Pap Smear

Description

# In the 1940s Dr. George Papanicolaou proposed that a trained observer could detect cancer of the cervix by scraping cells from the cervix and then evaluating them under a microscope. This test came to be known as the Pap smear, and, now serves as the modern basis for screening women for cervical cancer.
# Women should be screened with Pap smears, starting at either the year that they become sexually active or age 18, whichever comes first. Initially, the smears should be done every year, but sometimes screening can be done every 3 years if the first three or four specimens are normal and you are with the same sexual partner who is also monogamous. However, if you change sexual partners or notice any changes in your vaginal discharge and/or have spotting or bleeding after intercourse or between periods, see your gynecologist immediately.
# The Pap smear is the only screening test for cancer, and it is responsible for a decrease in cervical cancer cases and deaths.
# A Pap smear is a screening tool, not a diagnostic test; further evaluation is required when abnormal changes are reported. Occasionally, cervical cancer is present and the Pap smear is normal, which is why a gynecologist orders further tests if there is something abnormal on the cervix.
# Pap smears do not detect cancer of the uterus, fallopian tubes, or ovaries.



Causes

Of abnormal pap smear:
# Human papilloma virus (HPV) is the most important cause, because HPV is found in over 99% of women with cervical cancer. Tobacco use increases the cancer-causing potential of HPV. HPV is the major cause of genital warts, but people may have HPV on their genital organs and surrounding skin without any visible changes. Unfortunately, HPV is epidemic since condoms are not very effective in preventing HPV.
# Other cervical infections: Herpes simplex, Trichomonas, Candida, etc.
# Chemicals from contraceptive gels and/or foams, douches, etc.
# Acquired immunodeficiency syndrome (AIDS) and other lowered immune states allow HPV and other infections to grow and cause more damage.

Diagnosis

Pap smear:
# Requires a trained cytologist (person who looks at cells) and/or pathologist who will assign a 'class' to each Pap smear slide.
# Class I means that the sample is normal.
# Class II means that there are atypical (abnormal) cells present.
# Class III means dysplasia (a premalignant condition) is present.
# Class IV means there is carcinoma in situ present (cancer cells have not invaded).
# Class V means that there is evidence that invasive cancer is present.



Coloposcopy

# A colposcope is used to magnify the features of the cervix, allowing for a more detailed and thorough examination of the surface of the cervix than with the unaided eye. A colposcope is a large, electric microscope with a bright light and is positioned approximately 30 cm from the vagina. When a person uses the colposcope to determine the cause of an abnormal Pap smear or just to get a better look, the procedure is called colposcopy. Colposcopy is relatively simple and painless, and is performed in your physician's office. The time needed for colposcopy varies, depending on the cervix, but on average takes 15 minutes.
# Biopsy of the cervix: Definitive diagnose requires removal of a small sample of tissue from the cervix.

Treatment

# Medication for cervical and/or vaginal infection
# Stop using tobacco
# Removal of specific lesion on the cervix
# Cryosurgery freezes the surface of the cervix; the intent is that it will destroy abnormal cells and they will not be present when the cervix heals.
# Laser therapy uses heat to destroy the surface of the cervix.
# Conization: This procedure removes the surface of the cervix in the shape of an inward pointing cone.