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The Pap smear is named after Dr. George Papanicolaou (1883 -1962). Born in Greece, Dr. Papanicolaou received a medical degree from the University of Athens in 1904 and a PhD in zoology from the University of Munich in 1910. He came to the United States in 1913 as an assistant research biologist under Dr. Charles R. Stockard at Cornell Medical College in New York City. There, he studied the role of chromosomes in sex determination. In the process, he noticed recurring changes in the cells in the vaginal discharge of the guinea pig over the menstrual cycle. Extending his studies to humans, Dr. Pap began examining vaginal smear changes in 1923. He unexpectedly discovered that women with uterine cancer had "abnormal cells, with enlarged, deformed, or hyperchromaticnuclei." He called the discovery of these abnormal cells on the smear "one of the most thrilling experiences in my scientific career." A Pap smear (Pap test) is a medical procedure to screen for abnormal cells of the cervix. A woman should have her first Pap smear (in general) three years after vaginal intercourse, or no later than 21 years of age. The risks for women at increased risk for having an abnormal Pap smear include: HPV (genital warts), smoking, a weakened immune system, medications (diethylstilbestrol), and others (having multiple sex partners, becoming sexually active at a young age). Some of the conditions that may result in an abnormal Pap smear include: absence of endocervical cells, unreliable Pap smear due to inflammation, atypical squamous cells (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high -grade squamous intraepithelial lesion (HSIL), cervical intraepithelial neoplasia (CIN), and carcinoma in situ. In the vast majority of cases, a Pap test does identify minor cellular abnormalities before they have had a chance to become malignant and at a point when the condition is most easily treatable. The Pap smear is not intended to detect other forms of cancer such as those of the ovary, vagina, or uterus. Cancer of these organs may be discovered during the cou rse of the gynecologic (pelvic) exam, which usually is done at the same time as the Pap smear.
Recommendations for Women Having a Pap Smear: When To Start Pap Smear Testing Frequency of Pap Smear Testing At What Age To Stop Having Pap Smear 3 years after vaginal intercourse. Purpose:Is to collect cells from your cervix.DEFINITION: Pap Smear:A Pap smear (also known as the Pap test or Papanicolaou test) is a medical procedure in which a sample of cells from a woman's cervix (the end of the uterus that extends into the vagina) is collected and spread (smeared) on a microscope slide. . Women age 30 and older who have had three normal Pap smears in a row should have a Pap smear every three years. The cells are examined under a microscope in order to look for pre-malignant (before-cancer) or malignant (cancer) changes. Women in their 20's should have a Pap smear every two years. which is the lower end of your uterus. The cells collected in a Pap smear can detect if you have cervical cancer or suspicious cells that indicate you may develop cervical cancer. no later than age 21 Yearly with exceptions: y y Total hysterectomy for benign disease every 2 years if liquid-based kit y > 70 years old with at least three normal Pap smear results abnormal and no Pap y every 2-3 years if three normal tests in a row in women >30 years old results in the last 10 years Women should have their first screening Pap smear at age 21.
(A speculum is an instrument that allows the vagina and the cervix to be viewed and examined. If you have had a hysterectomy but still have your cervix. y A speculum is then inserted into the vaginal area (the birth canal). Pap smear screening can be stopped in women 65 -70 years old and above who have had three or more normal Pap smears in a row. Empty your bladder just before the test.) . to assure that they look normal. y With the woman positioned on her back. Having intercourse Taking a tub bath Using tampon These agents may wash away or hide any abnormal cervical cells. Avoid scheduling your Pap smear while you have your period (are menstruating). creams. a nurse practitioner. or a nurse midwife. These guidelines should be followed whether you have or have not had the vaccine. Things to Avoid 24 hours before the Procedure: Douching Using spermicidal foams. Procedure Proper: A Pap smear can be done in a doctor's office. such as a physician assistant. including the urethra (the opening where urine leaves the body). a clinic. because blood and cells from the uterus may affect the accuracy of the Pap smear.Women who have had a hysterectomy should no longer have Pap smears if the hysterectomy was for non-cancerous reasons and they don't have a history of severely abnormal Pap smears. or a hospital by either a physician or other specially trained health care professional. jellies. you will need to continue routine Pap smears. the clinician will often first examine the outside of the patient's genital and rectal areas.
is called the endocervical sample ("endo" meaning inside). y A small brush called a cervical brush is then inserted into the opening of the cervix (the cervical os) and twirled around to collect a sample of cells. The results of the Pap smear are usually available within two to three weeks. . y These cells are collected from a scraping of the area surrounding. she should contact her health care practitioner's office. each woman should ask how she should expect to be informed about the results of her Pap smear. y A second sample is also collected as part of the Pap smear and is called the ectocervical sample ("ecto" meaning outside).y A cotton swab is sometimes used to clear away mucus that might interfere with an optimal sample. the cervical os. y Both the endocervical and the ectocervical samples are gently smeared on a glass slide and a fixative (a preservative) is used to prepare the cells on the slide for laboratory evaluation. The bimanual examination involves the physician or health care practitioner inserting two fingers of one hand inside the vaginal canal while feeling the ovaries and uterus with the other hand on top of the abdomen (belly). If a woman has not learned of her results after a month. Because this sample comes from inside the cervix. At the end of Pap smear testing. A bimanual (both hands) pelvic exam usually follows the collection of the two samples for the Pap smear. but not entering.
