Pap Testing

Pap Testing: Management after an abnormal pap test result

A Pap test is a simple test that detects cell changes on your cervix. An abnormal Pap test result means that the cells taken from your body did not look like they should. This is different from an unsatisfactory result, which means that your Pap test could not be accurately analyzed and needs to be repeated.

When abnormal cervical cells are found early, they can often be treated effectively before these changes become dangerous. Sometimes abnormal cells may go away without treatment, but need to be monitored. If left untreated for several years, abnormal cells could develop into cervical cancer.

There are several causes for abnormal results: the cells on your cervix could be inflamed because of an infection (such as a yeast infection or a sexually transmitted infection). If you have mild abnormalities that suggest these causes, you will likely need to have another Pap test in six months, when a possible infection has had time to clear.

The abnormal cells could also be a very early sign of pre-cancer, or of cancer itself. In these cases, you may be referred to a specialist for colposcopy and treatment.

The first step: Colposcopy

Colposcopy is a procedure which allows a doctor or colposcopist to examine your cervix after an abnormal Pap test. Your health-care provider will use a solution on your cervix which causes abnormal cells to turn white. He or she will then use a colposcope (which magnifies an image) to look at your cervix. Your health-care provider may take a tissue sample from your cervix for further testing in a laboratory. Colposcopy doesn’t feel much different from a Pap test, although some women feel some cramping and bleed a little bit afterward. If a tissue sample is removed, you should not use tampons, put anything into your vagina or have sex until the bleeding has stopped.

Depending on the results of the colposcopy and laboratory tests, which usually take about three weeks to get back, your health-care provider may recommend either monitoring the cells or treatment to remove the abnormal cells. You may need a follow-up appointment within six months.

Treatment

There are several types of treatment for abnormal cells which need to be removed. Which one you have will depend on your case; one is not better than the other.

LEEP
One common treatment is called LEEP (loop electrosurgical excision procedure). A thin wire uses a small electrical current to cut the affected area, removing the abnormal cells. The treatment lasts about 10 minutes. You should not have sex, use tampons or have anything in your vagina for a month afterward. It is normal to have a mixed watery and bloody vaginal discharge that can be as heavy as a period for up to 10 days after LEEP.

Laser
The area of your cervix with abnormal cells is frozen using an injection, much like a dentist uses when working on your teeth. Your health-care provider then uses a laser to burn off the abnormal cells. You may have brown or blood-tinged discharge that may be as heavy as a period after the treatment.

Cryotherapy
In this case, a freeze-probe is put on your cervix for about five minutes to cool the cells to below freezing. These destroyed cells are washed away with a watery solution. This treatment is not used very much in Canada.

Conization or cone biopsy
This is a treatment used to find abnormal cells if they cannot be easily seen using another procedure. A scalpel is used to remove a cone shaped sample of tissue (biopsy) from the cervix. Stitches are sometimes used afterward to stop the bleeding. The biopsy is sent to the laboratory to be examined.

You will likely need at least two follow-up visits after your treatment. It is important to attend these appointments to ensure that no precancerous cells were left behind and that you are healing properly. If there are still abnormal cells, you will need another round of treatment.

 

What if it’s cancer?

It’s very unlikely that an abnormal Pap test result will be cancerous. If colposcopy results show that the cells could be cancerous, you will be referred to a gynaecologic oncologist (a physician who specializes in cancers of the female reproductive system) for treatment.

Why did I get abnormal cells?

Abnormal cells can be caused by the human papillomavirus (HPV). Both women and men get HPV. There are 40 different types of HPV that can affect the genital tract. All types cause infections and lesions that can clear up on their own.

However, some infections that do not clear may lead to precancerous cells, which could then lead to cancer if left untreated. These are called high risk HPV types because they lead to the development of cancer. The four HPV types most commonly associated with cancer are HPV 16, 18, 31 and 45.

Women can get cancer of the cervix, vulva and vagina; men can get cancer of the penis. As well, for both men and women, 10 to 20% of cancers of the head and neck, mouth and throat are caused by an HPV infection. Cancer of the anus in both sexes has also been associated with HPV. It is estimated that almost eight in 10 Canadians will get HPV at least once in their lifetime. It is spread by skin-to-skin contact, during genital, anal or oral sex.

You can’t really prevent contracting HPV, other than through complete abstinence, but there are things you can do to minimize your risk. You can wear a condom, because it provides some protection; limit your number of sexual partners; and you can get vaccinated, which protects against the two most frequent high risk strains that lead to cancer.

Further resources

  • The Society of Obstetricians and Gynaecologists of Canada’s public education website, www.HPVinfo.ca
  • The Society of Obstetricians and Gynaecologists of Canada’s public education brochure, Pap testing, available at www.sogc.org
  • The Society of Canadian Colposcopists public education website, www.paptestinfo.ca