Cervical Cancer and Pap Smears

Cancer of the cervix is a very common cancer for women and it occurs in part of the body which is hidden and not very sensitive. Because of this, it is rare to discover cancer of the cervix at an early stage unless women have regular testing specifically for this type of cancer.

The cervix is the lowest end of the uterus or womb and it is found at the top of a woman's vagina, way out of sight! The cervix has very little sensation and therefore diseases which affect the cervix usually don't cause any pain or discomfort. If a woman is unlucky enough to develop cervical cancer it is unlikely that she will feel anything different until it has grown quite large and has either spread to more sensitive areas or it starts to bleed. By this time there may not be any way to cure the cancer as it may have already spread through the lymphatic system to lymph glands in the pelvis and further into the abdomen and even to the liver and lungs!

Current efforts to reduce the death rate from this horrible cancer are focussed on encouraging women to have regular testing for cancer of the cervix. This is basically a test called a "Pap smear" (short for "Papanicolou" after the man who devised the test) and it is performed by doctors and a few special pap smear clinics.

The test doesn't cause a lot of pain - most women say that it is more embarrassing than painful! To have it done a woman must attend her doctor and request that the test be done. The doctor will ask the patient to lower or remove her underpants and lie on an examining couch either on her side with both her legs curled up into a ball or flat on her back with her knees up and apart. These somewhat undignified positions are essential for a doctor to gently introduce a small rounded instrument into the vagina to enable the cervix which is way up the top of the vagina to be seen. In fact it usually requires a light to be focussed into the vagina before the cervix can be seen.

Actually have the pap smear involves having a soft tiny bristle brush applied gently into the cervix and slowly twisted half a turn. This gentle and painless technique brushes off some loose skin cells from the inner surface of the cervix and its canal. The brush is then rubbed onto a glass slide which transfers a lot of these skin cell to the glass. A preservative and fixative spray then bonds these cells to the glass slide which, once it has dried, is sent away to a specialised laboratory where the cells are treated with pigment stains and examined under a microscope. The trained technicians are able then to spot cells which look abnormal.

The Pap smear is able to reveal changes in cell which occur long before cancer actually develops. In other words, "pre-cancerous" changes, which may one day lead to cancer, can be seen, as well as more obvious changes of cancer itself. There are a number of "grades" of severity of these pre-cancerous or "dysplastic" (pronounced "dis-plastic") changes.

If a woman's pap smear shows either cancerous or pre-cancerous changes and her previous pap smear taken 2 years earlier showed no changes then there's a very good chance that her cancer is very small and hasn't yet had the opportunity to spread and become incurable. Women are notified of any worrying results and are then sent to a gynæcologist for further testing and whatever treatment is considered important.

If a woman has only minor pre-cancerous changes revealed in a pap smear, a doctor may be advised by the laboratory scientist to repeat the pap smear either very soon or within six months.

Common treatments for pre-cancerous or dysplastic changes include:

  1. cautery or diathermy which is a type of superficial burning of the suspicious region of skin of the cervix, and
  2. cone biopsy which is a form of surgery where parts of the cervix are actually cut away and the cervix reshaped so that it can function as the "draw-string of the womb".

Cancer of the cervix often requires quite radical measures to ensure a cure. This often means a complete hysterectomy or removal of the entire uterus (or womb) and also removal of the ovaries and lymph glands within the pelvis. This is major surgery indeed but it does save lives!

However the take home message is that having regular pap smears will enable pre-cancerous changes to be picked up at a very early stage long before cancer develops. This allows very minor treatments to be performed thus preventing the development of cancer.