How Is Cervical Cancer Diagnosed, Part 2

Cancer |

Abnormal smears are divided into three categories:

Atypical squamous or glandular cells of undetermined significance, or ASCUS/AGUS, which are mildly abnormal cells on the surface of the cervix.
Low-grade squamous intraepithelial lesions, or LGSIL, which include human papilloma virus changes and mild dysplasia.
High-grade squamous intraepithelial lesions, or HGSIL, which include moderate dysplasia, severe dysplasia and carcinoma in situ.
These terms have markedly increased the number of Pap tests reported as “abnormal.” Most often with ASCUS/AGUS and LGSIL findings, the doctor will repeat the Pap test in three to six months, since many of these cases will revert to normal. However, if the repeat results are still abnormal, the woman should be advised to undergo colposcopy.

Colposcopy is a procedure where the doctor uses a lighted magnifying instrument or colposcope to look closely at the cervix and then applies a vinegar-like solution to it. The solution will make abnormal cells appear white, while normal cells appear pink.

The doctor may use a camera attachment, which projects the image on a TV screen. This examination usually takes place in the doctor’s office and may or may not include a biopsy, during which the doctor cuts a small sample of any abnormal-looking tissue for a pathologist to examine.

These procedures may cause some bleeding or other discharge. Women may also experience some pain, similar to menstrual cramps. After the colposcopy, the woman is usually advised to not have sexual intercourse for one or two weeks. Less often, the exam and biopsy need to be performed under anesthesia.

Conization and LEEP
In cases in which it is not clear whether the woman has the invasive disease, the doctor may need to remove a larger, cone-shaped biopsy specimen. This procedure is called conization.

Using a scalpel, the surgeon takes a cone of the cervix (much like the nose cone of a space ship). Three decades ago, surgical conization was performed for virtually all abnormal Pap smears, but today it is reserved for special situations.

Loop electrosurgical excision procedure, or LEEP, is a similar procedure. It is also sometimes performed when the results are inconclusive. (This procedure is described under Treating Preinvasive Disease.)

Both procedures require anesthesia, but LEEP is usually performed in the doctor’s office under local anesthesia.