Information On A Cervical (Pap) Smear Test

Information On A Cervical (Pap) Smear Test
The Pap test is a screening test for malignant and premalignant
changes of the cervix. A positive result indicates that there may be a
problem and that further diagnostic procedures must be done. The Pap
test is not a diagnostic test. It cannot be used to exclude a cancer of
the cervix for a person who has symptoms that could be due to a
cervical cancer. Women who have never had a smear often worry about
this. For most women the test is painless and for some slightly
uncomfortable. It only takes a few minutes to perform.

The cervix is the lower part of the uterus, or womb. Sometimes it is
also called the neck of the womb. The uterus is a muscular, pear-shaped
organ at the top of the vagina. The lining of the uterus is shed each
month, giving rise to bleeding called a period. These periods stop
temporarily during pregnancy and will normally continue until a woman
has the menopause.

It is possible for your doctor to see and feel the cervix during an internal (vaginal) examination.

The surface layer of the cervix is made up of two different types of
cells, flat cells called squamous cells and tall cells called columnar
cells. The place where these two cells meet is known as the
transformation zone. It is in this area that abnormal cell changes
occur. It is these cells, on the surface of the cervix, which are
examined in a cervical smear test.

The smear test is a very simple test and takes less than five minutes. It can be slightly uncomfortable but it is not painful.

Once you are lying comfortably on the couch the doctor or nurse will
gently insert an instrument called a speculum to keep the vagina open.
A small spatula is then used to take a sample of cells from the cervix.
The cells are spread onto a glass slide and sent to a laboratory for
examination under a microscope. The purpose of the Pap test is to
detect changes that may lead to cervical cancer long before cancer
develops. Pre-cancer of the cervix is easily treated, and almost always
prevents cancer from developing.

Pap tests are done on women who have no symptoms of cancer and have
no findings suggesting a cancer. Thus, Pap tests are done only on women
who are normal.

Most smears are normal. However, it is common to have a minor
abnormality. If the result is abnormal there is usually no cause for
worry. It may mean that there are mild changes in the cells and the
smear will need to be taken more regularly for a while. If the changes
in the cells are more marked you may be referred for colposcopy. If the
woman has symptoms or findings suggestive of cancer of the cervix then
a diagnostic test must be done to exclude a cancer or to diagnose a
cancer. Diagnostic tests are usually biopsies. This is the single most
important lesson to learn: if you have a symptom or a finding that
could be due to a cancer of the cervix, a normal Pap test never
excludes the possibility of cancer.

In the vast majority of instances, an abnormal Pap test results in
the diagnosis of a minor change on the cervix. Some of these changes
will be premalignant, but most will be of minor significance. They will
all have to be evaluated, diagnosed and treated, but most will be
easily and effectively treated. Occasionally, a real cancer will be
present which is why this is such an important test. Most cancers are
visible on examination and can be biopsied as soon as they are seen.
Sometimes the cancers are inside the cervix beyond view and the only
indication that it is there is the abnormal Pap test.

Sometimes your doctor may ask you to have another smear because the
specimen taken was `inadequate'. This means that not enough cells were
collected at your first test.

Some test results may be `borderline'. This means that there are
slight cell changes on the cervix, which may revert to normal. Further
monitoring will be needed, but not necessarily any treatment.

If your test result is borderline you will need to have another
smear. If the changes remain, your doctor may recommend that you visit
a gynaecologist for further tests.

Pap smears can be abnormal if the cervix is inflamed or irritated.
This can be caused by an infection of the cervix, douching, menopausal
changes, or irritation. The cervix may also be going through some
changes called dysplasia. Dysplasia means the cells on the Pap smear
look abnormal under the microscope. Dysplasia isn't the same thing as
cancer but may lead to cancer if it is not treated. If inflammation is
present in the cells on the Pap smear, it means that some white blood
cells were seen on your Pap smear. Inflammation of the cervix is very
common and usually does not mean there is a problem. If the Pap smear
showed that the inflammation is severe, your doctor may want to find
the cause, such as an infection. You may also need to have another Pap
smear in six months to see if the inflammation has gone.

The human papilloma virus (Wart Virus or HPV) can be seen on
cervical smear tests. It is unclear what the exact relationship is
between the wart virus and cell changes. If you have this virus, you
will need to have smear tests more often than usual.