A pap smear is a routine screening test performed regularly on sexually active women and women between the ages of 18 and 65. It involves the use of a speculum to open the vagina so a doctor can take a small sampling of cells from the cervix. The cervical cells are examined under a microscope to evaluate the presence of abnormalities. Abnormalities can indicate anything form an infection to the presence of cervical cancer.
Pap Tests Results
Most labs within the United States use a uniform system for classifying abnormal cell growths and normal pap smear results. This system is called the Bethesda system. There are four main classifications that describe the results of a pap smear: normal, atypical squamous cells (ASC or ASC-US), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), atypicl glandular cells, or cancer. A normal result indicates no abnormal cell growth and that no further testing is necessary. The other results indicate that some abnormal cell growth has been dedicated and that varying degrees of testing and treatment are needed.
Atypical Squamous Cells
ASC means that there is some type of abnormal cell growth but that the cause and indications of the abnormal growth is unclear. The abnormalities might be caused by an infection, simple irritation within the cervix or recent sexual intercourse. They also might be indicative of precancerous cell changes. Doctors may simply suggest that the pap smear be repeated within four to six months, or they may administer an HPV test. Because HPV is responsible for the vast majority of cervical cancers, if a woman is found to have one of the high risk types of HPV, it is more likely these abnormal cells are precancerous. A positive HPV test usually indicates that a colposcopy should be performed so the doctor can look inside the cervix and evaluate the extent of any abnormalities. A colposcopy simply involves the insertion of a coloscope into the vagina to allow the doctor a view of the cervix.
Squamous Intraepithelial Lesion
There are two different types of SILs, each with different treatment patterns. Low-grade SILs suggest that mild abnormal cell growth has occurred and that there are some precancerous cell changes that may clear up on their own. A repeat pap smear may be the best option. High-grade SIL suggests that moderate to severe abnormal precancerous cells exist. A colposcopy is usually performed to determine the extent of SIL. Cyrosurgery or laser surgery may be performed to freeze (cyrosurgery) or burn the abnormal cells in order to kill them. Fertility is not usually affected by these procedures.
Atypical Glandular Cells
Atypical glandular cells may indicate that abnormal cancerous cell growth is occurring. Generally, a colposcopy and a cervical biopsy are performed to determine the extent of the growth of the cancer cells.
Cancer
The final Bethesda System Classification of cancer suggests that a significant number of cancer cells are present in the cervix. This means that the woman most likely has cervical cancer and should be referred to an oncologist for further testing and treatment.
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