A Pap smear is a test designed to detect changes in the cervix that may indicate an infection, sexually transmitted disease or cervical cancer. During a Pap smear, a doctor opens the vagina with a speculum and then takes a small scraping of cells from the cervix. The sample is then evaluated by a lab to look for abnormal changes.
Guidelines for Treating Abnormal Pap Smears
The majority of labs within the U.S. use a universal system called the Bethesda System to classify Pap test results. There are four possible classifications under the Bethesda System. If there are no abnormal cells, the results are normal and no additional treatment is necessary. If there are some potentially abnormal cells, then the result is classified as ASC or ASC-US, and follow-up treatment may be required. The third classification exists when there are intraepithelial lesions present. The lesions can be either high-grade (HSIL) or low-grade (LSIL), and follow-up treatment may be required. Finally, if cancer cells or atypical squamous cells are present, the result indicates cervical cancer, and referral to an oncologist is appropriate.
ASC Treatment
If the Pap test results indicate potentially abnormal cells, or ASC, there are several different courses of action available. In some cases, the Pap test is simply repeated in four to six months. This is done because many mild infections, including non-high-risk forms of HPV, will clear up on their own. However, other doctors prefer to perform an HPV test on patients whose Pap smears indicate ASC. If the HPV test is positive for a high-risk type of HPV, a coloscopy is usually performed. A coloscopy involves using a colonscope to examine the cervix to look for abnormalities. It is an outpatient procedure.
HSIL and LSIL Treatment
For patients with LSIL, treatment may simply be a repeat Pap test in four to six months. However, in some patients with LSIL, and in all patients with HSIL, a coloscopy is appropriate. If the coloscopy reveals abnormal cells on the cervix, these abnormalities can be treated by destroying those cells. Cells are destroyed either by being frozen (cyrosurgery) or burned off with a laser. Both of these procedures are outpatient procedures that do not adversely affect fertility.
Tags: abnormal cells, patients with, Bethesda System, cervical cancer, follow-up treatment, follow-up treatment required, four months
