This is part 2/3 for this topic. Once you have done your PAP smear, one of the following things can happen:
- Your healthcare practitioner may tell you your results are “within normal limits” and they will see you when you are due for your next one (see previous article to see when the next one
- You may be told to come in to discuss abnormal results, which require treatment of an infection or repeat of the smear immediately or in near future
- You may be referred to a gynaecologist (if the gynae is not the one who did the test) for further examination and possibly other tests.
Should you receive unfavourable results, it is important to keep calm. There is no point in getting worked up about ‘what ifs and should haves’. Your nurse/ GP / gynae will guide you what to do next.
LET’S BREAK DOWN AN ABNORMAL PAP RESULT:
Inadequate for evaluation: This usually means the specimen was not sufficient enough to assess for abnormal cells. Usually the “endo-cervical component” is absent or scanty. This is the inner part of the cervix, where the abnormal changes usually occur, therefore it is important for this to be present. If it is absent, another sample may be taken immediately or in a few months time. Shift in normal flora: This simply means that there is too much of one or both types of the usual organisms that live in the vagina. There may be too much bacteria (Bacterial vaginosis) or too much Yeast (fungus)/ Candida (what is commonly known as thrush). You may need to take medication to restore the balance: an Antibiotic OR Anti-fungal OR a Betadine douche, which will kill both the bacteria and the fungi, and may help restore the balance. Evidence of Human Papilloma Virus infection: this means that the cervix has been exposed to HPV infection that has not been cleared. This is important to note as HPV infection can lead to cervical cell changes and eventually cervical cancer (read more in next article). HPV typing may be done to detect high risk types that commonly cause cancer.
Atypical cells: This does not mean cancer. It just means cells are abnormal and it is unclear the type or extent of the abnormality. Some of these abnormal cells the body may clear and subsequent smears may be normal. A repeat smear is recommended in 6 to 12 months. Squamous Intra-epithelial Lesion (SIL): This means that cell changes may be precancerous. These lesions are described as LOW GRADE (LGSIL) – changes are mild. Some lesions may go away on their own, some lesions may persist and take years to become cancerous; OR HIGH GRADE (HGSIL) – changes are severe/ very abnormal and will most likely become cancerous quicker than the low grade type. A repeat smear in 6 months is recommended in case of LGSIL. For HGSIL, a further examination by specialist gynaecologist is required to check how extensive the changes are and also to do a biopsy (take a tissue sample) of the cervix. SIL may also be referred to as Cervical Intraepithelial Neoplasia and be graded into CIN 1 for LGSIL and CIN 2 and 3 for HGSIL. Squamous Cell Carcinoma/ Adeno-Cell Carcinoma: This means that the cell changes are most or highly likely cancerous. Further examination and biopsy should be done soonest by a gynaecologist.
YOU HAVE BEEN REFERRED FOR FURTHER TESTS / TREATMENT, WHAT ARE THESE?
Colposcopy: This is done in the gynae’s rooms, it does not take long. The gynae will use a colposcope (a special microscope that does not go into the vagina) to look closely at the cervix and most likely also take a biopsy of the suspicious area. This examination is usually not painful. There may be discomfort form lying on the back a little longer (about 20mins.) than required for a routine PAP smear (about 3mins), but there shouldn’t be much pain. A local anaesthetic may be given if biopsy is being taken, or a patient may opt to come back at another date and be put under general anaesthesia for this.
Large Loop Excision of the Transformation Zone (LLETZ): A large area of the transformation zone of the cervix (an area just inside of the cervix) is removed by laser for further examination or as treatment of abnormal cells by removing all of them during the procedure. This procedure can be done under local anaesthetic or under general for the anxious patient who is too nervous to tolerate the procedure. Cone Biopsy: This is a minor surgical procedure done under general anaesthetic. A cone shaped specimen is taken to further look at and even treat the abnormal cells / cancerous cells. The cone includes the whole area of the cervix that has abnormal cells and is sent to lab for histology.**After effects of the LLETZ and Cone Biopsy include period pain like pains and mild post procedure
bleeding (if heavy please see your gynae soonest). You also need to rest give the cervix time to heal. No sex or heavy duty work/ exercise for 4 to 6 weeks. No tampons for any bleeding to avoid introducing infections.
Hysterectomy: Lastly, depending on the biopsy results and menopausal status, it may be necessary to remove the whole womb along with any cervical cancer or severe changes. This is not the ultimate
outcome for everyone, but in case of confirmed invasive cancer it may be life saving. But don’t panic, talk to your doctor. Younger women of child bearing age need to discuss their options with their
specialist. Cone Biopsy and LLETZ doesn’t affect fertility / ability to fall pregnant. However, the pregnancy will be high risk due to potential / likely weakness of the cervix. This weakness is fairly easy to manage, so it is important to let your GP or gynae know immediately you suspect or confirm pregnancy. Please remember to engage your doctor and be clear on what was found and treatment options available. In the third and last of this particular series of cervical cancer awareness, I will be tackling to Cervical cancer (HPV) vaccination.
Take Care as always!!