It’s a scary moment when you learn that your Pap smear results are abnormal, but take a deep breath and relax because it’s rare for Pap results to indicate cancer. You’ll need to come back to see Fred A. Williams, MD, for follow-up care, but in most cases, an abnormal Pap smear is an early alert that you have an HPV infection or that you need treatment to eliminate precancerous changes.
What you should know about Pap smears, HPV, and cervical cancer
When you get a Pap smear, we take a small sample of cells from your cervix and send it to a laboratory. At the lab, a technician examines the sample under a microscope, carefully evaluating every cell, looking for two types of abnormal changes:
Human papillomavirus (HPV) infection
HPV viruses are transmitted during sexual contact with an infected partner. While HPV infections are common, your immune system usually takes care of them and they clear up on their own.
Precancerous and cancerous cellular changes
If your immune system can’t suppress an HPV infection, the virus invades healthy cervical cells and causes abnormal cellular growth. Over the years, this growth becomes precancerous. If it goes untreated, it gradually turns into cervical cancer.
HPV infections and precancerous and cancerous changes don’t cause symptoms until the cancer grows into the surrounding tissues. That’s why it’s important to get a routine Pap smear to detect problems while they’re still treatable.
Range of results when you have an abnormal Pap smear
The cells observed in your Pap smear are graded based on the type and severity of cellular changes. A negative Pap smear means all your cells were normal. An abnormal Pap test reports the extent of the changes, separating the results according to the type of cervical cancer.
Squamous cell carcinoma
Squamous cell carcinoma, which represents 80-90% of all cervical cancers, starts in cells on the outer surface of the cervix. Your abnormal Pap results are reported as one of the following:
- Atypical squamous cells: The cells aren’t normal, yet the cause of the problem isn’t clear
- Low-grade squamous intraepithelial lesions: Cells are mildly abnormal due to HPV; they’re likely to return to normal when your immune system deals with the virus
- High-grade squamous intraepithelial lesions: HPV has caused moderate to severe abnormalities in cells; they’re likely to become cancerous if they go untreated
- Carcinoma in situ: The cellular changes suggest cervical cancer; abnormal cellular growth may invade into the cervix or the surrounding tissues
This type of cervical cancer begins in glandular cells in the cervical canal. There are three levels of changes reported on an abnormal Pap smear:
- Atypical glandular cells: The cells aren’t normal, but the cause of the problem is undetermined
- Endocervical adenocarcinoma in situ: Severely abnormal cells are present, but they haven’t spread
- Adenocarcinoma: Cellular changes suggest the presence of cancer
When you get routine Pap smears, you can be confident that abnormal Pap results will reflect early changes that are curable.
What happens after an abnormal Pap smear
What happens after you get an abnormal Pap smear depends on your results. If you have mild cellular changes, whether due to HPV or an unknown cause, we may recommend waiting a while and then repeating your Pap smear, or we may suggest an HPV test. In most cases, the problem clears up and the next test is negative.
If your repeat Pap smear still shows mild changes, or your original Pap results revealed moderate to severe cellular changes, the next step is a colposcopy.
To perform a colposcopy, we swipe a vinegar-like solution over your cervix to highlight abnormal cells. Then we look through a colposcope, which is a magnifying device that allows us to see abnormal cervical cells.
When abnormal tissues are identified, we take a biopsy using local anesthesia and then follow up on the findings. Your biopsied tissues are sent to a lab and are scrutinized to determine if cancer is present. If we need to treat the cervix and abnormal cells we may use one of these procedures:
- Loop electrosurgical excision procedure (LEEP): Abnormal tissues are removed using a thin wire loop carrying a mild electrical current
- Conization or cone biopsy: This is the removal of a cone-shaped wedge of tissue, which includes the abnormal tissues plus some of the healthy surrounding tissues
Your biopsied tissues are sent to a lab and are scrutinized to determine if cancer is present.
For women who are diagnosed with cancer, the next stop is having additional imaging tests to determine if the cancer has spread beyond the cervix. From this point, your treatment includes a hysterectomy to remove the cervix and uterus, and possibly radiation, chemotherapy, or both, depending on the stage of your cancer.
If you have questions or need to schedule a Pap smear, call Fred A. Williams, MD, or use the online booking feature.