Hill View Hospital and Research Center
Hill View Road, Bariatu, Ranchi – 834008, India
Cancer of the cervix is the second most common cancer in women caused by genital Human Papiloma Virus (HPV) worldwide with 5,24,000 new cases in 1995. In developing countries, it is the most common cancer in women 2,3,4. Screening for cervical cancer has become an accepted clinical practice. The prolonged early phase of cancer in situ can be detected by Pap smear. Current policy suggests that all women should have Pap smear at the beginning of sexual activity and then every three years thereafter. A periodic pelvic examination5 is also recommended.
MATERIALS & METHODS:
A pap smear essentially involves collection of cells lining the cervix in the ectocervix and endocervix (Mouth of the uterus) using a cytobrush. It is a very simple, painless screening procedure that can be performed as an office procedure by a trained cytologist/pathologist/ gynaecologist. The cells are than fixed with a fixative like ethanol, polyethylene gycol, stained with Papanicoulau’s stain and than studied microscopically by a cytopathologist/trained cytologist.
Interpretation of the Pap smear results
‘Borderline’ smear results:
This means that cell changes are seen but that they are so near normal that they will go back to normal on their own. A repeat smear (probably in 6 months) is done.
Abnormal smear results:
Abnormal smears can be reported as mild or slight cell changes (mild dyskaryosis), moderate cell changes (moderate dyskaryosis) or severe cell changes (severe dyskaryosis). They can be also reported as CIN 1 (Mild), CIN 2 (moderate) or CIN 3 (severe) cell changes. (fig. 1-3) The three grades of CIN (cervical intraepithelial neoplasia)1 relate to the thickness of the skin covering the cervix that is affected.
A repeat smear
A repeat smear may be required when the sample obtained could not be read properly because:
- Not enough cells were on the slide
- Infection of the cervix
- Test done during menstrual period
- The cervix was inflamed and so the cells could not be seen clearly enough.
In all these cases, the smear has to be repeated. If the patient has an infection, she is given some treatment