Cervical cell abnormalities follow-up, evaluation, and treatment
Abnormal Pap test result and treatment Abnormal Pap test result Follow-up and treatment when needed Atypical squamous cells (ASC)
- ASC-US (undetermined significance)
Watchful waiting includes follow-up Pap tests every 4 to 6 months.
Human papillomavirus (HPV) test for high-risk HPV types may be done.
- If results are positive, it means high-risk types of HPV are present and colposcopy is recommended.
- If results are negative, it means that no HPV is present or low-risk types of HPV are present and watchful waiting with follow-up Pap tests in 1 year can be chosen. If a repeat test shows ASC-US or low-grade squamous intraepithelial lesions (LSIL), then colposcopy is done. If a repeat test shows normal results, you may return to your regular Pap screening schedule.
Colposcopy with possible cervical biopsy may be done after watchful waiting or in special situations.
Further treatment may be recommended depending on the Pap test results and your medical history.
- ASC-H (cannot exclude high-grade squamous intraepithelial lesions [HSIL])
Colposcopy with possible cervical and endocervical biopsy
Further treatment may be recommended depending on the colposcopy and biopsy results and your medical history.
Low-grade squamous intraepithelial lesions (LSIL)
Colposcopy with possible cervical biopsy (depending on what is seen on colposcopy) is usually recommended. Watchful waiting after colposcopy may be recommended for women who are reliable for follow-up.
Watchful waiting, including repeat Pap tests, may be recommended for teenage women and women who are past menopause. Watchful waiting usually will include a repeat Pap test.
HPV testing is not done for this abnormality because most women with LSIL have a positive HPV test result, which means high-risk types of HPV are present.
Further treatment may be recommended depending on the colposcopy results and your medical history.
High-grade squamous intraepithelial lesions (HSIL)
Colposcopy with cervical biopsy. A biopsy from the inside opening of the cervix (called an endocervical curettage) will probably be done. A biopsy of the lining of the uterus (endometrium) is rarely done.
Further treatment, such as cone biopsy, cryotherapy, LEEP, or laser surgery, is likely to be recommended or done after colposcopy. If a hysterectomy is recommended for other gynecologic problems, it will also treat HSIL.
Follow-up after treatment includes a Pap test and colposcopy to monitor the success of treatment.
Atypical glandular cells (AGC)
Colposcopy with cervical biopsy and endocervical curettage. A cone biopsy may be recommended. A biopsy of the lining of the uterus (endometrium) may also be done at this time.
Cervical biopsy is done to confirm cancer in abnormal cervical cells. A cone biopsy may be done to determine whether cancer is present high in the cervical canal.
Total or modified hysterectomy to surgically remove a woman's cervix, uterus, and other affected pelvic organs may be done.
Radiation therapy to destroy cancer cells and shrink tumours with the use of high-dose X-rays may be recommended.
Chemotherapy to destroy cancer cells with the use of medication may be recommended.
For more information, see the topic Cervical Cancer.
Post-menopausal women may have abnormal Pap test results because of body changes during menopause, such as cervical cell atrophy and estrogen loss. These minor cell changes may improve with the use of estrogen cream and rarely progress to more severe cell changes.
If any minor cell changes persist over time, additional evaluation and treatment will be recommended.
| Author: | Shannon Erstad, MBA/MPH Carrie Henley | Last Updated: April 10, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Anne C. Poinier, MD - Internal Medicine Barbara S. Apgar, MD, MS - Family Medicine, Women's Health Ross Berkowitz, MD - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology | |
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