What to do when faced with an abnormal result of cervical cytology (Pap smear)?
The main objective of cervical cytology is to detect early pre-malignant diseases (pre-cancer) that results in a less radical treatment and a cure in almost 100% of cases.
The pre-malignant diseases of the uterine cervix are caused by a sexually transmitted infection: the human papillomavirus (HPV). If not diagnosed or treated properly, these pre-malignant diseases can progress to cervical cancer through many years.
The cervix is the lowest and most narrow part of the uterus. Its external part is easily visible through the vagina by placing a speculum.
Transmission of HPV Virus
Diagnosis of HPV infection: The HPV test
This test detects the presence of the virus that causes pre-malignant lesions or cancer of the cervix.
The HPV virus is, in fact, a family of numerous sub-types of viruses that fall into two categories:
- Low risk: two of the most frequent low risk HPV subtypes are 6 and 11. They cause genital warts but do NOT cause cancer of the cervix.
- High risk: two of the most frequent subtypes of high-risk HPV are 16 and 18. They can stimulate the uncontrolled growth of cervical cells and cause pre-malignant lesions and, later, cancer.
Diagnosis of pre-malignant lesions and cancer of the cervix.
The diagnosis of pre-malignant diseases and cervical cancer is usually performed initially by cytology. After that, a biopsy and a colposcopy should be performed in cases of an altered Pap smear.
What are the different types of pre-malignant diseases?
Cytology can report the following results:
- LG-SIL or low-grade intra-epithelial lesion: represents the beginning of pre-cancer diseases of the cervix
- SIL of AG or high-grade intra-epithelial lesion: means the evolution of the above and, without an adequate diagnosis and treatment, could progress to cervical cancer
- ASCUS-AGUS: means a result of cytology of uncertain significance. It should be repeated because, generally, pathologists cannot make any diagnosis based on the referral.
What is a Colposcopy?
Colposcopy is a direct visual examination using a colposcope to assess the surface of the cervix and vagina. Colposcopy is a device that works like a magnifying glass that increases the surface of the cervix from 6 to 40 times, allowing the assessment of different lesions at the same level.
What does a cervical biopsy mean?
The biopsy consists in taking a small portion of tissue to be analyzed by pathologists. This is commonly helpful to guide the best treatment and surveillance strategy in each individual patient.
Biopsies of the cervix or vagina are usually painless. They are made by using a special clamp, under colposcopic guidance to offer a better accuracy of the capture site.
- The beginning of sexual relations at an early age
- Multiple sexual partners
- Age: the highest incidence of this cancer is observed around 40-50 years. However, at younger ages, pre-malignant lesions that can cause cancer of the cervix throughout life are more frequent.
- Smoking: tobacco is a strong immunosuppressant. Its effect is further enhanced if the woman is already infected by some type of HPV.
- Immunosuppression: HIV (the virus that causes AIDS), diabetes, transplants.
- Oral contraceptives for long periods of time (usually more than 5 years)
- Having 3 or more children
If women have one of these diseases or conditions, it does not mean that they will have HPV infection or cervical cancer in the future. This only means that it is necessary to discuss these situations with the gynecologist.
HPV infection does not usually cause symptoms. They are usually diagnosed at the time of cervical cytology. In some cases, women may have vulvar warts that can alert the woman to consult the specialist.