Abnormal Pap Smear and Cervical Cancer

Screening guidelines:
Age 21-29: Every 3 years get a pap smear for screening cervical cancer
30-65: Combined cytology, HPV and pap smear every 5 years: takes that long for HPV (serotypes 16, 18 less commonly 31 and 33) to come to light unless HIV coinfection

Normal and Abnormal:



Abnormal HPV (serotypes 16 and 18 cause cancer)



Taking a Pap Smear: many different kinds of cervices:






Eversion: take care to sample the squamo-columnar junction where the columnar cells of the endocervix meet the squamous cells of the vagina. This is where cell changes occur in cervical cancer.

The most common histologic types of cervical cancer are squamous cell (69 percent of cervical cancers) and adenocarcinoma (25 percent)

Cervical cancer is less common in sexual partners of circumcised males.

Oral contraceptive use has been reported to be associated with an increased risk of cervical cancer. A collaborative analysis of data from 24 epidemiologic studies found that among current users of oral contraceptives, the risk of invasive cervical cancer increased with increasing duration of use (≥5 years' use versus never-use: relative risk [RR] 1.90, 95% CI 1.69-2.13). The risk declined after use ceased, and by 10 or more years, had returned to that of never users.

The most common symptoms at presentation are:

Irregular or heavy vaginal bleeding

Postcoital bleeding 

Prevention: includes regular screening with Pap Smear and vaccination twice at least six months apart and at most a year apart between ages 11 and 12 with Gardasil, protective against HPV 31 and 33.

Diagnosis: Pap smear. If Pap smear is abnormal, the diagnosis of cervical cancer is established by biopsy. Symptomatic women without a visible lesion and those who have only abnormal cervical cytology should undergo colposcopy with directed biopsy and, if necessary, diagnostic conization (surgical excision of the entire cervical os and involved tissue).

Treatment: Usually radical hysterectomy, but uterus-sparing conization of cervix can be used in early stage disease. The major prognostic factors affecting survival among women with cervical squamous cell carcinoma (SCC) are stage, nodal status, tumor volume, depth of cervical stromal invasion, and lymphovascular space invasion (LVSI). Given the available data, UpToDate suggests hormone replacement therapy rather than non-hormonal treatments for women with cervical cancer who experience menopausal symptoms. Treatment-induced menopause can result in bothersome symptoms (eg, vasomotor symptoms, vaginal dryness, or dyspareunia).