Patient Care

Abnormal Pap Smear

2024/05/14
What is a Pap Smear?

A Pap Smear is an easy test your doctor can perform for you. A speculum is placed in your vagina to allow the cervix to be seen. A small brush is then used to gently collect cells that are normally shed from the lining of the cervix into the surrounding mucus. The collected cells are then brushed into a liquid test medium that is sent to the lab to be examined under a microscope. The Technologist examining these cells has been specially trained to identify changes that are associated with pre-cancerous transformation.

Pre-cancerous or dysplastic changes usually take place in the cells of the lining of the cervix before eventually becoming cancer of the cervix. The more severe the dysplasia, the more likely it is to continue progressing towards cancer. The less severe the dysplasia, the more likely it is to reverse and return to normal.

Normal results

Normal or negative for intraepithelial lesion or malignancy. This means that the cells that were examined in your Pap Smear appear normal and do not show pre-cancerous changes.

Abnormal results
  • Atypical Squamous Cells (ASC) means that there are cells in your Pap Smear that appear unusual but are not abnormal. These mild changes can be caused by infections, or changes in a woman's hormones. Your healthcare provider will usually suggest treating an infection if you are found to have one, repeating a Pap Smear in six months or following-up with colposcopy.
  • CIN (Cervical Intraepithelial Neoplasia) and SIL (Squamous Intraepithelial Lesion) mean the same thing, and both refer to pre-cancerous changes of the cervix. CIN1 and Low-grade SIL are less severe changes that often will not need treatment. Low-grade SIL or mild change is also often seen when there is infection of the cervix with the Human Papillomavirus or HPV. CIN2 or 3 and High-grade SIL are more severe changes in the cervix that are more likely to progress to cancer and will usually require treatment. The good news is that HSILs (high-grade squamous intraepithelial lesions) such as CIN2 or 3 can be completely treated with simple procedures that can often be carried out right in your doctor's office or clinic.
  • Atypical Glandular Cells (AGC) means that a type of cell present in the cervix, uterus, fallopian tube, ovary or breast is present in the Pap Smear and shows changes that may be the result of the pre-cancerous or cancerous change. This result will usually prompt your doctor to suggest immediate follow-up with a colposcopy.
  • Cancer or Carcinoma means that there are abnormal cells on your Pap Smear that may have come from a cancer or a severe pre-cancerous lesion on the cervix. This result should always be followed up with an immediate colposcopy.
How are Abnormalities in a Pap Smear diagnosed?

‚ÄčA Colposcopy allows your healthcare provider to examine the cervix in detail.

A speculum is placed in the vagina to allow the cervix to be seen clearly. The cervix is then examined in good light with a colposcope. A colposcope is a special microscope designed to magnify the cervix, allowing a careful and detailed examination of the cervix for pre-cancerous or cancerous changes. Often a dilute solution of vinegar or acetic acid will be placed on the cervix to make cancerous or precancerous changes more obvious during the colposcopic examination.

A biopsy may then be taken of any cancerous or pre-cancerous lesions or changes on the cervix. A biopsy is a small sample of tissue. This is usually taken from an area of the cervix that appears abnormal when examined using a colposcope and acetic acid during Colposcopy.

There may be some light bleeding associated with a biopsy of the cervix, certainly no more than the bleeding in a normal menstrual period. Although the procedure itself is painless, you may experience some discomfort similar to menstrual cramping after the procedure.

What are the treatment options for Abnormal Pap Smear?

Most abnormalities on a Pap Smear do not require treatment. A colposcopy will usually be recommended to determine the cause and source of an abnormal Pap Smear.

Majority of pre-cancerous lesions or changes of the cervix can be treated easily with simple procedures that are performed right in your healthcare doctor's office or clinic.

Your healthcare provider will be able to explain these options to you in greater detail, but these are some of the more common treatments.

LEEP (Loop Electrosurgical Excision Procedure)

This simple procedure is sometimes also referred to as a LLETZ (Large Loop Excision of the Transformation Zone). It uses an electrically powered loop to remove abnormal portions of the cervix. An injection to numb the cervix and prevent bleeding is usually given before this simple procedure is performed. Hence, the procedure is usually painless. You can expect some light bleeding or spotting but no more than expected in a normal menstrual period.

Cone Biopsy

This procedure involves the removal of a larger cone-shaped portion of the cervix. A cone biopsy is usually recommended when pre-cancerous or cancerous changes are found in the canal or tunnel-like portion of the internal part of the cervix. This simple procedure can be performed in the office under local anaesthesia or more commonly in an operating suite under general anaesthesia. Lasers or electrosurgical instruments are most commonly used to remove the abnormal portion of cervix. Although less than a menstrual period, more bleeding can be expected after a cone biopsy because a larger portion of the cervix is removed as compared to a LEEP. Mild cramping may be expected after a cone biopsy. Your healthcare provider will usually recommend that you avoid having sexual intercourse for about two weeks to allow your cervix to heal from the procedure. You will not need to be hospitalised after a cone biopsy.

Cold Coagulation or Ablation

Depending on where the abnormal lesions are on the cervix, cold coagulation or other treatment options that completely destroy the abnormal areas completely may be offered. These treatment options use heat, freezing temperatures or laser energy to destroy the abnormal tissue of pre-cancerous lesions on the cervix. These procedures are painless and usually associated with some mild discomfort like abdominal cramping. Minimal bleeding can also be expected. There will usually be more watery or thick yellow vaginal discharge in the seven days following the procedure as the cervix heals.

Find A Doctor

Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.

You can search by -
  • Condition name 'Abnormal Pap Smear' AND
  • Institution
1E Kent Ridge Road, NUHS Tower Block, Singapore 119228
Last updated on
Best viewed with Chrome 79.0, Edge 112.0, Firefox 61.0, Safari 11
National University Health System
  • National University Hospital
  • Ng Teng Fong General Hospital
  • Alexandra Hospital
  • Jurong Community Hospital
  • National University Polyclinics
  • Jurong Medical Centre
  • National University Cancer Institute, Singapore
  • National University Heart Centre, Singapore
  • National University Centre for Oral Health, Singapore
  • NUHS Diagnostics
  • NUHS Pharmacy
  • Yong Loo Lin School of Medicine
  • Faculty of Dentistry
  • Saw Swee Hock School of Public Health
Back to Top