Cervical Smears

Cervical Smears test for early signs of cancer in the neck of the womb. Cervical cancer is a slow progressive cancer that can be very effectively treated in the early stages.

The cervical smear is taken by placing a speculum within the vagina, finding the cervix and gently using a brush or spatula to take some cells from the entrance to the womb, in the cervix.

These cells are then examined under a microscope to find if there have been any changes that might suggest early cancer. NHS laboratories often take six weeks or more compared to private laboratories will do the test in a week. However cancer of the cervix progresses sufficiently slowly that this delay is not significant. It is, of course, important to get the result of your smear by checking with your doctor until you have it.

Frequency
In America and many parts of Europe, women will have a cervical smear every year. Undoubtedly this means that any abnormalities are picked up sooner, and if necessary treatment can be given earlier. Nevertheless, the changes that lead to cervical cancer occur so slowly that it is safe to only have a smear once every three years.

Prevention
Nuns and women, who have never been sexually active, rarely have cervical cancer. Cervical cancer is often found in association with human papilloma virus and other sexually transmitted diseases such as warts. This suggests that it maybe caused by a virus that is sexually transmitted. Condoms may offer some protection but regular smear test are the best way to detect abnormalities early when they are easily treated.

Abnormal Smears

Inflammation and infection
Cervical Smears can show infections and inflammations as well as cancerous changes and these are the most common abnormalities. Thrush, chlamydia or other infection may cause these changes.

HPV
The human papilloma virus (HPV) or wart virus can sometimes be seen on cervical smears. Some types of this virus are closely associated with cervical cancer, it is probably advisable to have annual smears if this virus has been found.

CIN 1 or Low grade changes
This stage of abnormality will often revert to normal over the following six to twelve months. It is advisable to have a repeat smear in six months. If the changes are persistent then a colposcopy may be advisable.

CIN 2 or High grade changes
This stage indicates that there have been serious changes in the cell structure. It is important to have a colposcopy to investigate the extent of these changes.

CIN 3 or early cancer
It is unusual such advanced changes in women who have had regular smear tests. Occasionally a cancer may be very aggressive. This needs an urgent referral to a gynaecologist for further treatment.

Colposcopy
This is like a prolonged smear test done on a colposcopy table. It is no more uncomfortable but may take up to 15 minutes, in order for the gynaecologist to have a good view of the cervix and take the necessary samples

Treatment
After colposcopy, treatment is planned, this may involve laser therapy to remove the abnormal cells. Laser therapy can be done as an Outpatient. If the case is more advanced, the next stage of treatment is a wider removal of the tissue, done in hospital under a general anaesthetic.

Follow up
After abnormal cells have been found smears should be done annually for five years. Treatment should not alter fertility, although it not advisable to have treatment during pregnancy.

Screening tests
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