Your latest pap smear showed abnormal cells. Don't panic. The pap smear was done in the first place to pick up these abnormal cells before they turn nasty.

We will now explain what is happening and give you a better understanding . The explanation should not replace your doctors advise and management. Doctors are trained to deal with your problem.

Depending on the pathologist report you will either have a repeat smear or be advised to have a colposcopy.

The instrument use to do a colposcopy is called a colposcope. A colposcope is a special kind of microscope. It enlarges the cervix ( mouth of womb ). Abnormal areas are than easier recognized. It is done by a doctor who is trained to use it. It is done in the same way that pap smears are taken. Abnormal areas are visualized and biopsies taken. The biopsies are done with a special instrument that cuts away very small pieces of tissue. These pieces can than examined and analyzed by a pathologist. The next drawing show the cervix (refer also to CERVIX .You will see two small fragments mark biopsy. The instrument used to take biopsies will remove small fragments of tissues that are smaller than the ones in the example. Your doctor will send them to a pathologist. See PATHOLOGIST The actual fragments that will be removed during the colposcopy are even smaller than the ones in the drawing. There might be a very slight bleeding afterwards, You might not even notice it. There is no need to be scared.

Certain inflammations can also cause the presence of abnormal cells. Inflammatory changes usually dissappear after treatment.

In this discusssion we are only interested in the potentially dangerous cells. The medical classification of these lesions keep on changing but in order to simplify things we use the following classification :

1. Normal

2. Grade I

3. Grade II

4. Grade III

5. Invasive cancer

Grade I, II and III's more recent scientific names need not to be discussed here.

The following drawings show the appearance of the different abnormalities in a simplified way. Only the cells that covers the mucous membrane ( see Glossary) will be shown.

The mening of the symbols in the right border:
1 = Basement membrane. The blood vessels, nerves and connective tissue are below or deeper.The cells of the mucous membrane (skin), that covers the cervix, rest on this basement membrane.
2 = Basal layer of cells. The cells in this layer are actively multiplying to replace the upper cells that are constantly discarded ( layer 6).
3 = Cells in the ldeeper third of the covering skin(mucous membrane).
4 = Cells in the middle third of the covering skin (mucous membrane).
5 = Cells in the upper third of the covering skin.
6 = Old cells that are discarded . They are shead into the vagina.

Use this alos as a key to the next drawings.

GRADE ONE CHANGES

If you look in the middel of the two lower rows, you will see cells that are different from the rest. They represent the abnormal potentially dangerous cells. Their appearance are limitted to the inner third of the mucous membrane. Fortunately some of these cells will be between those scraped off while the papsmeer was taken. thus enabling us to diagnose annormalities early.

GRADE II

The obvious abnormal cells are now also visble in the middle third of the covering cells. More abnormal cells are present among the discarded cells and on the papsmear.

GRADE THREE

The full thickness of the covering cells are effected. The most superficial cells are also effected.
Current opion is that it takes a few years to develop from Grade I to Grade III.
The next stage is invasive cancer.

INVASIVE CANCER BEGINS

The abnormal cells broke through the basement membrane and start invading the underlyning tissue. The blood and lymph vessels (see lymph and lymph nodes in Glossary. are invaded and the cancer spread to the lymph nodes.

We hope you will have a better understanding of abnormal smears. Treatment is necessary and should not be post poned. You went for papsmears and the abnormality was diagnosed early .

Your doctor will discuss the different treatment options. For more infomation about the different options click here

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