These two tests are commonly used to screen for cervical cancer:
- A Pap test: This test examines cervical cells to see if they're normal.
- Molecular testing (a newer approach): This checks for the presence of one or more of about 14 types of human papillomavirus (HPV) that cause cervical cancer.
Abnormal results from either the Pap test or molecular testing may indicate cervical dysplasia. In this condition, precancerous cells have formed on the cervix, the lower part of the uterus that connects to the vagina. Left untreated, those cells can turn into cancer.
Cervical dysplasia is typically caused by human papillomavirus (HPV). There are usually no symptoms, although it may be associated with abnormal bleeding or spotting.
How the tests are done
Both the Pap test and molecular testing for HPV involve a similar procedure. As in a routine gynecologic exam, you lie on a table and place your feet in footrests. Your health care provider places an instrument (called a speculum) in your vagina and opens it slightly to see inside.
Cells are gently collected from the surface of the cervix and the area around it. You may feel some pressure or discomfort; some women say it feels like menstrual cramps. You may bleed a bit after the test.
For the Pap test, the cells are sent to a laboratory for examination under a microscope to see if they look abnormal. For the molecular test, the cells are sent to a lab to determine whether the sample shows evidence of a type of HPV that causes cancer.
PAP and molecular test results, and further testing
A normal result for the Pap test means the cells look normal under the microscope. A normal result for the molecular test means you don't have a high-risk type of HPV.
Abnormal results may be a sign of cervical dysplasia. In that case, your provider may recommend further evaluation with a colposcopy, a close examination of the cervix with a magnifying lens.
Colposcopy takes about 10 minutes and often involves doing a biopsy (taking a small sample of tissue). A biopsy can cause some cramping. Two major goals of colposcopy are to determine whether there's cancer on the cervix and to find precancers so they can be treated before they turn into cancer.
Treatment of cervical dysplasia
At UCSF, we offer the full range of treatment options for cervical dysplasia. In certain situations, you may choose to defer treatment and follow a course of watchful waiting.
Alternatively, the abnormal cells created by dysplasia can be removed, either surgically or nonsurgically. Methods for removing the cells include:
- Loop excision: This technique uses a fine wire loop with electrical energy flowing through it to remove the abnormal area of the cervix. The technique is also called a LEEP and is usually done in the clinic using a local anesthetic. It takes about 15 minutes. The tissue that's removed is sent to a laboratory for examination.
- Cone biopsy: In this outpatient surgical procedure, the doctor uses a scalpel to remove a cone-shaped section of the cervix. It's done in the operating room, typically while the patient is asleep. The tissue is sent to a laboratory for examination.
- Laser therapy: A laser (a highly focused beam of light) is used to vaporize abnormal cells. The laser is directed through a colposcope so the area and depth of treatment can be precisely controlled. It's usually done in the clinic using a local anesthetic and takes about 15 minutes.
- Cryotherapy: Your doctor uses a probe to cool the cervix to subzero temperatures. The cells damaged by freezing are shed over the next month in a heavy watery discharge. The procedure is typically done in the clinic without an anesthetic and takes about 15 minutes.