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What
if I have an abnormal result
From
the brochure "A guide to understanding your abnormal Pap test
result"
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What
does an abnormal Pap test mean?
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Abnormal
results mean a change in the cells of the cervix, located
at the top of the vagina. Abnormal results include a range
of different cell changes.
About
1 in 10 Pap test results are abnormal yet only about 3 women
in every 10,000 will have a Pap test result which shows cancer.
It is important to have any abnormal changes checked to prevent
cancer of the cervix.
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What
happens after an abnormal Pap test?
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This
will depend on the type of result, on your medical history
and any symptoms you may have. Common recommendations for
results are listed in the following tables.
Abnormal
cell changes are divided into low and high grades. High grade
changes are the more serious.
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LOW
GRADE - which may be referred to as a Low Grade Epithelial Abnormality
| What
your Pap test result says |
What
does this mean? |
What
usually happens next? |
| Non-specific
minor changes |
This
means there are some changes that need to be checked sooner
than 2 years. Often these changes will get better with
time. |
You
will be advised to have a Pap test in 12 months.
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| Wart
virus, sometimes also called HPV, short for human papilloma
virus |
Wart
virus is very common. Often these changes will get better
with time. Visible warts on the cervix are not common.
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You
will be advised to have a repeat Pap test in 6 months.
If after more tests the wart virus changes are still present
you will be referred for a colposcopy. |
| CIN
1, mild dysplasia |
These
are changes that need to be checked more closely by other
tests. |
You
will be advised to have a colposcopy and biopsy. |
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HIGH
GRADE - which may be referred to as a High Grade Epithelial Abnormality
| What
your Pap test result says |
What
does this mean? |
What
usually happens next? |
| CIN
2, moderate dysplasia |
These
are more severe abnormal changes that may get worse if
left untreated. |
You
will be advised to have a colposcopy and biopsy and then
treatment if these tests confirm CIN 2. |
| CIN
3, severe dysplasia, sometimes called carcinoma in-situ |
These
are the most severe abnormal changes that may get worse
if left untreated |
You
will be advised to have colposcopy and biopsy and then
treatment if these tests confirm CIN 2 or CIN 3. |
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(Dysplasia
describes a range of changes that need to be checked more closely
by other tests. Dysplasia may also be referred to as CIN. CIN is
short for cervical intraepithelial neoplasia)
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A
colposcopy is an examination which shows where the changed
cells are and what they look like. The colposcope is like
binoculars which sit on a stand at the end of the examination
couch. It is used to magnify and look at the cervix. A speculum
is used to hold the vagina open, just like having a Pap test.
The colposcope does not enter the vagina.
Colposcopy
can be done in a hospital, clinic or doctor's rooms.
Colposcopy
should not be painful but it may be uncomfortable because
of the time taken to look at the cervix.
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If
an abnormal area is seen using the colposcope, the doctor
will take a biopsy using local anaesthetic. A biopsy is a
very small piece of tissue usually only a few milliliters
in diameter. It is important to take a biopsy to test the
abnormal cells. The Pap test only gives an indication of the
changes, but the biopsy allows a more accurate assessment.
The
biopsy is sent to a laboratory for testing. Biopsy results
can take about a week. Once the result is known, your doctor
will discuss whether you need any treatment. Your doctor will
also discuss treatment options if necessary.
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If
the biopsy result is CIN 1 or mild dysplasia there is a choice
of treatment. You and your doctor can monitor the changes
by having a Pap test every 6 months because cell changes could
return to normal. Alternatively you can choose to have treatment
straight away. Discuss this with your doctor.
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If
the biopsy result is CIN 2, moderate dysplasia or CIN 3, severe
dysplasia you will usually need to have treatment as it is
difficult to tell if these abnormal changes will progress.
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There
are a number of different treatments including loop excision,
laser therapy, diathermy and cryosurgery.
All
these types of treatments are effective, your doctor will
discuss the treatment with you. If the biopsy shows high grade
abnormality, CIN 2 or CIN 3, sometimes a cone biopsy is used.
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| Loop
Excision |
This
method uses an electric loop to remove the abnormal cells.
This method may also be referred to as wire loop excision,
LEEP or LLETZ. |
| Laser
Treatment |
This
method uses the heat from a laser beam to destroy the
abnormal cells. |
| Diathermy |
This
method uses heat carried in a wire to remove the abnormal
cells. |
| Cryosurgery |
This
method uses freezing to destroy the abnormal cells. |
| Cone
Biopsy |
This
treatment removes a small cone shaped piece of tissue
from the cervix. It is used to provide a larger sample
for assessment. |
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Loop
excision, laser, diathermy and cryosurgery are usually done
in the doctor's rooms or as a day patient or an outpatient
in a hospital or clinic. Local anaesthetic is usually used.
The procedure takes about 30 minutes. You will not normally
have to stay overnight.
A
cone biopsy sometimes requires general anaesthetic and sometimes
staying in hospital overnight.
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Some
women experience abdominal pain like period pain after treatment.
It is normal to have some watery or dark vaginal discharge
for several weeks.
You
will be advised not to have sexual intercourse or use tampons
for a short time. Ask your doctor.
Some
women find that abnormal results and the tests and treatments
involved can be an emotional experience. It may help to talk
to your friends or your doctor about how you feel.
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The
doctor will need to check how the treatment went in 2 to 6
months. Another colposcopy and another Pap test are done at
this visit. You will need Pap tests every 6 or 12 months until
your doctor advises you to return to Pap tests every 2 years.
Women who have had CIN 2 or CIN 3 should continue to have
Pap tests every year. These follow-up checks are very important.
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- WHAT
does my Pap test result mean?
- WHAT
does my biopsy result mean?
- WHAT
sorts of treatments are available?
- WILL
I need to rest or have time off work after having treatment?
- WHAT
can I expect after treatment?
- WHEN
do I need my next check-up?
- HOW
much will it cost?
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For
a free copy of the booklet, "Pap test result: A guide
for women with an abnormal Pap test", please phone the
NSW Cervical Screening Program toll-free on 131 556.
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