Cervical cancer is cancer that develops in the cells of the lower portion of the uterus. This region is called the cervix.
The small and narrow cervix connects the uterus to the vagina. It provides an entry for sperm to pass into the uterus. The cervix also provides an exit from the uterus for monthly menstrual blood flow or a baby during delivery.
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The small cervix is divided into two sections and is home to two types of cells:
- Endocervix: This portion of the cervix is the innermost part. It lines the “tunnel” leading from the uterus into the vagina. The endocervix is home to tall, column-like cells that are responsible for mucus secretion.
- Ectocervix: This portion of the cervix is the outer portion, which protrudes into the vagina. The ectocervix is the home to squamous cells, which have the appearance of fish scales under the microscope.
Where these two cell types join is where most cervical cancers and precancerous cells form.
What is a Pap smear?
A Pap smear is a screening tool that helps in the detection of abnormal cells and cancer by sampling cells from the cervix.
Pap smear is vital for the prevention and early detection of cervical cancer. Tools such as the Pap smear and human papillomavirus (HPV) testing are essential to detect:
- The presence of HPV
- Precancerous cell changes
- The presence of cancer
An HPV test can be obtained at the same time. It is recommended that women over 30 years old undergo both a Pap smear and HPV testing at least every year.
According to the American Cancer Society, deaths from cervical cancer have decreased by more than half in the last 40 years due to the use of the Pap smear.
What happens during a Pap smear?
A Pap smear is usually done during a gynecological pelvic exam. A tool called a speculum is introduced into the vagina so that the cervix can be fully examined. A sample of the cervical cells is then taken with a brush or spatula and sent for testing.
When should I have a Pap smear?
Frequency of Pap smear depends on several factors. These include:
- Medical history
- Exposure to diethylstilbestrol (DES) when in the womb
- A weakened immune system
It is recommended that women start receiving Pap smears at the age of 21. They should have another test every 3 years until the age of 65. Testing every 5 years can be considered in women over 30 who undergo a Pap smear with HPV testing.
In some situations, it may be recommended that women stop undergoing screening with a Pap smear. Some women may no longer require screening after a total hysterectomy in which the uterus and cervix are removed.
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Women who are over 65 years old usually no longer require Pap smears. Though, each person’s risk factors may differ. Women with a history of positive cervical cancer screening and those who are sexually active with multiple partners may require continued testing.
Results of Pap smear
At times it is possible for a Pap smear result to be negative even with abnormal cells present on the cervix; this is called a false-negative result. False-negative results can be triggered by:
- Not collecting enough cells for testing
- Low amounts of abnormal cells
- The presence of blood or inflammatory cells
A positive Pap smear result does not always indicate that cervical cancer is present. The result may simply be abnormal. If a patient receives a negative result, their Pap smear was normal and did not reveal unusual cells.
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Abnormal results, referred to as positive findings, may indicate the presence of abnormal cells or cancer. These results require following up with a colposcopy, with or without a biopsy.
During a colposcopy, the vulva, cervix, and vagina are magnified with a colposcope. A biopsy may be taken for evaluation if necessary.
Common cell abnormalities include:
- Atypical squamous cells of undetermined significance (ASCUS): This diagnosis is for slightly abnormal cells that do not meet the conditions of precancerous cells. If HPV is present, additional testing will be recommended.
- Squamous intraepithelial lesion: This diagnosis means possible precancerous cellular changes that are expected to need further testing. They are divided into two categories:
- Low grade: A low-grade lesion has a low risk of developing to cancer in the near future.
- High grade: A high-grade lesion has a high risk of developing to cancer
- Atypical glandular cells: This diagnosis is indicative of abnormal cells in the endocervix. These will require further testing.