Understand Your Results

Understand Your Results

The Pap test takes little time and may save your life. This simple screening test checks for cell changes in the cervix, the opening of the uterus. If your Pap results were abnormal, you may be worried. The good news is that cervical problems, when caught early, can almost always be treated. Read on to learn about abnormal Pap results and what to do next. Don t panic. An abnormal Pap test result can mean many things. It may be due to changes (inflammation) caused by normal cell repair or infection. Or, you may have cell changes that are due to a virus. If ignored, this problem might progress to cervical cancer. That s why it s so important to have Pap tests as often as directed. Pap tests can show cell changes in the cervix early, when treatment is most effective. Be sure to discuss your results with your healthcare provider. Find out about any follow-up tests you ll need. You may be scheduled for another Pap test in a few months. You may be tested for the virus that can lead to cervical cancer. Or, you may be scheduled for a special exam so your healthcare provider can get a closer look at your cervix. In any case, be sure to keep your follow-up visits. They are one of your best safeguards against future problems. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2011 Krames StayWell, LLC. www.kramesstaywell.com 800-333-3032 All rights reserved. Made in the USA.

Infection with the human papillomavirus (HPV) is the most common reason for an abnormal Pap result. HPV is a family of viruses that spread with direct contact. Some types of this virus cause genital warts (condyloma). A few HPV types can cause cell changes (dysplasia) in the cervix that sometimes lead to cancer. In most cases, though, the virus passes from the body without causing lasting health problems. If your Pap results suggest HPV, further testing is likely. Most types of HPV don t cause symptoms. In fact, many people who are infected don t know it. However, if you know that you have HPV, you can take steps to limit the effect of the virus. Talk about your sexual histories before having sex with a new partner. Use latex condoms each time you have sex. This helps to prevent passing HPV. If you smoke, quit. People who don t smoke are more likely to clear the virus from their bodies. Both woman and men can be protected against certain types of HPV infection that cause genital warts and cervical cancer. Ask your healthcare provider if getting vaccinated makes sense for you. If your Pap test showed signs of HPV, your cell sample may be checked to find out if you have a lowor high-risk form of the virus. Even if you have HPV, being vaccinated could help protect you from getting infections from other HPV types in the future. This is true for your partner as well.

During a Pap test, your healthcare provider collects sample cells from your cervix and vagina. These samples are sent to a lab, where they are studied. The lab then reports any abnormal cell changes. Your healthcare provider will discuss these changes with you. In some cases, an abnormal Pap test is due to an infection. More serious cell changes range from dysplasia to cancer. Cervical cells, even normal ones, are always changing. As they mature, normal squamous cells move up from deeper layers within the cervix. Over time, these cells flatten and cover the surface of the cervix. Within the cervical canal, the cells are different. These glandular cells are taller and not as flat as the cells on the surface of the cervix. When a Pap test sample shows healthy cells of both types, the results are normal. Keep having Pap tests as often as directed.

An abnormal Pap test result means some cells in the sample showed abnormal changes. These results are grouped by the type of cell change and the location, or extent, of the changes. Talk to your healthcare provider about your Pap test. Depending on the results, you may need further testing. Mild dysplasia (reported as low-grade SIL or CIN 1): Cells show distinct changes. Your healthcare provider may want to observe the health of your cervix over time. The Pap test is likely to be be repeated at least once. Inflammation (also called reactive cellular changes): Noncancerous changes are present. They may be due to normal cell repair. Or, they may be caused by an infection, such as HPV or yeast. Further testing may be needed. Atypical squamous cells (reported as ASC-US or ASC-H): Test results are unclear. Cells on the surface of the cervix show changes, but their significance is not yet known. Testing for HPV and other STDs may be needed. Treatment may be required. Atypical glandular cells (reported as AGC): Cells lining the cervical canal show abnormal changes. Further testing is likely. You may also have treatment to destroy or remove problem cells. Moderate to severe dysplasia (reported as high-grade SIL or CIN 2 or CIN 3): Cells show precancerous changes. Or, noninvasive cancer (carcinoma in situ) may be present. Treatment to destroy or remove problem cells is likely. Cancer: Cancer has spread deep into or beyond the cervix. Tests to assess the cancer s extent are likely. Treatment options will depend on the test results, your age, and health history. You may be referred to a cancer specialist.

Depending on your Pap test results, other tests or procedures may be done to help diagnose or treat your problem. For a closer look at cells on your cervix, your healthcare provider can do a colposcopy. This simple exam takes only minutes. Tissue samples may be removed at the same time. Certain types of treatment can also be done during colposcopy. Most abnormal Pap test results are due to HPV infection. But there are many types of HPV, and they affect the body in different ways. Some forms of HPV are more likely than others to lead to cervical cancer. To learn if you have a low- or high-risk form of the virus, a sample of your cervical cells may be screened. This will help your healthcare provider plan for follow-up and treatment. Your healthcare provider can use a colposcope to look at changes on the surface of the cervix. The colposcope, which sits outside the body, provides a magnified view of the cervix. If a problem is suspected, you may need procedures to further assess or treat it. Or, you may simply need follow-up visits to check on the health of your cervix. As with Pap tests, colposcopy may be repeated to check your cervix over time.

Some procedures can be done at the time of the colposcopy. Expect them to take no more than 15 to 30 minutes. You may have some cramping during a procedure. Some women have light spotting for a few days afterward. This is normal. A non-aspirin pain reliever, such as ibuprofen, can help reduce any discomfort. After your procedure, be sure to follow up as directed by your healthcare provider. While viewing the cervix through the colposcope, your healthcare provider may perform a biopsy. During this procedure, a small sample of tissue is removed from the cervix. The sample is then studied under a microscope for signs of cancer or other problems. More than one area of the cervix may be biopsied. The cervical canal cannot be seen with colposcopy. So, to detect problems in the cervical canal, you may need endocervical curettage. During this procedure, cells are scraped from the canal wall. These cells can then be studied under a microscope. This procedure is often done along with a biopsy. Your healthcare provider may destroy abnormal cells on the cervix. This may be done by freezing the cells (cryotherapy). Or, the cells may be destroyed with a beam of high-energy light (laser surgery). To remove abnormal cells, your doctor may use a cutting laser, electric loop (loop electrosurgical excision procedure or LEEP), or another surgical instrument to remove a small section of the cervix. In some cases, a cone biopsy is done. This procedure removes a cone-shaped piece of tissue extending from the center of the cervix into the canal. Cone biopsy may be performed in an outpatient setting.

To stay healthy, have follow-up exams and Pap tests as directed. If you ve had an abnormal Pap, your healthcare provider may want you to be checked more often. This helps make sure your cervix is back to normal. Give yourself the best chance for cervical health. Have Pap tests as often as recommended for the rest of your life. With contributions by: Shelley Binkley, MD, FACOG Carolyn V. Brown, MD, MPH Scott E. Eder, MD, FACOG, FACS, OB/GYN Susan Frank, RN Frederick W. Hanson, MD, FACOG William C. McBee, Jr, MD, Gynecologic Oncology Deborah A. Metzger, PhD, MD, GYN Patrick W. Morell, MD William W. Young, MD, OB/GYN Take our Patient Survey. Help us help other patients. Please visit www.kramesurvey.com to provide your feedback on this booklet. www.kramesstaywell.com 800.333.3032