What treatments are available if a Pap smear is abnormal?
If a Pap smear is interpreted as abnormal, there are a number of different
management and treatment options including colposcopy, conization,
cryocauterization, laser therapy, and large-loop excision of the transformation
All of these procedures have essentially the same overall cure rate of over
90%. However, the procedures do vary considerably in a number of other respects
and so will be discussed separately.
Colposcopy is a procedure that allows the doctor to take a
closer look at the cervix. The colposcope is essentially a magnifying glass for
the cervix. For colposcopy to be adequate, the whole cervical lesion, as well as
the whole transformation zone (the transition between the vagina-like lining and
the uterus-like lining), must be seen.
During colposcopy, the cervix is cleaned and soaked with 3% acetic acid
(vinegar). This mild acid not only cleans the surface of the cervix but it also
allows cellular abnormalities to show up as white areas (called acetowhite
epithelium or acetowhite lesions).
If suspicious areas of cervical tissue are seen during colposcopy, a biopsy
(tissue sampling) is often done. The sample is sent to the laboratory for
analysis by a pathologist, and the biopsy results determine the next step in the
The procedure is essentially painless and quite simple, usually taking only
several minutes to perform. Generally, the woman is instructed not to have
intercourse, douche, or use tampons for about a week afterwards if a biopsy is
done. Pregnancy is not a contraindication to colposcopy. Colposcopy can
adequately evaluate 90% of women who have abnormal Pap smear results.
Conization allows the entire area of abnormal tissue to be
removed and provides the maximum amount of cervical tissue for laboratory
evaluation to rule out the presence of invasive cancer. After the cervical area
is visualized, generally by colposcopy, a small cone-shaped specimen of tissue
is taken from around the endocervical canal.
Conization is usually done on an out-patient basis under anesthesia in a
hospital or surgical facility. For three weeks after the procedure, the woman
needs to avoid douching, and using tampons and refrain from sexual intercourse.
Cure rates close to 100% are achieved with conization as long as the cells
along the margins of treatment are normal.
With conization, there are associated risks from anesthesia and postoperative
hemorrhage (bleeding-in about 10% of cases) as well as possible future adverse
effects on fertility. Conization is generally performed only on women who have
had severe changes on biopsy, have adenocarcinoma in situ (a diagnosis of cancer
in the inner portion of the cervix), or whose Pap smears suggest they may have
some invasion of cancer into the nearby tissue.
Large-loop excision (LEEP) of the transformation zone
Large-loop excision of
the transformation zone (LEEP) removes the cervical transformation zone (the
area where the vaginal-type lining changes to the uterine-type lining) using a
thin-wire loop to administer electrocautery. It allows samples to be collected
for additional tissue analysis and can be performed in the office under local
Specialized (more frequent) follow-up is necessary after LEEP. This follow-up
includes Pap smears, colposcopy, and sometimes other techniques. This is now the
most commonly used treatment for Pap smear abnormalities.
A hysterectomy for the treatment of abnormal Pap smears is appropriate only for those women who are finished with childbearing and have severe pre-cancerous abnormalities that have persisted despite other treatments.