. The cells are smeared onto a glass slide (3) or put into a bottle of preservative solution for examination under a microscope. your doctor uses a vaginal speculum to separate your vaginal walls and expose your cervix. The doctor then scrapes a sample of cells from your cervix with a small cone -shaped brush. cotton swab or wooden spatula (1 and 2).In a Pap test.
However. Although smoking is associated with many different cancers. those taken af ter an organ transplant) also have a higher risk of precancerous changes in the cervix. Smoking: One common risk factor for premalignant and malignant changes in the cervix is smoking. although most women with HPV infection do not get cervi cal cancer. Medications: Women whose mothers took the drug diethylstilbestrol (DES) during pregnancy also are at increased risk.Risk for Having a Pap Smear: y No known medical risks associated with Pap smear screening. (See below for details). Weakened immune system: Women whose immune systems are weakened or have become weakened by medications (for example. many women do not reali ze that smoking is strongly linked to cervical cancer. Some women are more likely to have abnormal Pap smears than other women. Other risk factors: Other risk factors for precancerous changes in the cervix and an abnormal Pap testing include having multiple sexual partners and becoming sexually active at a young age. also called the human papillomavirus (HPV). Risk for Having An Abnormal Pap Smear: A number of risk factors have been identified for the development of cervical cancer and precancerous changes in the cervix. HPV: The principal risk factor is infection with the genital wart virus. . About 95% -100% of cervical cancers are related to HPV infection. there are medical risks of not having a pap smear . Smoking increased the risk of cervical cancer about two to four fold.
2. this category was called atypical squamou s cells. "Intraepithelial " indicates that the surface layer of cells is affected. flat cells that lie on the surface of the cervix. this category was called CIN grade II. The presence or absence of cellular abnormalities: The reader then notes whether cellular abnormalities were seen on the slides. The word "squamous " describes the thin. CIN grade III. A " lesion " means that abnormal tissue is present. just ASC. The new system requires the reader to pick one of two choices to add at the end of ASC: ASC US. 3. Under the old system of classification. HSIL: This abbreviation stands for high-grade squamous intraepithelial lesion.Major Categories of Abnormal Pap Smears: ASC-US: This abbreviation stands for atypical squamous cells of undetermined significance. . this category was called CIN grade I. The patient's history: The reader (the person reading the smear) takes into account the woman's history as noted on the lab request by the clinician performing the smear. which means undetermined significance or ASC -H. or CIS. These important terms . LSIL: This abbreviation stands for low-gradesquamous intraepithelial lesion. If the appearance of the Pap smear does not seem to coincide with the woman's clinical history. Under the old system of classification.LSIL and HSIL . which means cannot exclude HSIL-see below. Under the old system of classification. Final Pap Smear Diagnosis: The final Pap smear diagnosis is based on three determining factors: 1. Sample adequacy: The reader then decides whether the sample was adequate for interpretation. a comment may also be made to that effect.are described in greater detail below.
Absence of endocervical cells on the Pap smear. called a cryoprobe. Examples of final diagnoses include: Within normal limits. Unreliable Pap smear due to inflammation. Treatment for Abnormal Pap Smear: Colposcopy: Colposcopy is a procedure that allows the physician to take a closer look at the cervix. It may also be appropriate for women with certain specific findings after conization. Hysterectomy: (surgical removal of the uterus and the cervix) for non-cancerous abnormal Pap smears is now rarely done. Atypical squamous cells of undetermined significance ( ASCUS). as well as the whole transformation zone (the transition between the vagina -like lining and the uterus-like lining). Conization: This is still the standard method to which all other methods are compared. A probe. Low-grade squamous intraepithelial lesion (LSIL). generally by colposcopy. The colposcope is essentially a magnifying glass for the cervix. For colposcopy to be adequate.The final diagnosis is a short statement that summarizes what the reader has found. is first cooled by carbon dioxide and then touched to the . Cryocauterization: Cryocauterization is a simple and safe procedure. the whole cervical lesion. A hysterectomy is appropriate only for those women who are finished with childbearing and have severe pre -cancerous abnormalities that have persisted despite other treatments. After the cervical area is visualized. or High-grade squamous intraepithelial lesion (HSIL). Conization allows the entire area of abnormal tissue to be removed and provides the maximum amount of cervical tissue for laboratory eva luation to rule out the presence of invasive cancer. must be seen. a cone-shaped specimen of tissue (perhaps 1/2 -1 inch long and 3/4 inch wide) is taken from around the endocervical canal.
The benefit of laser therapy is that it may cause less cervical scarring as compared to cryocauterization. All of these procedures have essentially the same overall cure rate of over 90%.abnormal cervical area. This type of laser can instantly boil water and therefore can also be used to kill and vaporize cells. the chances of adequately viewing her cervix may be better after laser therapy. Laser therapy: Laser therapy makes use of the principle that laser light can be produced by electricity running through gas. should the woman need colposcopy in the future. It allows samples to be collected for additional tissue analysis and can be performed in the office under local anesthesia. Large-loop excision (LEEP) of the transformation zone: Large-loop excision of the transformation zone (LEEP) removes the cervical transformation zone (the area where the vaginal-type lining changes to the uterine -type lining) using a thin-wire loop to administer electrocautery. This freezes and kills the cells. However. the procedures do vary considerably in a numbe r of other respects and so will be discussed separately. . the gas is usually carbon dioxide. resulting in the sloughing of the abnormal tissue. This in turn may mean that. In the treatment of cervical les ions.