Abnormal PAP Smears

All sexually active women are recommended to have a PAP Smear every two years as part of the National Cervical Screening Programme. This smear test can be performed by your local doctor. If there is an abnormality with your PAP Smear you will be referred to a gynaecologist that specialises in Colposcopy.

Symptoms

Most women present for a colposocpy with an abnormal PAP Smear rather than any symptoms. However symptoms that may occur include irregular bleeding, bleeding between your periods, post-coital bleeding (after intercourse) or vaginal discharge.

PAP Smear abnormalities are due to infection with the Human Papilloma Virus (HPV). Most infection is cleared by the body’s immune system within 12 months and does not require treatment. In some women the virus is unable to be cleared and this can lead to changes within the cells of the cervix. Abnormalities include squamous abnormalities, glandular abnormalities or cancer.

Squamous Abnormalities

This group included possible low grade, low grade, possible high grade and high grade lesions. The majority of low grade lesions will clear themselves and patients are recommended to have a repeat PAP Smear in 12 months without the need for a colposcopy. However if a low grade abnormality persists or there is a high grade lesion a referral for colposcopy is necessary.

Glandular Abnormalities

These are uncommon changes in the gland cells of the cervix. Women who have any gland abnormality need to be referred for colposcopy.

Cancer

Cancer cells can arise from the squamous or glandular cells of the cervix. A smear test may indicate that a cancer is present but is not a definitive diagnosis of cancer. Further colposcopy and biopsy is warranted.

Diagnosis and Investigations

A PAP Smear is a screening test only. If an abnormality is detected you will be referred for a colposcopy. Colposcopy is a procedure where the cells of the cervix are magnified in order to be viewed properly. A vinegar (acetic acid) solution is applied to the cervix - abnormal cells will turn white. An iodine based solution may be applied – abnormal cells do not take up the brown stain. If there is any abnormality detected a biopsy (pinch of tissue) will be obtained. This biopsy is sent for analysis by the pathologist to determine the level of abnormality present. After the biopsy you may experience some mild crampy period like pain and slight bleeding for up to 72 hours.

Treatment

If a low-grade abnormality is confirmed on biopsy then no treatment is required. You will be asked to return for a repeat PAP Smear and colposcopy in 12 months time. The majority of these lesions will regress within that time. If a high-grade lesion is confirmed or a cancer is suspected you will require treatment with a LLETZ or Cone Biopsy.

LLETZ
Large Loop Excision of the Transformation Zone (LLETZ) is a procedure where a semi-circular wire loop is used to remove the area of the cervix containing the abnormal cells. This can be performed under local or general anaesthetic and is performed in the operating theatre. You may experience some crapmy period pain, bleeding or discharge after the procedure. This should decrease in volume over the following weeks. If heavy bleeding or an offensive discharge occurs please contact the rooms for advice. Tampons, sexual intercourse and swimming should be avoided until all bleeding or discharge has ceased.

Cone Biopsy
A cone biopsy is a procedure where a cone shaped wedge of the cervix is removed. The tissue removed is larger and deeper than a LLETZ and is performed under general anesthetic in an operating theatre. You may experience some crapmy period pain, bleeding or discharge after the procedure. This should decrease in volume over the following weeks. If heavy bleeding or an offensive discharge occurs please contact the rooms for advice. Tampons, sexual intercourse and swimming should be avoided until all bleeding or discharge has ceased.

Follow Up

After a LLETZ or Cone Biopsy Dr Andrea Garrett will call you with results. You will be seen six weeks after the procedure. You will then require a repeat PAP Smear and colposcopy at 6 months, 12 months and 24 months after your procedure. If a cancer has been diagnosed you will need imaging studies and further treatment (refer to section on cervical cancer).