You just got a call to say that your pap smear is not quite normal?
Ok—first off—relax a bit—it is VERY unlikely that you have cancer. We see abnormal pap smears all the time–several thousand women are seen every day in North America for abnormal cells—way less than 1% will progess to cancer.
So, first off, what is the abnormality?
CANADIAN GUIDELINES FOR PAP SMEAR–click here
Most pap smears are normal, and then you can move along a line, like a train–first stop:
ASCUS Atypical (not typical) Squamous (skin) Cells of Undetemined Significance (we don’t know what the significance is)—like ASK US what this means–we’re not sure! This can be due to recent intercourse, time of the month, dryness with menopause, mild infection……
then: the PRE PRE PRE cancerous stuff
CIN Cervical Intra(in)epithelial (skin) Neo(new)plasia(growth) (In the skin of the cervix there is new growth)
CIN is divided into 1, 2, 3 (mild, moderate, severe)
CIN1-mild is ALSO called LOW GRADE SQUAMOUS (skin)INTRA(in)EPITHELIAL(skin)LESION(growth)–LGSIL
CIN2 (moderate)and 3 (severe)are also called HIGH GRADE SQUAMOUS INTRAEPITHELIAL (in skin)LESION—HGSIL
LAST STOP: this doesn’t happen very often–and regular pap smears is best way to reduce your risk!
Make sure you know what your pap smear says!
Now—the CIN pap smears, and cervical cancer are typically caused by the HPV virus
HUMAN PAPILLOMA (wart) VIRUS
HPV is THE most common sexually transmitted virus out there! If you have had more than once sexual partner, it is very likely that you have the virus! Oh–and by the way–condoms don’t do anything to protect you from HPV—or herpes!!! Condoms can reduce (not eliminate) your risk of HIV, chlamydia , gonorrhea (the clap).
This is a mild case of genital warts–due to HPV
About the Gardasil vaccine—GET the GARDASIL 9—-it covers MORE strains than the Gardasil 4. 10 years ago we were all worrying about cervical cancer with HPV. We still worry about it–but now–more and more cancers have been linked with different strains of HPV.
Farrah Fawcett’s anal cancer was statistically most likely due to HPV. It appears that she either didn’t know this, or maybe wasn’t tested. Her Foundation is putting their money towards anal cancer HPV research. Oh–and for you folks out ther who say–“Well, I don’t have anal sex”—ummmm I believe we are all taught to wipe from FRONT TO BACK–so you could spread virus from wiping!
So–oral sex, and anal sex is a way to get the virus! This is why we are starting to see throat and anal cancers associated with HPV.
The new Gardasil 9 gives some protection against the strain of the HPV (and there are over 100 types of HPV), that can cause anal and throat cancer. Even if you have had the Gardasil 4, experts are recommending that you get the Gardasil 9!
SO—-if your pap smear is abnormal you may be referred for COLPOSCOPY (colpo–is latin for cervix, scope—look at)–we are “scoping out” the cervix. You may be advised to repeat your pap smear in 6 months. If a SECOND pap smear comes back “atypical” or more, then a colposcopy.
So–we put you up in those darn stirrups again—and take a close look at your cervix with a special magnifying scope. We put a vinegar soaked swab against your cervix and let it sit there for a minute or so. The vinegar will make any abnormal area look white.
We then look at your cervix, and if we see areas of concern we take a tiny biopsy–about the size of an apple pip. We also scrape the lower part of your cervix canal. Sometimes the abnormal part is just out of site, inside the cervix.
Do you see the white area? That is the abnormal area, after vinegar has been used.
After biopsies are taken, we take a look to see if you are bleeding and how much. Sometimes you just need a tampon to put pressure on the cervix. Sometimes we have to put a special solution against your cervix to help it to stop bleeding.
WHEN YOU ARE PREGNANT WE DO NOT DO SCRAPINGS INSIDE THE CANAL–OR BIOPSIES, UNLESS WORRIED. We will certainly have you come in after the baby is born for another colposcopy.
So—you get your biopsy back! Now what?
If the biopsy shows nothing, you will likely be asked to get another pap smear in 6 months.
If the biopsy shows LOW GRADE–CIN1–we will follow that with pap smears every 6 months–because these typically will go back to normal within 2 years with no treatment.
If your biopsy shows HIGH GRADE (CIN 2 or CIN3), we will recommend treatment. If you are under the age of 25, we can do another colposcopy in 6 months, and try to wait to see if the problem will clear on its own. We will follow you for up to two years, as long as it doesn;t move on to CIN3. The hope is that your immune system will fight the HPV. The abnormality may go away. If you are OVER 25, we treat. EVERYONE with CIN3 gets treated.
See how the cells look more and more abnormal under the microscope?
Treatment can be FREEZING (called CRYO (cold) THERAPY), or a LEEP (Loop Electrosurgical Excisional (like exorcism–we cut it out) Procedure.
With FREEZING–we are talking COLD!!!
This the probe we use–only the very end of it touches you–we need it looonnng so we can reach your cervix!
The probe is turned on for 3 minutes–then we ‘defrost’ you and freeze you again for 3 minutes.
There is the probe being taken off the cervix–which is white and FROZEN–it takes a few minutes for it to turn pink again. The idea is to freeze the abnormal cells off, like a bad frost bite, and then healthy skin will replace the abnormal area. Of course, this doesn’t get rid of the VIRUS!! SO can it come back?—sigh YES!!!!
LOOP because we use an instrument that has a LOOP on it!
ELECTROSURGICAL–that loop thingie plugs in, and CUTS–hey don’t worry–we REALLY numb you up down there–you won’t feel it!
EXCISIONAL that just means we cut it out (excise it) PROCEDURE
The piece that we remove gets sent to the lab and analyzed. You will need another pap in 6 months for sure and another in 6 months after THAT–and YOU WILL NEVER GO FOR MORE THAN ONE YEAR WITHOUT A PAP–and YOU have to make sure you do this–it is NOT your doctor’s job to track you down wherever you are! That HPV virus just can;t be cut out!!