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Information On A Cervical (Pap) Smear Test

The Pap test is a screening test for malignant and premalignant changes of the cervix. A positive result indicates that there may be a problem and that further diagnostic procedures must be done. The Pap test is not a diagnostic test. It cannot be used to exclude a cancer of the cervix for a person who has symptoms that could be due to a cervical cancer. Women who have never had a smear often worry about this. For most women the test is painless and for some slightly uncomfortable. It only takes a few minutes to perform.

The cervix is the lower part of the uterus, or womb. Sometimes it is also called the neck of the womb. The uterus is a muscular, pear-shaped organ at the top of the vagina. The lining of the uterus is shed each month, giving rise to bleeding called a period. These periods stop temporarily during pregnancy and will normally continue until a woman has the menopause.

It is possible for your doctor to see and feel the cervix during an internal (vaginal) examination.

The surface layer of the cervix is made up of two different types of cells, flat cells called squamous cells and tall cells called columnar cells. The place where these two cells meet is known as the transformation zone. It is in this area that abnormal cell changes occur. It is these cells, on the surface of the cervix, which are examined in a cervical smear test.

The smear test is a very simple test and takes less than five minutes. It can be slightly uncomfortable but it is not painful.

Once you are lying comfortably on the couch the doctor or nurse will gently insert an instrument called a speculum to keep the vagina open. A small spatula is then used to take a sample of cells from the cervix. The cells are spread onto a glass slide and sent to a laboratory for examination under a microscope. The purpose of the Pap test is to detect changes that may lead to cervical cancer long before cancer develops. Pre-cancer of the cervix is easily treated, and almost always prevents cancer from developing.

Pap tests are done on women who have no symptoms of cancer and have no findings suggesting a cancer. Thus, Pap tests are done only on women who are normal.

Most smears are normal. However, it is common to have a minor abnormality. If the result is abnormal there is usually no cause for worry. It may mean that there are mild changes in the cells and the smear will need to be taken more regularly for a while. If the changes in the cells are more marked you may be referred for colposcopy. If the woman has symptoms or findings suggestive of cancer of the cervix then a diagnostic test must be done to exclude a cancer or to diagnose a cancer. Diagnostic tests are usually biopsies. This is the single most important lesson to learn: if you have a symptom or a finding that could be due to a cancer of the cervix, a normal Pap test never excludes the possibility of cancer.

In the vast majority of instances, an abnormal Pap test results in the diagnosis of a minor change on the cervix. Some of these changes will be premalignant, but most will be of minor significance. They will all have to be evaluated, diagnosed and treated, but most will be easily and effectively treated. Occasionally, a real cancer will be present which is why this is such an important test. Most cancers are visible on examination and can be biopsied as soon as they are seen. Sometimes the cancers are inside the cervix beyond view and the only indication that it is there is the abnormal Pap test.

Sometimes your doctor may ask you to have another smear because the specimen taken was `inadequate'. This means that not enough cells were collected at your first test.

Some test results may be `borderline'. This means that there are slight cell changes on the cervix, which may revert to normal. Further monitoring will be needed, but not necessarily any treatment.

If your test result is borderline you will need to have another smear. If the changes remain, your doctor may recommend that you visit a gynaecologist for further tests.

Pap smears can be abnormal if the cervix is inflamed or irritated. This can be caused by an infection of the cervix, douching, menopausal changes, or irritation. The cervix may also be going through some changes called dysplasia. Dysplasia means the cells on the Pap smear look abnormal under the microscope. Dysplasia isn't the same thing as cancer but may lead to cancer if it is not treated. If inflammation is present in the cells on the Pap smear, it means that some white blood cells were seen on your Pap smear. Inflammation of the cervix is very common and usually does not mean there is a problem. If the Pap smear showed that the inflammation is severe, your doctor may want to find the cause, such as an infection. You may also need to have another Pap smear in six months to see if the inflammation has gone.

The human papilloma virus (Wart Virus or HPV) can be seen on cervical smear tests. It is unclear what the exact relationship is between the wart virus and cell changes. If you have this virus, you will need to have smear tests more often than usual.

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