is a Cytotechnologist and not a physician.
What Exactly is a Pap Smear?
A Pap Smear is a cellular sample taken from the endocervical canal and/or
vagina. The specimen is collected and fixed with a preservative
to keep the cells from becoming distorted. The specimen is
then delivered to a laboratory where it is prepped with special
techniques and stains and then screened by a Cytotechnologist.
What's a Cytotechnologist? Here is a definition:
Cytotechnologist - specially trained individuals
who identify cellular abnormalities in cytology laboratories; graduates
of an accredited school of cytotechnology who then successfully complete
a board certification examination with the American Society of Clinical
Pathologists (ASCP) Board of Registry; all hold a bachelor's degree;
cytotechnology is the practice of reviewing cells on slides
The special stains used on slides
let us see nuclear and cytoplasmic detail. We are able to tell whether
the cells are normal, dysplastic (pre-cancerous) or cancerous. We can
also see infections such as Candida (yeast), Trichomonas (a protozoan)
and herpes as well as certain bacterial infections.
What kinds of cells do we examine? We look at cervical
and vaginal samples, and also non-gynecological specimens such
as urine, sputum, pleural fluid, peritoneal fluid, and spinal fluid. An
especially useful sample collection procedure is the Fine Needle Aspiration
(FNA). An FNA allows us to examine cells from organs and tumors deep inside
the body without the patient having to undergo surgery. FNAs come from
the lung, liver, peritoneum, pancreas, thyroid, salivary gland, breast,
lymph nodes, you name it.
When your clinician discusses your Pap smear with you, s/he may use some
of the following clinical terms.
- Actinomyces: a bacteria, sometimes found in women with an intrauterine
device (IUD)
- Atrophic vaginitis: vaginal inflammation caused by decreased
estrogen
- Atypia or atypical cells: cells that do not appear normal;
a sign of possible infectious disease or other abnormality
- Benign Cellular Changes or Reactive Cellular Changes: an abnormal
area often related to infection, inflammation, or irritation
- Candida (yeast or Monilia): a common fungus; causes itching
and vaginal discharge
- Carcinoma: cancer; a malignant growth of cells
- Carcinoma in situ (CIS): early cancer; limited to the top layer
of the cervix; does not invade; 100% cure rate, if completely removed
- Cytoplasm: the part of the cell that is not the nucleus
- Dysplasia: abnormal cells that may be pre-cancerous; may regress
to normal or progress to cancer
- Endocervix: the neck of the womb, beyond the opening of the
cervix
- Epithelium: surface layer of tissues
- Gardnerella (Bacterial Vaginosis): a bacteria, sometimes asymptomatic
and sometimes causing an odorous discharge
- Genital warts (condyloma): abnormal growths of epithelium resulting
from HPV
- Herpes virus: a common virus, sometimes causing genital ulcers
and pain
- HPV (Human Papilloma Virus): a sexually transmitted virus;
increases the risk of pre-cancerous and cancerous changes in some women
- Invasive cancer: cancer that has spread from the surface cells
to deeper tissues
- Neoplasia: cell/tissue abnormality; new growth
- Nucleus: the (normally) round, middle part of the cell that
contains the cellular DNA
- Pre-cancerous: abnormal cells or tissue which may become cancer
if not treated; dysplasia
- Squamous Intraepithelial Lesion (SIL): cell abnormality seen
before development of cancer
- Trichomonas vaginalis: a common infection causing a frothy
vaginal discharge in women and a urinary discharge in men.
- Within normal limits; Negative for Intraepithelial Lesion or Malignancy. This means
there is no sign of infection, irritation, inflammation, cell repair,
atypical cells, pre-cancerous changes, or cancer. No treatment is required.
A repeat Pap smear in one year or later is recommended, depending on
your risk history for developing pre-cancerous cervical changes, and
how many satisfactory negative (normal) annual Pap smears you have received
in the past.
- Benign cellular changes. Treatment for the specific infection, irritation,
or inflammation is often recommended if symptoms are present. Infections
which may require treatment are Actinomyces, atrophic vaginitis, Candida,
Gardnerella, herpes, or Trichomonas vaginalis. The recommendations for
a repeat Pap smear are the same as for "normal".
- Atypical Cells of Undetermined Significance (ASCUS). Dysplasia or
HPV or inflammation is possible, but the Pap smear is not diagnostic
or definite, and the laboratory cannot be sure. Your clinician may want
to repeat the Pap smear and/or perform colposcopy with or without biopsy.
An HPV DNA probe (discussed in the next section) is extremely helpful
in determining the significance of the ASCUS diagnosis.
- Low-grade Squamous Intraepithelial Lesion (LSIL) with HPV. Your clinician
may want to repeat the Pap smear and/or perform colposcopy and biopsy.
There is also a DNA test available that can classify whether the HPV
infection is a low-risk type or high-risk type for progression to cancer.
- Low-grade SIL (Mild Dysplasia). Your clinician may want to repeat
the Pap smear and/or perform colposcopy and biopsy.
- High-grade SIL (Moderate Dysplasia). Your clinician may want to perform
colposcopy and biopsy.
- High-grade SIL (Severe Dysplasia). Your clinician may want to perform
colposcopy and biopsy.
- Carcinoma in situ (CIS). Your clinician may want to perform colposcopy
and biopsy.
- Invasive carcinoma. Your clinician will discuss with you the diagnostic
procedures and treatment options.
- Inadequate/Unsatisfactory. Your clinician will probably want to repeat the Pap
smear.
Risk factors for cervical cancer:
- Beginning sexual activity at an early age
- Multiple sexual partners
- Having sexual partners who have had multiple sexual partners
- Low income, which may make it more difficult to afford preventive
care
- Smoking
- And the number 1 risk factor: infection with the Human Papilloma
Virus, a sexually transmitted virus
Author's note: The basic gist of this page is that if
you are sexually active to please get a yearly pap smear. Most of the
invasive cervical cancers we see are in sexually active females
who have gone 5+ years without a pap
smear. You should get regular checkups if you are sexually active, and if you get
back abnormal pap smear results, please get the follow-up care which may
include a minor surgical procedure to remove the dysplasia. Cervical
cancer is 100% curable if it is found while still non-invasive.
And one more note: We are now starting to do anal-rectal pap smears on
women and gay men and have unprotected anal sex. The HPV virus attacks squamous cells, which
line the vagina, cervix, and anal-rectal area. If you have unprotected anal sex, you may want to
mention the anal-rectal pap to your medical provider. HPV can cause squamous cell carcinoma
and it doesn't discriminate between squamous cells in a vagina and those in a rectum.
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