Abnormal Pap Smear

If you have a positive HPV or abnormal Pap test result, you may need further testing. The following tests may be done depending on your risk for cervical cancer.

Testing is based on your age, initial screening test result, and any previous tests results.

Types of follow-up testing include:

• Reflex testing: If you had an HPV test, a Pap test may be done on the same cells used for the HPV test, an HPV test may be done on the same cells used for the PAP test. This is called reflex testing.
• HPV Typing: There is another kind of HPV test that looks specifically for HPY type 16 and HPV type 18. These two types cause the most cases of cervical cancer. This kind of HPV test is called HPV typing.
• Repeat testing: Repeat HPV testing or co-testing (having the HPV test and Pap test done at the same time) may be done. The timing of repeat testing depends on your initial test result, your age, and the result of previous tests.
• Colposcopy, biopsy, and endocervical sampling: Coloposcopy is an exam of the cervix with a magnifying device. If an area of abnormal cells is seen, you may need a cervical biopsy. For a biopsy, a small sample of tissue is removedand sent to a lab for testing. The lab testing can determine how severe the cell changes are. Endocervical sampling may also be done. This sampling uses a small brush or other instrument to take a tissue sample from the cervical canal.
• Endometrial sampling: A sample of the endometrium (the lining of the uterus) is collected for study. Some women with ACG result just need to have this follow-up test.

If your initial test results show you have a very high risk of developing cancer, you may consider treatment without additional testing. If your obstetrician - gynecologist (ob-gyn) recommends this option, you should talk together about the risks and benefits.

Cervical intraepithelial neoplasia (CIN) is used to report cervical biopsy results. CIN describes the actual changes in cervical cells. CIN is graded 1, 2, 3:

• CIN 1 is used for mild (low-grade) changes in the cells that ussualy go away on their own without treatment.
• CIN 2 is used for moderate changes.
• CIN 3 is used for more severe changes.

Moderate and severe changes can process to cancer. These chnages are called high-grade changes.

In general, there are two ways to treat abnormal cervical cells:

1. Excisional treatment: Tissue is removed from the cervix and sent to a laboratory to be studied. Results can tell whether CIN actually present and, if so, how severe it is.
2. Ablative treatment: Abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.

In some cases, the HPV vaccine may be given to help with treatment for CIN 2 or CIN 3.

Excisional treatments include the following:

• Loop electrosurgical excision procedure (LEEP): A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix.
• Conization: A cone-shaped piece of the cervix that contains the abnormal cells is removed.

Ablative treatments include the following:

• Cryotherapy: An instrument is used to freeze abnormal cervical tissue, which then sloughs off.
• Laser therapy: A focused beam of light is used to destroy abnormal cervical tissue.

THe HPV vaccine may help prevent abnormal cells from coming back the cells have been removed or destroyed. The HPV vaccine may be given to help with treatment for CIN if the following applies to you:

• You are getting treatment for moderate or severe CIN (CIN 2 or CIN 3).
• You are age 27 to 45 and have not previously gotten the HPV vaccine.
• You have a healthy immune system.

Anyone age 9 to 26 should get the HPV vaccine as usually recommended regardless of whether you are getting treatment for CIN. Read Human Papillomavirus (HPV): Infection and Vaccination to learn more.

Will I need more cervical cancer screening after treatment?

Yes. An HPV test is recommended 6 months after treatment. Then you should continue with cervical cancer screening as recommended by your ob-gyn. The recommended screening schedule depends on what type of abnormal cell changes you had. Talk with your ob-gyn about the screening you need.

Glossary

Anus: The opening of the digestive tract through which bowel movements leave the body.

Biopsy: A minor surgical procedure to remove a small piece of tissue. This tissue is examined under a microscope in a laboratory.

Cells: The smallest unit of a structure in the body. Cells are the building blocks for all parts of the body.

Cervical Biopsy: A minor surgical procedure to remove a small piece of cervical tissue. This tissue is examined under a microscope in a laboratory.

Cervical Intraepithelial Neoplasia (CIN): Abnormal changes in the cells of the cervix that are caused by infection with human papillomavirus (HPV).

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Colposcopy: Viewing of the cervix, vulva, or vagina under magnification with an instrument called a colposcope.

Conization: A procedure that removes a cone-shaped wedge of tissue from the cervix.

Cryotherapy: A freezing technique used to destroy diseased tissue.

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cancer of the cervix, vulva, vagina, penis, anus, mouth, and throat.

Loop Electrosurgical Excision Procedure (LEEP): A procedure that removes abnormal tissue from the cervix using a thin wire loop and electric energy.

Obstetrician-Gynecologist (Ob-Gyn): A doctor with special training and education in women's health.

Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer.

Penis: The male sex organ.

Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vulva: The external female genital area.