Saturday, June 25, 2011

apa fungsi pap smear tu??

bagi mereka yang sudah pun mendirikan rumahtangga ataupun pada sesiapa yang aktif dalam hubungan seksual ni perlu mendapatkan dan menjalani ujian pap smear..bukannya lama pun nak wat ujian ni kejap jer..tapi masih ramai di antara kita yang masih malu2 dan malas nak wat..antar faktor yang paling utama ialah MALU..betul tak?? kalau x betul iyerkan jerlah..he..he..ramai yang pernah mendengar Pap Smear, tapi ramai yang tak tahu apa itu pap smear..so check it outtt..

1. What does a Pap Smear test for ?
Pap smears are designed to pick up changes in the cells of the cervix that may lead to cause cancer. These changes form a sort of spectrum with cancer at one end. Early detection of pre- cancerous cells allows intervention that may well prevent the woman developing cancer.
There are two main types of cervical cancer Pap smears are designed to pick up changes consistent with squamous cell carcinoma – the most common type of cancer.
Pap smears may incidentally identify some other things not related to cancer but these are not the reason for doing the test.

2. How reliable is a Pap Smear ?
It is claimed that "regular pap smear tests every two years can prevent the most common type of cancer of the cervix in 90% of cases " ( Pap Smear Test results - a guide for women with an abnormal pap smear – Commonwealth Department of Health and Family Services 1997) . It’s important to remember however that a Pap smear is a screening test and as such is not a perfect diagnostic tool. However cervical cancer is generally accepted as a slow developing cancer maybe taking up top 10 years to develop. If symptoms are present, even with a normal result further investigations are probably warranted. Also a Pap Smear is done at one point in time and although it is thought that statistically it is not appropriate to screen the general population any more frequently than 2 years (or shorter in certain groups like those with previous abnormalities) if symptoms arise in the interim – don’t ignore them just because your last smear was ok !

3. What things may cause a pap smear to not be reliable ?
  1. It is possible for the area of the cervix containing an abnormality to not have been smeared by the test. Doctors should take care to take a sample from both a wide area of the outside surface of the cervix as well as a brush sample from inside the canal. This error may occur may be through poor technique or it may be that the abnormal cells were too far up the canal and so out of "reach" .
  2. Sometimes interpretation can be difficult because the sample is obscured by debris – blood mucus or inflammatory cells. These may not be visible to the naked eye.
  3. Human error is possible when the slide is looked at under the microscope.

4. What is the " Endocervical Component" and why is it important?
The canal inside the cervix (endocervical canal) which leads to the uterus cavity is lined by cells which make a transition to become those of the internal lining of the uterus. The transition point can easily vary from woman to woman and even from time to time in the same woman. This transition is not visible with the naked eye.

One theory is that the abnormal calls occur at the point of transition. This is why a doctor aims to get a sample from the endocervical canal. A pap smear result routinely reports the presence or absence of these endocervical cells. The aim is to have a representation of endocervical component ensuring that the transition point has been past. 

It is important to check with your doctor that the endocervical component is present. I always use a brush inserted into the cervix canal when I do a pap smear . I tell the patient whether I feel I have adequately sampled the area. If there is no endocervical component present I discuss with the patient that forcing the brush up any further may not be appropriate. We discuss risks versus benefits of screening tests and decide together whether we will take any further action on the matter. 

5. What sort of abnormalities may be reported ?
a. Unsatisfactory sample - this may occur when the cells are unable to be "read" under the microscope because there aren’t enough on the sample, they are obscured by other cells, or the sample has not been "fixed" properly ( alcohol is sprayed onto the slide to "pickle" the cells to maintain their appearance), or the slide was broken. A repeat smear in 6- 8 weeks is usually recommended. This gives the cells adequate time to regenerate. An earlier smear may miss an abnormality which has been smeared off with the first test.

b. Benign non specific changes this family of reported changes are a pain. Basically there is no evidence of cancer or its precursors but the smear simply doesn’t fall into the exactly normal slot. Most people get all worried over nothing – and understandably so. The pathologist will recommend if the smear needs to be repeated earlier than 2 years. 

c. Inflammation – sometimes the cervix may be irritated and become inflammed. This may be because of an infection which may well be minor and transient. This has nothing to do with cancer but your doctor may or may not suggest further tests to identify the bug and treat you. It may not be necessary if you have no symptoms. Your doctor will discuss the options in your individual case. You will not necessarily need to repeat your smear any earlier.

d. HPV – d. HPV – Infection with certain strains of the Human Papilloma Virus ( HPV), or wart virus, is suggested as a possible link to development of cancer of the cervix. There are lierally scored of different members of the HPV family and only a handful that affect the genital region and even less which are associated with development of cancer. Some researchers claim that everyeone who has ever had sex has probably been exposed to the HPV and that its incubation period can be several years. The hardest thing about giving a result of HPV infection to a patient is the immediate look of shock followed by anger. They usually say "but I’ve never had a wart" quickly followed by "the bastard ! " . I have my prepared statement about how no one may have necessarily knowingly passed the virus on and that it may not even be the current partner. They then usually mention how they have had a wart on their finger or foot and I hasten to add that it’s a different virus.

