SMEARS
The smear test (PAP smear)
A smear test should be done at least every 3 years on all women who are or have been sexually active. After the menopause it can be done less often. It is not necessary if the womb has been removed, unless recommended by your doctor. It is not done during a period. It involves a simple internal examination with an instrument called a speculum. It is essential that the doctor sees the area which is at risk clearly. A small plastic or wooden instrument is used to scrape some cells from this area. They are then smeared on to a glass slide and sent to the laboratory. An internal examination is a little embarrassing but a smear should not be painful or otherwise unpleasant. The result of the smear will take a few weeks. If urgent, however, the result can be obtained in a few days. The result of the smear
NORMAL Most smears are negative. If this is the case, it does not need repeating for at least 3 years. If there have been previous abnormal smears, the doctor might suggest an earlier repeat. INADEQUATE Sometimes the number of cells obtained from the smear may be insufficient for an adequate examination. The laboratory may then request that the smear is repeated. INFLAMMATION Quite often the laboratory asks for the smear to be repeated because the cells show inflammation. This should not cause worry to the patient: the explanation is simple. It means that the cells are distorted by the changes of inflammation or slight infection. These changes make the cells impossible for the laboratory to analyse. It is for this reason they want a repeat and not because of any question of pre-cancer. Sometimes a course of treatment may be suggested before the repeat. This is to treat the inflammation. POSITIVE (DYSKARYOSIS, CIN I, II OR III) All these terms indicate an abnormality in the cells. Dyskaryosis refers to the type of change in the cell. CIN I, II or III are codes which describe how deeply these changes penetrate into the skin. CIN I is the mildest change. These sorts of changes are often associated with wart virus infections. If the smear is positive, there is about a one in three chance of cancer developing if nothing further is done. The disadvantage of the smear test is that it only shows abnormality of the cells. For this reason, smears are often reported as showing dyskaryosis and suggesting CIN I, II, or III. It is not possible to fully assess the severity and depth of the changes. For this, more tissue (not just a few cells) needs to be obtained. The patient is therefore advised to have colposcopy. Colposcopy
This is done on a special couch with the patient's legs being supported. Otherwise there are no differences from an ordinary examination. The doctor, however, examines the cervix through a microscope called a colposcope. The magnification gives a much better idea of the severity of the changes in the cells. If the colposcopy confirms the abnormal changes, the doctor may remove some very small pieces of tissue for closer examination. This is called a biopsy. This may cause brief discomfort, but should not be painful. Sometimes the changes in the cells reach further up the canal in the cervix. The upper margin of the abnormal cells cannot then be seen. The doctor will then suggest admission to hospital for an anaesthetic to allow access to this tissue. Treatment
If the colposcopy or biopsy shows that the abnormal cells are all confined to surface skin, treatment may be given to you immediately. This treatment will be to destroy the cells of the affected and surrounding areas completely. Laser, freezing or an electric current can be used for this. Only a local anaesthetic is necessary. If the biopsy suggests that the cell changes may extend deeper into the skin, the management is different. It will mean admission to hospital, an anaesthetic and removal of part of the cervix. This operation is called a cone biopsy . If this shows that the changes are only on the surface, then no further treatment is needed. If the changes are deeper, then further surgery or radiotherapy might be recommended. After treatment
It is vital that any woman who has had an abnormal smear has frequent, regular smears. How frequent and for how long will vary from patient to patient. All women must follow the instructions they are given for future smears. If they are not given clear instructions, they must ask. A positive smear does not mean cancer. It means only the possibility of cancer developing in the future. Any woman with a positive smear who follows the advice given should not get cancer of the cervix. |
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