Screening and treatment of cervical cancer | Blog By Dr. Monica Agarwal, Paras Bliss, Panchkula and Mohali
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PAP test and HPV tests – Screening for Cervical Cancer

PAP test and HPV tests – Screening for Cervical Cancer

by: Dr. Monica Agarwal
Consultant Obstetrics & Gynecology - Paras Bliss, Panchkula

Cervical cancers are caused by oncogenic, high-risk types of HPV which are sexually transmitted. Most HPV infections go away on their own within 1-2 years without any sequels. Cervical infection with high-risk HPV if persists can cause cellular changes which can develop into precancerous lesions and can eventually progress to cancer. It usually takes 10-20 years for a persistent infection with high-risk HPV to develop to cancer.

Screening for cervical cancer

It is done to detect precancerous and early cervical cancer lesions as these are completely curable. Two types of screening are available cytology-based called as PAP smear and HPV testing. PAP can detect abnormal cells, infections and inflammation. HPV testing detects the presence of high-risk HPV types in cervical cells.

How is the test done for Cervical Cancer 

It is done in a clinic during a pelvic examination. A speculum is inserted into the vagina so that cervix is visible. Cells are taken with a wooden or plastic brush and sent to the laboratory after fixing. Conventional one is on a glass slide and liquid is collected in a vial of liquid. In a liquid, both cytology and HPV DNA can be done.

Guidelines for testing for Cervical Cancer 

  • First test at age 21 if sexually active
  • Age 21-29 should be screened with PAP every 3 years
  • Ages 30-65 can be screened with PAP and HPV co-testing every 5 years or with PAP alone every 3 years
  • Women with high-risk factors need to be screened more frequently and even after age 65. High risk are women with HIV, immunosuppressed, exposed to diethylstilbestrol before birth or treated for precancerous cervical lesion or cancer cervix
  • Women who had hysterectomy or removal of uterus and cervix need not be screened. If hysterectomy done for precancerous lesions then screening needs to continue

Interpretation of the results of Cervical Cancer Tests 

Normal-
The report is negative for intraepithelial lesions or malignancy

Abnormal-

  • ASCUS- Atypical squamous cells of undetermined significance. Cells are not totally normal but the doctor is uncertain. Maybe due to HPV or other factors
  • ASC-H –Atypical cells could be high grade and could be precancerous
  • LSIL- Low grade squamous intraepithelial lesion. It is a mild abnormality by HPV infection. Colposcopy with biopsy is usually done and may reveal mild dysplasia or CIN-1
  • HSIL – High grade squamous intraepithelial lesions. More severe and likely to convert to cancer if not treated. Also called for severe dysplasia or CIN-2 or 3
  • Squamous cell cancer is frank cancer of the cervix

Abnormal PAP like LSIL needs colposcopy and biopsy and repeat screening after 1 year. If the biopsy reveals CIN-2 or more, treatment should be done.

Treatment of Cervical Cancer 

  • LEEP- Loop electrosurgical excision procedure
  • Cryotherapy- Abnormality is destroyed by freezing
  • Laser therapy
  • Conization

Screening for women with CIN-2 or above should continue for 20 years even if they are above 65. Women vaccinated against HPV also need to be screened for cancer cervix.

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