UNDERSTANDING CERVICAL CHANGES A HEALTH GUIDE FOR WOMEN PATIENT U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES &family National Institutes of Health EDUCATION National Cancer Institute A Pap Test Showed Cell Changes in Your Cervix You’re probably reading this booklet because your health care provider told you that your recent Pap test (sometimes called a Pap smear) showed cell changes in your cervix. Although it is quite common to feel uneasy about your Pap test results, it may comfort you to know that each year more than 3 million women receive similar results. Not All Cell Changes Are Cancer The good news is that almost always, women with cell changes do not have cancer of the cervix (also called cervical cancer). But it is important that you protect your health by getting the follow-up tests and care that your health care provider suggests. Cell changes do not mean that you will get cancer of the cervix. And because your cell changes were found, simple tests or treatments can help you. When cell changes are found and treated early, almost all women can avoid getting cervical cancer. Getting Your Questions Answered So what is the next step? What do your results mean? Does this mean you need treatment and, if so, what kind? This booklet helps answer these questions and discusses: “I didn’t understand my results at first— I Types of changes in your cervix and a part of me didn’t want to I Common tests and treatments understand. But I knew this was I How to find the support and resources you need important . and in the end, You will probably have other questions, or you might be everything turned out fine.” concerned about the choices you may need to make. These —MARLENE, AGE 45 reactions are normal. But understanding your Pap test results—and what to expect when the results are not normal—can help you make informed decisions and plan your next steps. A dictionary, beginning on page 31, explains terms that may be new to you. These terms will appear in bold. Understanding Cervical Changes What Is the Cervix?................................................................1 Finding the Support You Need.............................................13 Common Changes in Cervical Cells ........................................2 Table 1: What Your Pap Test/HPV Test Results Cell Changes Caused by HPV Are a Special Concern ..............3 Mean and Follow-Up .............................................14 Other Risk Factors for Cervical Cancer.....................................3 Table 2: Tests or Follow-Up Treatments That Health Care Providers Use for Abnormal What Should I Know About HPV Infection?..........................4 Pap Tests ...............................................................18 How Women Get HPV ..............................................................4 Table 3: What Does It Mean: Results From How Can I Tell if I Have HPV? And What Can Your Biopsy or Endocervical Curettage ................22 Happen to Me if I Have It?.................................................4 How Is an HPV Infection Treated? ...........................................5 Table 4: Treatments for Major Cell Changes......................24 If I Have HPV and It Goes Away, Can I Get It Again? .............5 Resources..............................................................................28 Finding Abnormal Cells..........................................................6 Dictionary.............................................................................31 The Pap Test ..............................................................................6 The HPV Test.............................................................................7 How Is the HPV Test Done?......................................................7 When Is an HPV Test Useful? ...................................................7 What Do My Pap Test Results Mean? ....................................8 Why Did I Get an Unclear Result? ...........................................9 Is It All Right if I Don’t Get Tested Again Right Away? .........10 Questions To Ask Your Health Care Provider.......................11 Getting a Second Opinion....................................................12 1 What Is the Cervix? The cervix is the narrow, lower part of the uterus (where the baby grows when a woman is pregnant). During a pelvic exam, the doctor or nurse practitioner can see the cervix at the upper end of the vagina. The cervix has an opening to the endocervical canal. This opening lets blood flow from the uterus into the vagina during a woman’s menstrual period. During childbirth, the cervix opens much wider to let the baby pass through. The surface lining of the cervix is made up of two different types of cells: I Tall cells, called glandular cells (or columnar cells) toward the top of the endocervical canal (above the cervix). They make mucus, which helps guard the entrance to the uterus. I Thin, flat cells, called squamous epithelial cells (or squamous cells). Arranged in layers, they protect the tissues underneath them. Pap tests can help health care providers find changes in these cells. 2 3 Cell Changes Caused by HPV Are a Special Concern Some cell changes are a sign of a certain viral infection called HPV (human papillomavirus). In most women, HPV infections go away on their own. Sometimes, the cells infected with HPV will become precancerous. These precancerous cells can become normal normal and precancerous cervical cancer (called invasive cancer of the cervix). They can cervical cells precancerous mix cervical cells grow and spread, invading nearby tissues and possibly spreading throughout the body. An HPV test, which is done much like a Common Changes in Cervical Cells Pap test, can detect the virus in cervical cells. Cervical cells can go through many types of changes that are not cancer. Many times these changes will go away on their own. What is HPV? These changes can be caused by: I It is a very common virus. I Inflammation (redness and swelling) I There are more than 100 types. I An infection (bacterial, viral, or yeast) I About 15 types can cause cervical cancer. I Growths such as benign polyps or cysts I Some types cause warts on the fingers or feet but do not cause I Changes in hormones from pregnancy or menopause cancer. These cell changes are very common and are not related to cancer. I Other types cause warts in the genital area that are not cancerous. But they sometimes make these cells look like abnormal cells. So your health care provider may suggest that you repeat your Pap test or have other follow-up tests to be certain you don’t Other Risk Factors for Cervical Cancer have any cell changes. (See the tables beginning on page 16 for HPV is the most important cause of and risk factor for cervical more information.) cancer. But studies have shown that other factors may act together with HPV to increase your risk of developing cervical cancer. These factors include cigarette smoking and having given birth to many Although most cell changes in the cervix are not cancer, children. Also, if you have a weak immune system, you may be at it is still important to get a Pap test at least once every higher risk because your body may not be able to clear up HPV on 3 years to be sure. its own. For example, if you take medicine to block your body’s immune response or if you have HIV, you may be at higher risk. 4 5 What Should I Know About HPV Infection? “I was really afraid when I found out How Women Get HPV I have HPV, but Almost all HPV that affects the cervix is spread by sex talking to the nurse (through intimate genital to genital contact including vaginal or really helped me anal intercourse, finger to genital contact, and finger to anal understand what it contact). It is rarely spread through oral sex. You are at higher risk is and what we can of getting HPV if: do about it…” I You have had more than one sex partner, or —JESSICA, AGE 28 I Your sex partner(s) has had other partners. If your health care provider finds you have HPV, your sex partner(s) should also get checked. They usually will have no symptoms. For more information about HPV and how to protect yourself, see the Resources section (pages 28–30). How Is an HPV Infection Treated? Although HPV itself cannot be treated, the cell changes that it How Can I Tell if I Have HPV? causes can be treated. Simple treatments that remove or destroy And What Can Happen to Me if I Have It? the cells may prevent cancer. This is why regular pelvic exams and Pap tests are important, along with care for cell changes. Most women with HPV of the cervix do not know they have it. Most of the time, it does not cause any symptoms. Certain types of HPV can cause warts on the outside of the genitals, but the only If I Have HPV and It Goes Away, way to know for sure whether you have HPV is by seeing your Can I Get It Again? health care provider. If you or your partner has HPV, you will share it until your bodies’ Almost all HPV infections clear up on their own. Many women immune systems get rid of the infection. If you have sex only with with HPV will have cell changes at least briefly within a few each other, you will not pass the HPV virus back and forth. This is months to a year after getting the virus. Most types of HPV do not because when the HPV goes away, the immune system will lead to cancer. But if HPV does not go away, you are more at risk remember that HPV type and keep you from getting it again. Even of developing a precancerous change that needs to be treated. It is though you are protected from one type of HPV, you are not best to see your health care provider on a regular basis. protected from getting the many other types of HPV. 6 7 Finding Abnormal Cells The HPV Test Almost all cervical cancer begins as an infection with the virus called HPV. An HPV test, which is done much like a Pap test, can The Pap Test detect the virus in cervical cells.