Follow up for wart virus changes is usually a repeat smear in 6 months. HPV will often resolve by itself but If there is still HPV present in 12 months your doctor will probably refer you to a gynaecologist for a colposcopy ( a closer look and sampling using a fibre optic device)

e. Atypia – this report means that there are some changes but the pathologist can determine what category to place them in – Atypia literally means not typical – not normal – The recommendation may be to repeat the smear in 6 or 12 months to check cells have returned to normal.

f. Low or High grade abnormalities - CIN - f. Low or High grade abnormalities - CIN - on the spectrum of abnormalities where normal is one end and cancer is the other CIN is what we are really looking for. The changes may be referred to as "dysplasia" ( dys – abnormal plasia – growth) or high or "low grade " or CIN 1,2, or 3, - these are all abnormalities which need referral .It is important to remember that NONE of these abnormalities are cancer. I frequently speak with women who mistakenly believe that they have cervical cancer because they have CIN – Although , the higher the grade of abnormality the more likely it is that cancer may develop with out treatment. Any of these grade may regress on their own – especially the low grade abnormalities. But proper assessment and surveillance is crucial because it is impossible to predict which of them will regress and which will go on to become cancer. Referral to a gynaecologist for further investigation is usual. 

6. What further tests may I require if I have CIN ?

Colposcopy - this test involves a referral to a gynaecologist . You will be asked to lie in a position with your knees supported. The end of the bed is usually on hinges so the doctor sits quite up close and personal. A speculum is inserted and then some dye is painted over the cervix. A fibre optic telescopic tube is inserted and the doctor can get a close look at the potential abnormal spots on the cervix which show up using the dye. Sometimes there is a video screen hooked up and you can observe the whole thing ( these home movies will wow’em at your next dinner party – I think not ) .The doctor may take a small tissue sample (biopsy) of the abnormal appearing areas which is sent to pathology. The whole procedure takes around 15 minutes and most women feel no pain and only little discomfort it any, and then usually relating to the length of time the speculum is remaining in place.

7. What treatment is available if I have abnormalities ?

This will obviously vary depending on the abnormality. If colposcopy and biopsy confirm an abnormality then you will be given options.
  1. CIN 1 - you will be given a choice of

"watchful waiting" where you may wish to opt to see if it heals on its own . A repeat smear in 6 months may reveal resolution or it may be the same or it may be progressing. If it has resolved then it is still recommended that you repeat the smear in 6 months again. Two normal test in a row and you can have a test once a year for the next two years then back to 2 yearly if they are all normal. If it is still the same to worse at 6 months you will be referred for a treatement .

" immediate treatment " where you opt to have the abnormal cells removed forth with. You will still need to have the frequent follow up paps as well.
* researchers are trying to establish tighter guidelines for recommendations in treatment of CIN I .
    b. CIN 2 and 3 – treatment is recommended for these abnormalities. There may be a delay of several weeks on occasions before the treatment is available and this shouldnt make a difference in the "life cycle" of the condition. However the anxiety level at home can be enormous. It is important to get reading matter on the subject and may be to take your partner in for a chat with the doctor so there is no misunderstandings. I will place some contact details at the end of this article.

LASER – this can usually be done in the gynaecologists rooms using local anaesthetic.

DIATHERMY – this technique may require a general or local anaesthetic and involves burning the abnormal cells using an electric heated probe

CRYOSURGERY - this technique involves freezing the abnormal cells using gas at temperatures as low as 175 degrees Celsius below zero
WIRE LOOP EXCISION - WIRE LOOP EXCISION - abnormal cells are removed using a wire loop which scoops them out. Local anaesthetic is used
CONE BIOPSY – this technique involves a pyramid of tissue being removed from the cervix. It usually requires a general anaesthetic and may be done as a day procedure or involve and overnight stay.

Management  of your condition should be shared and you should be making the decisions based on solid information. You have the right to have all your questions answered. You have the right to have a second opinion.One very common question is :

8. What effect will treatment have on my chances of having a baby?
An abnormal Pap smear will not have any bearing on your ability to conceive. However it is important to have an abnormality sorted out before embarking on a pregnancy if possible.
A cone biopsy is the only treatment listed where there may be potential problems for future pregnancies and this is only because removal of a portion of the cervix may weaken its ability to stay closed during the pregnancy and may result in increased risk of miscarriage. The procedure wont affect the ability to get pregnant and your gynaecologist may recommend a stitch be placed in the cervix to ensure it stays closed during the nine months.

9. When can I stop having Pap Smears ?
Current recommendation is 70 for the normal population. However if you have had abnormalities it is important that you discuss options for your individual case.

1 comment:

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