What is a Pap Smear and What do the results mean? Maria E Daheri RN Cervical Nurse Case Harris Health System

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Bennett Harrison
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1 What is a Pap Smear and What do the results mean? Maria E Daheri RN Cervical Nurse Case Harris Health System

2 What is a Pap Smear and when is it recommended? Pap smear The Pap smear is a screening test for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina How the Test is Performed You lie on a table and place your feet in stirrups. The doctor or nurse gently places an instrument called a speculum into the vagina to open it slightly. This allows the doctor or nurse to see inside the vagina and cervix. Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination

3 What is a Pap Smear and when is it recommended Cont. Why the Test is Performed The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap smears. Screening should start at age 21 Women Ages should do Pap Smears every 3 years Women 30 and older can do Pap Smears every 5 years if the facility or physician co-test for HPV

4 Normal Results A normal result means there are no abnormal cells present. The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly, and follow-up Pap smears should find any changes in time for treatment

5 Abnormal Results ASCUS or AGUS This result means there are atypical cells, but it is uncertain or unclear what these changes mean The changes may be due to HPV They may also mean there are changes that may lead to cancer LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia): This means changes that may lead to cancer are present The risk of cervical cancer is greater with HSIL

6 Follow Up Tests or Exams Colposcopy with or without Directed Biopsy: A colposcopy is a special way of looking at the cervix. It uses a light and a low-powered microscope to make the cervix appear much larger. This helps your health care provider find and then biopsy abnormal areas in your cervix Cervical Biopsy Endometrial biopsy: tissue sample from inside the uterus (womb) Endocervical Curettage: tissue sample from inside the cervix is removed

7 Biopsy Results Dysplasia CIN 1 is mild CIN 2 is moderate CIN 3 is severe dysplasia or very early cervical cancer called carcinoma in situ Cervical cancer

8 Treatments The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP is usually done at your doctor's office, a clinic, or a hospital as an outpatient procedure. You do not have to spend a night in the hospital. Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. Recovery time depends on how much was done during the procedure. LEEP is a very effective treatment for abnormal cervical cell changes. During LEEP, only a small amount of normal tissue is removed at the edge of the abnormal tissue area

9 Treatments Cont. Cryosurgery : is a procedure that uses freezing gas to destroy precancerous cells on the cervix. The cervix, the lowest part of the womb or uterus, opens into the vagina. When unhealthy cells are destroyed, the body can replace them with new, healthy cells. Generally, you will be able to return to your normal activities as soon as the cryosurgery is over.

10 Post Care For the first week or two after cryosurgery, you may notice watery or blood-streaked vaginal discharge. Don t be alarmed. This is your body s way of ridding itself of old, dead cells. Your doctor will ask you not to douche, use tampons, or engage in vaginal intercourse for two to three weeks following cryosurgery. This gives the cervix time to heal. This also include oral sex.

11 HPV Virus Human Papillomavirus (HPV) is a common virus that is spread through sexual contact. Most of the time HPV has no symptoms so people do not know they have it. There are approximately 40 types of genital HPV. Some types can cause cervical cancer in women and can also cause other kinds of cancer in both men and women. Other types can cause genital warts in both males and females.

12 HPV Virus Cont. In general, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers. Cancers of the head and neck are mostly caused by tobacco and alcohol, but recent studies show that about 70% of cancers of the oropharynx may be linked to HPV. Many of these may be caused by a combination of tobacco, alcohol, and HPV. For more information, see How Many Cancers Are Linked with HPV Each Year?

13 HPV Vaccine The HPV vaccine works by preventing the most common types of HPV that cause cervical cancer and genital warts. It is given as a 3-dose vaccine. Who should get HPV vaccine? QUADRIVALENT HPV (HPV4) VACCINE (GARDASIL, MERCK) WAS APPROVED BY THE FOOD AND DRUG ADMINISTRATION IN JUNE THE VACCINE IS APPROVED FOR FEMALES AND MALES 9 THROUGH 26 YEARS OF AGE

14 HPV Vaccine Cont. ACIP (ADVISORY COMMITTEE ON IMMUNIZATAON PRACTICES) RECOMMENDS ROUTINE VACCINATION OF ALL FEMALES 11 OR 12 YEARS OF AGE WITH 3 DOSES OF EITHER HPV2 OR HPV4. IN OCTOBER 2011 ACIP RECOMMENDED ROUTINE VACCINATION OF MALES 11 OR 12 YEARS OF AGE WITH HPV4 ADMINISTERED AS A 3-DOSE SERIES. THE VACCINATION SERIES CAN BE STARTED BEGINNING AT 9 YEARS OF AGE. ACIP RECOMMENDS ROUTINE VACCINATION WITH HPV4 AS FOR ALL MALES THROUGH 26 YEARS OF AGE FOR THOSE WHO HAVE NOT BEEN VACCINATED PREVIOUSLY OR WHO HAVE NOT COMPLETED THE 3-DOSE SERIES. CD PINKBOOK 12 EDITION

15 Patient Navigation With all this said how do you navigate a patient into the next step? First determine what she needs. Does she need screening services or diagnostic. Assess financial need Indigent care, federally qualified health centers, or private care. Look up resources American Cancer Society, Livestrong or Cancare. Build a referral list and individuals who might be able to help.

16 References Reference Epidemiology and Prevention of Vaccine- Preventable Disease 12 th Edition Chapter 10

17 Questions Thank you Maria E Daheri RN

Your Colposcopy Visit

Your Colposcopy Visit Introduction Welcome to the colposcopy clinic. This booklet tells you about. The colposcopy examination.. Tests that are done in the colposcopy clinic.. What these tests look for Take a few minutes to