Download Pap Smear Crucial for Early Detection of Common Women`s Health

Pap Smear Crucial for Early Detection
of Common Women’s Health Problems
A simple in-office test for women, called the pap smear, can help doctors detect early
signs of what was once the most common cancer in women, cervical cancer. Regular pap
smear screenings have diminished the cancer’s mortality rate and, today, cervical cancer
has fallen to seventh in the ranks of cancers in women.
The pap test is standard in routine gynecological exams. By gently taking sample cells
from the cervix, gynecologists can detect abnormalities that warn them of the possibility
of cancer.
“Removing these cells early is key,” says Ronald P. Portadin, M.D. of Women’s Medical
Center in Mays Landing. “Cervical cancer usually shows no symptoms and its progress is
slow. It might be 10 years before the cancer goes from a group of abnormal, or
dysplastic, cells to full blown invasive cancer. The pap is usually our only way of
knowing something is amiss. And if we catch cervical cancer early, while it is confined to
the cervix, it is curable in virtually all cases.”
The Test
Gynecologists insert a speculum and a tiny spatula to scrape sample cells from the area of
the cervix that protrudes into the vagina. The doctor also uses a small brush in the
endocervical canal, the tunnel into the uterus, and picks up epithelial cells as an
additional sample. The slides containing the samples are sent to a laboratory for analysis.
“Ninety percent of all cervical cancers originate in the area from which we take a
sample,” says Portadin.
Results vary according to the types of cells detected. The classification system most
widely used is the Bethesda system, a program adapted by clinicians to standardize how
cervical cell changes are classified. “Abnormal cells don’t necessarily mean cancer;
rather, they show a degree of change. Measuring this degree allows doctors to determine
the next steps to take,” says Portadin
Atypical cells are least worrisome. These show some changes, but might result from a
yeast or bacterial infection, inflammations or normal tissue repair, and these are normally
1
not cancerous. Low-grade squamous intraepithelial lesions show mild dysplasia, which is
an abnormal cell growth that could signal cancer. High-grade squamous intraepithelial
lesions send a warning to doctors that a patient has moderate or severely dysplastic cells.
“While these lesions, in most cases, do not necessarily lead to cancer, they can be precancerous and, therefore, require careful monitoring and frequent testing and treatment,”
says Portadin.
After an abnormal pap
A woman found to have abnormal epithelial cells on pap smear sometimes undergoes a
more extensive procedure that gives doctors a detailed picture of what’s going on. The
test, a colposcopy, is an office procedure during which the doctor uses a lighted
microscope near the vagina to examine the cervix. The doctor then takes samples, or a
biopsy, of tissue from abnormal looking areas.
“In many cases, we’ll combine the colposcopy with endocervical curettage (scraping), to
take a thin layer of tissue from the endocervical canal. These biopsies can reveal and
confirm the type and degree of abnormality,” says Portadin.
At this early stage, the condition is still completely curable, even if the entire thickness of
the tissue is affected. It is when the disease affects the underlying tissue of the cervix or
neighboring tissue that doctors consider the patient to have more severe cancer. And, at
this stage, the cancer can be more difficult to cure.
“Cervical cancer treatment offers patients options based on the degree of cancer and our
patients’ preferences. Most women respond well to in-office procedures or laser therapy,
but some require more extensive treatment, primarily hysterectomies, radiation or
chemotherapy,” says Portadin.
According to the gynecologist, the less invasive treatments include cryotherapy, laser
therapy, and a procedure called the loop electrical excision procedure (LEEP).
Cryotherapy, an in-office treatment, involves destroying the abnormal tissue by freezing.
With laser therapy, the physician uses high-intensity light beams to evaporate abnormal
tissue. Sometimes laser therapy can be done in the office, but often it is performed in
surgery centers or hospitals. Doctors performing LEEP remove the abnormal tissue by
inserting an electrically charged wire loop. The loop removes the tissue without
destroying it so the tissue can be examined later.
Patients with a severe degree of dysplasia or the possibility of invasive cancer might
undergo conization. This more extensive procedure involves removing a cone-shaped
segment of tissue in the operating room, under anesthesia. A hysterectomy is the surgical
removal of the uterus and cervix. Extensive cancer might also warrant the removal of the
ovaries, fallopian tubes, and surrounding lymph nodes. Radiation and chemotherapy are
also an option in widespread uterine cancers. These therapies can help to destroy cancer
cells that surgery misses.
2
“Women today should have regular pap tests. These tests are generally covered by
insurance, usually involve little if any pain, and can be done in seconds in the doctor’s
office. As with all cancers, an ounce of prevention can make a difference between a
curable and incurable cancer,” says Portadin.
Ronald P. Portadin, M.D., earned his degree from Georgetown University in Washington,
D.C. He is board certified in obstetrics and gynecology and is a Fellow of both the
American College of Obstetrics and Gynecology and the American College of Surgeons.
Dr. Portadin is also a member of the American Society of Colposcopy and Cervical
Pathology, the American Fertility Society, New Jersey Obstetrical & Gynecology Society
and The Society of Surgeons of New Jersey. He practices gynecology and has expertise
in colposcopy and cervical disease and laser surgery.
Women’s Medical Center in Mays Landing offers an exemplary tradition of women’s
care based on years of medical experience supported by a caring and knowledgeable staff
in a modern office setting. The board-certified physicians of WMC are Ronald Portadin,
MD and Jonathan Gewirtz, MD. Together with Nurse Practitioners Karen Duncan and
Sharie Hiller, they bring outstanding women’s health care to 3980 Black Horse Pike, The
Festival at Hamilton, in Mays Landing. WMC provides comprehensive gynecology
services and reproductive medicine for the female patient, including gynecologic
screening exams, adolescent medicine and contraceptive care, major and minimally
invasive gynecologic surgery, including laser surgery, in-office endometrial ablation and
sterilization, and laparoscopy. WMC also provides incontinence therapies, well women’s
care, basic infertility evaluations, preconception care, and pre- and post-menopausal care.
To schedule an appointment, visit www.WMCMaysLanding.com or call (609) 625-1600.
3
About the Pap Test
Dr. Portadin answers common questions about the pap smear.
How often should women have pap tests?
Women should start at age 18 or when they become sexually active with annual pap test and pelvic
exams. However, women with HPV or HIV, who smoke, or who have multiple sexual partners, or
take the pill, should be screened at least semi-annually. Women with a history of abnormal results
should also be screened more often.
Do I need a pap smear after hysterectomy?
Yes. Having a hysterectomy does not preclude a woman from getting gynecologic cancers.
What are the symptoms of uterine, or cervical, cancer?
Cervical cancer can be without noticeable symptoms; however, abnormal bleeding is sometimes a
symptom.
Who is most at-risk?
Women who become sexually active at an early age, and, also, those who smoke or use drugs, and
have multiple sexual partners are at increased risk.
4