What is abnormal pap test?

Abnormal Pap Test

Abnormal Pap test: Overview

A Pap test (also called a Pap smear) is used to look for early changes that may become cancer of the cervix. Your Pap test was abnormal. That may mean that some cells in your cervix have changed. The cell changes are most often caused by human papillomavirus (HPV) infection.

An abnormal Pap test does not mean that the abnormal cells will lead to cancer. Changes in cervical cells may go away on their own or may progress slowly. Your doctor may have you follow a schedule of regular cervical cancer screening tests. Or your doctor may have you take other tests to find out more about your cell changes.

It is very important that you have regular cervical cancer screening tests after you've had an abnormal Pap test.

Abnormal Pap test

A Pap test is done to look for changes in the cells of the cervix. An abnormal Pap test shows that cells in the cervix have changed from a normal to an abnormal appearance. Only a small number of abnormal Pap test results are cell changes that may progress to cervical cancer. Changes in cervical cells may go away on their own or may progress slowly. So it is important to have regular cervical cancer screening tests.

What are the symptoms of abnormal cervical cell changes?

HPV, which causes most cervical cell changes, usually doesn't cause symptoms. But some people with cell changes may have abnormal vaginal bleeding. This may include bleeding between periods, heavy periods, or bleeding after sex. If another vaginal condition is the cause, you may have other symptoms, such as vaginal pain, itching, or discharge.

What is the treatment after an abnormal Pap test?

Not everyone needs treatment after an abnormal Pap test. Whether or not you need treatment can depend on the type of cell changes you have, your age and medical history, and the possible cause of the cell changes.

Mild cell changes.

For mild cell changes you probably will not need treatment. Mild changes often go away on their own. But if mild changes are caused by a treatable vaginal infection or atrophic vaginitis, you may be treated with medicine.

Moderate or severe cell changes.

For moderate or severe cell changes you may have treatment that focuses on destroying or removing abnormal tissue.

Treatment choices include:

  • Cone biopsy, which removes a cone-shaped wedge of abnormal cells that are high in the cervical canal.
  • Loop electrosurgical excision procedure (LEEP), which uses a thin, low-voltage electrified wire loop to cut out abnormal cervical cells.
  • Cryotherapy, which destroys abnormal cervical cells by freezing them.
  • Laser therapy, which uses a laser beam to destroy abnormal cervical cells.

If you're pregnant, you'll be monitored closely throughout your pregnancy. Most treatment for abnormal cell changes is done after delivery.

How can you care for yourself after an abnormal Pap test?

  • Do not smoke. Smoking may increase your risk for cervical cell changes. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • Be sure to get follow-up Pap tests or other follow-up tests as recommended by your doctor.

What increases your risk for an abnormal Pap test?

Certain sexual behaviors, like having sex without condoms and having more than one sex partner (or having a sex partner who has other partners), can increase your risk for getting HPV. And HPV raises your risk for having an abnormal pap test.

HPV can stay in your body for many years without your knowing it. You may not know you have it until you get an abnormal pap. So it can be hard to know when you were exposed.

Other things that may also play a role in increasing your risk include:

  • Smoking.
  • Having an impaired immune system.
  • Having been exposed to the drug DES before you were born. But this is rare.

If you have had one abnormal Pap test result, you're more likely to have another in the future.

What happens after an abnormal Pap test?

You may need more tests to find out if you have an infection or to find out how severe the cell changes are. For example, you may need:

  • Colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool.
  • An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix.
  • Another Pap or HPV test in about 6 to 12 months.

A colposcopy is usually done before any treatment is given. During a colposcopy, the doctor also may take a small sample of tissue from the cervix so that it can be looked at under a microscope. This is called a biopsy.

Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. In moderate to severe cases, you may have treatment to destroy or remove the abnormal cells.

How are cervical cell changes classified?

Cervical cell changes are classified according to their degree of abnormality using the Bethesda system (TBS). Further evaluation decisions are guided by the kinds of changes seen in the cells.

Minor cell changes

Minor cell changes may go away without treatment. But sometimes they turn into more serious cell changes. Types of minor cell changes include:

  • Atypical squamous cells (ASC). These are changes for which the cause is unknown. They may be caused by an HPV infection. Or they may be caused by inflammation, another infection, or atrophic vaginitis. ASC is further classified as:
    • ASC of undetermined significance (ASC-US). These changes usually stay the same or return to normal.
    • ASC that cannot exclude high-grade squamous intraepithelial lesions (HSIL) (ASC-H). These changes are also minor. But they are more likely to become more serious.
  • A low-grade squamous intraepithelial lesion (LSIL). This is also called mild dysplasia. This change is usually caused by HPV and may be more likely to become more severe over time. But even when it does, it usually returns to normal.

Moderate to severe cell changes

Moderate to severe cervical cell changes (also called moderate to severe dysplasia) mean cell changes that are more likely to be precancerous and develop into cervical cancer if left untreated. Moderate to severe cervical cell changes are classified in the Bethesda system (TBS) as high-grade squamous intraepithelial lesions (HSIL) or atypical glandular cells (AGC). Follow-up evaluation is needed, and treatment may be needed.

All abnormal Pap tests require follow-up to identify development of more severe cell changes, including cervical cancer. Most abnormal cells can be removed or destroyed before they become cancerous.

What causes an abnormal Pap test?

Most of the time, the abnormal cell changes are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted infection.

Sometimes the changed cells are due to other types of infection, such as those caused by bacteria or yeast. These infections can be treated.

During or after menopause, a Pap test may also find cell changes that are caused by atrophic vaginitis.

What is an abnormal Pap test?

A Pap test, or Pap smear, is done to look for changes in the cells of the cervix. If your test is abnormal, it means it found some cells on your cervix that don't look normal. Having an abnormal test doesn't mean you have cancer. The chances that you have cancer are very small.

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