What is a cervical smear test?
It is a test where many thousands of cells that have fallen off the skin of the cervix (exfoliated) are collected and spread on a microscope slide. The cells are stained using a special protocol developed by the originator of the test, George Papanicolaou, and examined under a microscope by a specially trained pathologist.
What is a “borderline” smear?
Smears are reported as borderline if the changes seen in the cells do not amount to mild abnormalities (as described in the abnormal smear section) but the cells are still not completely normal. I like to think of it as “a half” on a scale of one to three. By that I mean that the abnormalities are barely on the scale, but the cells are still not quite normal.
What does an “abnormal” smear test mean?
An abnormal smear test suggests the possibility of an area of skin on the cervix where the cells are growing a bit faster than normal. We know that if such an area of rapidly growing cells is present then, if left over a number of years, it may become a cancer.
Do the abnormal areas of skin cause any symptoms?
No. To the naked eye the skin of the cervix will look entirely normal. No bleeding or discharge will occur and no pain or change in the menstrual cycle occurs when CIN is present.
Does an abnormal smear mean I have a cancer?
No. The changes described above are not cancer. To become a cancer, further changes need to occur in the abnormal cells to give them the ability to invade into the tissues beneath the skin. Cells in the CIN do not have that ability and so are confined to the skin. Cancer is a very different entity.
Do these abnormalities go away without treatment?
Low grade abnormalities (borderline changes or mild atypia) do commonly resolve. High grade abnormalities (moderate and severe changes) very rarely resolve. It is best to discuss with your doctor what further action is necessary.
How are the abnormalities graded?
Abnormalities seen on smears are graded as mild, moderate or severe depending upon how abnormal the cells appear. Similarly, abnormalities seen on biopsies of the skin are correspondingly graded as mild, moderate or severe dysplasia. These are equivalent to CIN 1, CIN 2 and CIN 3 respectively. Even severe abnormalities only suggest changes that might become a cancer if left for a number of years. None of these findings suggest the presence of a cancer.
Is the smear test accurate?
The smear test is about 95% accurate in the best laboratories. In many labs the accuracy is only about 80%. The cells seen on the smear come from all parts of the cervix, not just from the abnormal area. If the abnormality is very small, most of the cells will be normal, and only a very few abnormal cells may be present making diagnosis very difficult for the pathologist. This is why it is important to follow up smear tests with “borderline” or “inconclusive” results. Although the possible ramifications can seem scary, the likelihood is you do not have any serious problems, so the best course of action is always to talk through everything with your doctor.
What is CIN?
CIN is short for cervical intraepithelial neoplasia. This seems a complicated medical term, but when translated it is easy to understand. “Cervical” is because the skin is on the cervix. “Intra” means within and “epithelial” means skin so intraepithelial means that the abnormal cells are confined to the skin and therefore have not spread at all. “Neoplasia” is a collective term for any areas of tissue where the cells are growing faster than they should. “Neo” means new and “plasia” means growth. Another term that is used instead of CIN is “dysplasia”.
What are the abnormalities on a smear test called?
When cells are abnormal on a smear test “dyskaryosis” is said to be present, or the cells are said to be dyskaryotic. This is a technical term describing the abnormality shown by these cells when seen individually in a smear test.
What is Liquid Based Cytology?
Smears used to be taken using a wooden spatula to collect the sample from the cervix and then spread it directly onto a glass slide. A modern alternative to this is liquid based cytology where the sample is collected on a brush and transported in liquid. A machine in the laboratory then spreads the cells in a thin uniform layer across the slide making it easier to see the individual cells.
What is carcinoma-in-situ?
This term is not now in current use but was previously used for some CIN 3 lesions. The term “carcinoma” may sound a little frightening, since it is another word for cancer. However the “in-situ” part of this term reflects that the abnormality is confined to the skin, and so is not behaving like a cancer.
What is the Human Papillomavirus?
Human Papillomavirus (HPV) is the name for a group of viruses that cause warts in various parts of the skin. HPV are remarkably specific in where they grow. So, for example, the virus types that cause hand warts rarely will cause warts on the feet. HPV types that cause genital warts cause only very low grade abnormalities on the cervix.
Should I be worried if I have HPV infection on my smear test?
No. HPV infection is very common and most of the time the body will recognise the virus and develop an immune response that will stop the virus growing. However, this may take a number of months or years.
How would I know if I had an HPV infection?
HPV infections on the cervix cause no symptoms at all, and are usually identified at the time of a smear test. HPV infections on the vulva are associated with genital warts and these can also occur in the vagina.
How can HPV infection of the cervix be treated?
No treatment has been shown to be effective against HPV on the cervix. For this reason HPV infection alone is not usually treated. Only if the cells develop further abnormalities should they be treated.
What happens to HPV infection of the cervix?
Just as hand warts disappear spontaneously after a number of months or years, so HPV infection of the cervix resolves spontaneously after an interval of months or years.
How can HPV infection of the cervix be treated?
No treatment has been shown to be effective against HPV. For this reason HPV infection alone is not usually treated. Only if the cells develop further abnormalities should they be treated.
What is colposcopy?
Colposcopy is a detailed examination of the cervix. A speculum is used in the vagina to allow the cervix to be seen just like for a smear test. The colposcope is a microscope that remains outside the body and magnifies the view of the cervix 10 to 20 times. During the examination the legs are supported by leg rests. The procedure does not usually hurt at all, although some women may experience a bit of discomfort.
What does colposcopy show?
Colposcopy is used to identify where any areas of abnormality are. A very dilute solution of acetic acid is used to stain the cervix. With this solution the abnormal skin looks white and may have patterns which allow it to be recognised when compared with healthy skin. Most of the abnormalities we are looking for occur at the squamo-columar junction.
How does colposcopy help in the management of CIN?
Colposcopy allows us to identify abnormal skin on the cervix. Often a biopsy will be taken from any areas of skin that appear abnormal. That biopsy may determine whether treatment is necessary or not.