PAP SMEAR

INTRODUCTION
Pap smear or Pap test is performed to check for cervical cancer in females. Pap smear
involves the scraping of the cells from the cervix, which is a narrow, lower end of the
uterus, present at the top of the vagina. This collection of cells sample is then sent to
the lab to be reviewed under the microscope. The Pap smear test enables the physician
to make an intervention and thereby helps in curing cervical cancer, if detected at an
early stage. This test may also detect the risk of developing cervical cancer sometime
in the future or detect any other relevant changes in the cells present in the cervix. The
Pap test is an important step in the early diagnosis of developing cancer. Pap test is a
quick, simple and painless screening test and is usually advised for every woman
between the age range of 21 and 65 years.

A Pap test is usually performed with the pelvic examination. In the women above 30
years, Pap test is combined with a test for HPV i.e. human papillomavirus. This is a
sexually transmitted disease-causing virus that can lead to cervical cancer in many
women.
Usually, the doctor and the patient decide on when to undergo the Pap test and how
frequently it should be done. The doctors generally advised going for Pap smear at the
age of 21 years and then once every 2 to 3 years. In the women aged 30 years or
above, the doctor advises the Pap test every 3 years or 5 years, in combination with
the HPV test. In some cases, if the woman has certain risk factors for developing
cervical cancer, the doctor can suggest a Pap test more frequently. Some of the
factors, which can increase the risk of cervical cancer include:
A diagnosis of cancer of the cervix or a previous Pap test that showed some
precancerous cells.
An HIV infection in a woman
Exposure to DES i.e. diethylstilbestrol, before birth.
 Weak immune system due to the organ transplant, chronic use of corticosteroid or
chemotherapy.
There are certain cases, wherein patients do not require pap test, as mentioned below.
After the total hysterectomy procedure — After the removal of the uterus and the
cervix of the woman, the patient should consult the doctor if the Pap test is to be
continued. In case, the surgical procedure of hysterectomy was conducted to eliminate
the non-cancerous lesions, then the routine Pap test can be discontinued. However, if
the hysterectomy procedure was conducted for a cancerous or precancerous lesion,
then the doctor advises to continue undergoing Pap test regularly.
Age factor — Older women can discontinue routine Pap testing. In the women aged
30 years or above, the doctor generally advises the Pap test every 3 years or 5 years,
in combination with the HPV test. However, after the age of 65 years, and in case of
normal screening results, the patient might be advised to stop the Pap test.
Pap test is a quick, simple and painless screening test for cervical cancer detection.
However, sometimes, the Pap smear may give false-negative results, which means
that the test report shows no abnormality, when actually there is a presence of
abnormal cells. There are some factors which may cause a false-negative report, as
mentioned below.
A very small number of abnormal or cancer cells
Inappropriate sample collection of the cervical cells
Presence of some unclear inflammatory blood cells.
Cervical cancer takes a long time to develop. Hence, it is possible for the abnormal or
cancer cells to go undetected. In case, the Pap test gives unclear results, the doctor
might advise undergoing some other test to confirm the diagnosis.
Some side effects and complications associated with the Pap smear test are as
mentioned.
Vaginal bleeding or blood spotting after the Pap test. Excessive or heavy bleeding is
specifically a concern.
Chances of infection if the instrument is not sterilized.

• BEFORE THE PROCEDURE:

The doctor or the nurse explains the procedure in detail to the patient. Some pointers to be
considered, before the Pap test to ensure its efficacy are as mentioned.

Avoid using any vaginal medicines

Avoid douching
Avoid having intercourse
Do not use tampons for at least 24 hours before the Pap test.
Avoid using spermicidal foams, jellies or creams for at least two days before the Pap
test, as using such products may wash away the abnormal cells. Avoid scheduling
the Pap test during the menstrual period.
 DURING THE PROCEDURE:

The Pap test is done in the outpatient facility or the doctor's examination room. The
Pap test takes only a few minutes to complete. The patient may be asked to change
into a hospital gown or undress the part below the waist for testing.
The patient is asked to lie down on the back on the examination table with the knees
bent. The heels are rested on the stirrups for support. The doctor then inserts or puts
an instrument known as a speculum, into the patient's vagina. The speculum helps to
hold the vaginal walls apart for the doctor to clearly see inside the cervix of the
woman. The speculum insertion may cause a feeling of pressure exertion in the vagina
or pelvic part.
The doctor then collects the samples of the cells of the cervix with the help of a small
and soft brush or sometimes with a small scraping instrument known as a spatula. The
process of scraping or collecting cervical cells is completely painless.

• AFTER THE PROCEDURE:

Pap test can be of multiple types, depending on the type of instrument used in
collection of sample. In case the doctor puts the collected cervical sample in a
container with a special liquid to preserve the cervical sample, the test is known as a
liquid-based Pap test. In case, the collected sample is directly put onto a glass slide, the
procedure is known as a conventional Pap test.
The collected cervical sample is then sent to the lab for further testing for the
detection of cancer cells. The collected cervical sample is put under the microscope to
examine closely for any precancer or cancer cells.
 After the test, the patient can change back to normal clothes and can return back to
normal routine activities without any problem. The patients can easily drive back
home on their own.
After the report for the test is ready, it is sent from the lab to the concerned doctor.
The doctor discusses the Pap test report with the patient in detail.
If the report is normal or negative, it means that the cervical cells are normal and there
is no sign of cancer growth in the vagina of the patient. In such cases, the patient is
asked not to go for further testing and wait until the next routine Pap test schedule.

The doctor may inform the patient about some of the following mentioned abnormal cells:

Atypical squamous cells of undetermined significance (ASCUS) — The squamous cells

are flat and thin in nature and usually grow on the healthy cervix's surface. On the
detection of ASCUS, the Pap test report states the growth of some abnormal
squamous cells, however, these changes do not give a certain diagnosis of the
presence of precancerous cells. If the patient undergoes a liquid-based Pap test, the
doctor can analyze the sample again to examine the presence of viruses such as HPV
(Human Papilloma Virus),that may develop cancer cells in later stages. If even after
the liquid-based Pap test, no high-risk viruses are found, then the abnormal cells
identified by the Pap test earlier are of no concern. Further testing is advised only if
the high-risk viruses are found in the sample collected.
Squamous intraepithelial lesion — Presence of such type of cells in the Pap smear,
indicates that there are precancerous or cancer cells present. If the cell changes found
are of low-grade, then the doctors can detect from the cell shape, size, and other
characteristics, if there is a presence of a precancerous lesion. This detection of
precancerous lesion determines that the precancer cells will grow into cancer cells in a
later period or over years. If the cell changes are of high grade, then there is a high
risk of development of cancer very soon. In such cases, the doctor advises the patient
to go for some further testing.
Atypical glandular cells — Glandular cells secrete mucus and grow within the uterus
and the opening of the cervix. The presence of atypical glandular cells is slightly
abnormal but there is no clear evidence if they are cancerous or not. Further testing
may be advised in this case as the doctor will know the source and significance of
these abnormal cells, only through further tests.
Adenocarcinoma cells or squamous cell cancer — The presence of these cells in the
collected sample strongly indicate the presence of cancer. Adenocarcinoma refers to
the cancer cell growth in the glandular cells. Squamous cell cancer, refers to the
arising of cancer in the flat surface cells of the cervix or vagina. In case of detection of
these cells, the doctors advise a prompt evaluation.

If the Pap test shows abnormal results, the doctor may suggest the patient to go for a
procedure known as colposcopy. Sometimes, the doctors also recommend a biopsy test, in
order to get a confirmed diagnosis.