Cervical cancer is a major health concern to women all over the world; thankfully the medical profession has a screening tool in use today that can help prevent it, the Papanicolaou test, or Pap smear. There is a classification system in place to determine the degree of abnormality, and these are the recommendations for the steps to take when they occur. To determine what level of dysplasia (CIN1-mild, CIN2-moderate, CIN3-moderate, adenocarcinoma, or carcinoma in situ) is present, a colposcopy with biopsies is usually performed. Those results determine what further action if any is needed, the 2006 consensus guidelines, which are the most current guidelines available (Wright, Massad, Dunton, Spitzer, Wilkinson, & Solomon, 2007), are outlined here.
Atypical Squamos Cells of Undetermined Significance
Atypical squamos cells of undetermined significance (ASCUS) is the lowest level of abnormality in pap smears, and is not necessarily indicative of any further treatment on its own. However, it is recommended to do further HPV DNA testing with this sort of result is highly recommended (Apgar, Brotzman, 2004). The rationale for this is that if the HPV test is negative for any oncologic types of HPV, then further testing does not need to be done except for repeat cytology in one year. However, if the HPV DNA test does reveal the presence of an oncologic type then colposcopy is the recommended next step.
Low-Grade Squamos Intraepithial Lesions
The next level of abnormal screenings is called low-grade squamos intraepithial lesions (LGSIL or LSIL). A pap smear with LGSIL findings necessitates a colposcopy, and the biopsies are likely to show at least CIN 1 is present and further management needs to be determined.
High Grade Squamos Intraepithelial Lesions
The next level of
abnormality is high grade intraepithelial lesions (HGSIL), which is the highest
level of abnormality for precancerous cells before adenocarcinoma in situ (AIS) which is cancer. Colposcopy results for biopsies taken usually
come back as CIN2 or higher when HGSIL is the pap smear diagnosis, and most
women proceed to having a LEEP done.
Atypical Glandular
Cells
If a pap smear has a result of atypical glandular
cells (AGC) then that can be indicative of a problem within the uterus or
glandular carcinoma. All patients with
this diagnosis should receive a colposcopy, endometrial biopsy, and
endocervical sampling.
Any results, pap or colposcopy, that come back as
“favors neoplasia” or “carcinoma in situ” should have immediate excisional
procedures (such as LEEP) performed (Apgar & Brotzman, 2004). If carcinoma
or severe dysplasia is detected a LEEP is the first step in treatment, followed
by possible surgery to remove the uterus and cervix if warranted.
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