Cervical cancer is the most common Gynecologic cancer, affecting thousands of women in the US every year. Screening for the early stages of precancerous cells, the Pap smear, has reduced the incidence of cancer over the past 30 years. While most advanced cervical cancers are found in women who have not been getting pap smears, most precancerous lesions are found in women who do get regular pap smears. Their first sign of a problem is an abnormal pap smear on a routine examination.
The abnormal pap smear generally comes as a shock to most women, and they often assume the worst that they have cancer and their life is over. Not So. Most abnormal pap smears can be easily treated with minimal damage to the cervix and minimal impairment of future fertility. Most women with abnormal cells on their pap smear do not need a hysterectomy.
Abnormal pap smears are generally evaluated with a specialized examination called colposcopy. A magnifying microscope is positioned to see the fine details of the cervix, and the tissue is stained using a dilute form of vinegar. Abnormal appearing cells are sampled with a biopsy, and often several biopsies of different areas of the cervix are taken. Dr. Holley uses local anesthetic for most biopsy procedures to minimize your discomfort during the procedure.
The biopsy may reveal just inflammatory changes, no cancer cells at all. This can be caused by a transient vaginal infection, use of tampons, or the presence of an IUD. Generally no treatment is needed aside from a general antibiotic if active infection is found.
Often the biopsy shows Mild Dysplasia, precancerous cells that are usually caused by HPV human papilloma virus. Most of the time, mild dysplasia resolves on its own as your immune system controls the expression of the virus. A period of observation with frequent pap smears and microscopic examinations may be all that is needed.
If the biopsy shows Moderate or Severe Dysplasia, treatment is recommended. This more advanced dysplasia is also caused by HPV, but usually does not resolve on its own. Treatments include cryosurgery to freeze the abnormal cells, or LEEP – loop electrode excision procedure, to excise the abnormal cells. There is no medication or hormone treatment that can remove the abnormal cells.
All of the methods of removing abnormal cells involve some risk of recurrence, and so frequent pap’s are obtained for 1-2 years after the procedure, and annual pap smears are required for the rest of your life, even after a hysterectomy.
All of the methods of removing abnormal cells also involve some risk of an adverse effect on a future pregnancy. The risk of premature labor or miscarriage is increased by any operation that removes cells from the cervix. Some women may experience scarring of the cervix such that they are unable to get pregnant after the procedure. If you plan to have another child after treatment for an abnormal pap smear, make sure Dr. Holley is aware of your plans. There are precautions we can take to reduce these risks for you.