WHAT IF YOU HAVE AN ABNORMAL PAP SMEAR?
What if your pap smear is abnormal?
The cells from a pap smear need to be looked at under a microscope, so it will take about a week to result. What happens next depends on the result. Your doctor will give you further information, but basically HOW abnormal the cells are determine how quickly we need to act. It also matters if you test + or – for HPV, since it accelerates abnormal growth. Left alone, the cells may progress into cancer. Some cells are so close to being cancer that they are even called “pre-cancer” cells (Cervical Intraepithelial Neoplasia).
If the cells are only a little abnormal, such as “Atypical Cells of Undetermined Significant (ASCUS),” or “Low-Grade Squamous Intraepithelial Lesion (LGSIL),” it is possible to wait 1 year to repeat the pap smear and see if they’ve gone away. Your body is very powerful at fixing things, especially if you are young.
If they are very abnormal, however, “High-Grade Squamous Intraepithelial Lesion (HGSIL)” or HPV test is +, your doctor will want to further investigate with an office procedure called a Colposcopy. Like a pap smear, s(he) will use a speculum again to look at your cervix, but this time use powerful binoculars and vinegar and brown dye solutions to look VERY closely at your cervix. If s(he) sees anything abnormal, s(he) will use a tool to take a very small piece of your cervix (it feels like a crampy pinch) to look at under the microscope. This is called a Biopsy.
You can have pain or spotting. It can be brown or even black in color since doctors use a special solution to stop any bleeding from the biopsy site.
This result takes another week. The biopsy result can be normal (negative), full-on cancer, or a results in between — grade 1, 2, or 3 of “Cervical Intraepithelial Neoplasia (CIN),” the pre-cancer cells.
Grade 1 CIN has a low chance of developing into cancer and your body could clear it on its own, thus it is usually monitored with a repeat pap smear in 1 year’s time.
Grade 2 or 3 CIN, however, have high risk of developing into cancer if left alone, so your doctor will recommend literally taking the abnormal cells out with a procedure, either a Loop Electrode Excision Procedure (LEEP) or a Cold Knife Cone (CKC). Both of them “carve” a piece of the cervix containing the abnormal cells out (Don’t worry, cervixes heal well and they usually have plenty of mass to spare!)
A LEEP uses a hot wire in the shape of a loop. It can be done in the office using local numbing medicine, or in the operating room under anesthesia, depending on your preference.
The CKC uses a scalpel and removes a deeper piece of the cervix shaped like a cone. It is typically used for larger or deeper clusters of the abnormal cells.
A follow-up appointment is made to check in and make sure you are healing well after the procedure, and to discuss results. If the piece removed had “clear margins,” meaning all of the abnormal cells were definitely taken out, that’s great! If not, don’t fret, your doctor usually will have burned the edges (“margins”) during the procedure to kill off any remaining abnormal cells. However, a follow up pap smear in 6-12 months’ time is extremely important to show up to.
Here are some more detailed common questions regarding pap smears. As with anything, don’t hesitate to ask your doctor further questions. Remember, cervical cancer is one of the slowest-growing ones, which is a good thing. Pap smears, colposcopies, LEEPs, and CKCs have made a world of difference and saved millions of lives since they were invented!
It is SO important to see a doctor for a pap smear regularly, at least every 3-5 years. The sooner you catch an abnormal result, the sooner you can take care of it!
Another reminder about HPV, since it makes an abnormal pap smear result MUCH MUCH worse. Try to reduce your risk by using condoms and getting the HPV vaccine!!