Pap Smear

1 What is a Pap Smear?

Pap smear or the pap test is a diagnostic test conducted in order to detect cervical cancer in women. This test is very helpful in curing cervical cancer by diagnosing it at an early stage. It also helps in determining the abnormal cell count in the cervix which may tell a patient if there are chances of cancer development.

In this test, a small portion of the cells from the cervix, which is a narrow end of the uterus in women, is removed and examined for any kind of abnormalities and the cancer cells. Detection of these abnormal cells is the first step in halting the development of cancer.

2 Reasons for Procedure

Here are the most common reasons to undergo a pap smear. This test is performed mainly for the detection of cervical cancer and is done in conjugation with a pelvic examination.

The test may also be combined with the human papillomavirus (HPV) test for women who are more than 30 years of age. The HPV is a sexually transmitted infection that may result in the development of cervical cancer.

The doctor, in general, will recommend for this test at the age of 21 and may also advise repeating the test at the interval of every 3 years for the women age group between 21-65. The women more than the age of 30 can opt for the pap test at the interval of 5 years if the test is combined with the HPV test.

But, if the patient has any factors that are posing any risk, the doctor may also recommend the patient to opt for the pap smear test more frequently irrespective of the age.

These risk factors may include:

  • If cervical cancer or a precancerous cell are detected in the pap smear.
  • Any exposure to the diethylstilbestrol (DES) before birth.
  • HIV infection
  • Weakened immune system due to any type of organ transplantation
  • Use of chemotherapy or chronic corticosteroid.

The patient and the doctor may sit and discuss the benefits and the risks associated with the test. The patients can stop undergoing the test if the patient has undergone a total hysterectomy.

Hysterectomy is a procedure wherein, the uterus of the patient along with the cervix is removed surgically in order to treat a non-cancerous condition like uterine fibroids.

If the reason for hysterectomy is the presence of cancer cells then the doctor will advise the patient to continue the test, regularly. After the age of 65, the doctor will not suggest continuing for the test.

3 Potential Risks

Pap smear test is considered to be a safe test for the screening of cervical cancer but still it is not a full proof test as there are chances for false negative results i.e. the test may show normal cells even if the cancer cells are present and this may not be because the test was not performed correctly but may be due to other factors.

These factors may include:

  • Less amount of cells collected
  • Presence of small number of abnormal cells
  • Blood or inflammatory cells that may lead to the confusion between the cancer cells and the normal cells.

Even though there are chances for false results, cervical cancer usually takes several years to develop and if not detected in one test then it can be detected in other tests.

4 Preparing for your Procedure

In preparing for your pap smear, you must follow your doctor’s orders. The person in order to achieve effective pap smear test should keep in mind certain points.

The patient should avoid following things for two days before the test:

  • Avoid intercourse
  • Avoid douching
  • Avoid using any vaginal medicines, spermicidal foams, creams or jellies

Not adhering to the restrictions can lead to the loss of abnormal cells and therefore will result in false negative result. One should also avoid pap smear test during the menstrual cycle.

5 What to Expect

Read on to learn more about what to expect before, during, and after your pap smear. The test is performed at the doctor’s office and may take few minutes. The patient might be asked to remove the clothes completely or only the from the waist part.

The patient will lay down on the table with the back on the table and the knees folded and the doctor will gently insert an instrument called speculum into the vagina. This instrument will help to inhold vagina apart so that the doctor is able to see the cervix.

Then the doctor will collect the cervical cells with the help of a small soft brush. The cells collected is transferred to a holder consisting of a liquid that will help in preserving the sample which is liquid based pap smear or onto a glass slide which is a conventional pap smear.

The choice of the test method depends on upon the type of pap testing a patient is undergoing. The sample is then sent to the laboratory to be viewed under a microscope for detecting the presence of normal or abnormal cells.

6 Procedure Results

If you do not understand your pap smear test results, consult with your doctor. If the cells identified are normal cervical cells, then the test is considered negative and the person will not need further testing.

The presence of abnormal cells is an indication of cervical cancer presence or the chance of having cancer in near future and therefore the test is considered positive. The result may suggest an indication about any kind of abnormality that needs attention and further testing.

If the pap smear test shows abnormal results, then the doctor may recommend opting for colposcopy where the part of the tissue is removed and examined for any abnormality under a microscope. 

The interpretation of positive test results varies with the type of cells found in the test. The doctor may state certain terms like:

Atypical squamous cells of undetermined significance (ASCUS) where the squamous cells that are thin and flat cells that grow on the healthy cervix. In the case of ASCUS, the pap smear will indicate abnormal squamous cells but will not clearly propose that the cells are precancerous.

In a case of a liquid-based test, the doctor has the advantage to reanalyze the cells for the presence of the HPV that results in cervical cancer. If the signs of the presence of virus are not there, then the abnormal cells observed are of no concern but if the virus is present, further testing is required.

The Squamous intraepithelial lesion is a term that indicates the cells collected from pap smear may be precancerous. If changes in the cells present are of low grade, then it is considered that the cancer development may take years and if the cells are of high grade then cancer may develop early.

Atypical glandular cells: Normal glandular cells grow and produce mucus at the opening of the cervix and in the uterus. Atypical glandular cells appear abnormal but are not always the sign of cancer and therefore, further, testing is necessary to determine the cause of the abnormality.

Squamous cell cancer or adenocarcinoma cells: If these type of cells are present, it is an indication that cancer has developed.

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