Abnormal Cervical Cells and Cervical Cancer

If abnormal cells are shown on a Pap smear, do they indicate cervical abnormalities?

Abnormal cells may be caused by inflammation or lack of estrogen after menopause. They may, however, indicate abnormalities in the cervix as well. Cervical abnormalities are a spectrum of conditions which range from Low Grade Squamous Intra-epithelial Lesion (LGSIL), High Grade Squamous Intra-epithelial Lesion (HGSIL) to cervical cancer (CA Cervix). If a Pap smear showed these conditions, colposcopy examination is needed for further investigation.

Range of Cervical Abnormalities

Normal → LGSIL → HGSIL → Cervical Cancer

What is a colposcopic examination?

Colposcopic examination is a simple investigation procedure that is similar to the usual gynaecological examination. A vaginal speculum is inserted into the vagina to expose the cervix. The doctor will then use a telescope-like instrument to examine the cervix at a distance of about 12 inches. Some diluted vinegar will be applied and the cervix will be re-examined. The whole procedure takes about 15 to 20 minutes. During the examination, the doctor may take biopsies from any suspicious areas of abnormalities for histological diagnosis.

Is treatment required if colposcopy showed LGSIL?

LGSIL indicates very early and mild changes in the cervix. At least 50% of these cases will spontaneously regress within a year or two. Therefore most women are put under observation with no immediate treatment. However, treatment may still be given if the lesion is persistent. Only a small proportion of women may have persistent disease that progresses into cervical cancer. As such deterioration can often be detected by regular Pap smear check up; with the use of appropriate treatment, chances of the persistent disease developing into cancer can be reduced.

What should be done if colposcopy showed HGSIL?

Treatment is required as the chance of cancerous changes is much higher. LEEP (Loop Electro-excision Procedure), Laser Therapy and Cryotherapy are minor operations used to prevent the progression into cancer. In Hong Kong, LEEP is the most preferred procedure to treat precursors of cervical cancer.

Operations are usually done after menses to ensure that the woman is not pregnant. The whole procedure, which takes about 20 to 30 minutes, is very safe and can be done under local anaesthesia or general anaesthesia, depending on the size and extent of the lesion and characteristics of the patient. Even when the operation is done under local anaesthesia, the patient would not feel much pain.

What follow-ups are required after examinations or treatment of the disease?

More frequent Pap smears are required in the initial period after examinations or treatment. Patients should pay follow-up visits according to their doctor’s recommendations. If thereafter all pap smears show normal results for a certain number of years, the woman can then get back to routine screening programs.

Cervical Cancer

Cervical Cancer is a common female cancer caused by certain types of human papillomavirus (HPV).

Who are at higher risk of Cervical Cancer?

Women who started having sex at young age
Women who had multiple sex partners, or partner had multiple sexual partners

What are the signs and symptoms of Cervical Cancer?

Cervical Cancer in its early stage does not give rise to any conspicuous symptoms
In advanced stages, there may be abnormal vaginal bleeding or discharge

HPV Vaccine

What is 9-in-1 HPV vaccine? How should the vaccine be given?

  • The 9-in-1 HPV vaccine contains Human Papillomavirus (HPV) 6, 11, 16, 18, 31, 33, 45, 52, 58 L1 protein. It prevents genital warts, premalignant genital lesions and cancers affecting the cervix, vulva, vagina and anus caused by HPV types included in the vaccine.
  • Based on the information from the vaccine’s manufacturer, the vaccine should be given within half a year. People who are 15 years old or above need 3 doses, after the first injection, the second injection will be given 2 months later and the third injection will be given after another 4 months. People who are 14 years old or younger only need two doses, so the first injection will be followed 6 months later by the second injection. Currently there is no evidence that further booster is needed.

Can Cervical Cancer be prevented by HPV Vaccine?

  • For girls and women aged 9 or above who have not started sexual activities, HPV vaccine can significantly reduce the chance of getting cervical cancer.
  • For women who have been sexually active, the effectiveness of HPV vaccine varies. They should discuss with their doctor first before deciding on having vaccination.
  • Vaccination is not 100 percent effective in preventing cervical cancer. No matter they have been vaccinated or not, all sexually active women should have regular pap tests.

Does the vaccination cause any transient reactions? 

  • The safety of the HPV vaccine is widely accepted by many monitoring agencies in USA, Canada, Europe, and the World Health Organization. Transient reactions after injection include: pain and swelling at the injection site, skin redness or itching, fever, headache, etc.
  • If the problem persists, you should consult a doctor and tell the doctor about your recent vaccination. Please inform your doctor before injection if you have any of the following conditions: allergic reaction to yeast or vaccines; pregnancy; disease of the immune system; low platelet count; blood clotting problem causing continued bleeding after injection, injury or tooth extraction; and any fever or medication taken on that day.

How to prevent Cervical Cancer? 

  • Prevention of Cervical Cancer takes more than HPV vaccination. Avoid risky sexual behavior by maintaining a stable and monogamous relationship, using a condom every time, and do not smoke or drink alcohol, so that your own immune system can resist the virus.

The Pap Test

  • The pap test is used to detect early changes in the cells of the cervix. Appropriate treatment of abnormal changes can prevent progression into cancer
  • Sexually active women should have regular pap tests
  • The procedure is simple and painless
  • The doctor inserts a speculum into the vagina so that the cervix is easily seen. She/He then uses a special plastic broom-like device to collect the cells from the cervix. The broom is rinsed in an individual bottle containing a preservative solution. The cytology samples are then sent to the laboratory for processing.

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