Cervical Changes: From Abnormal Pap Smears to Cancer Concerns

Cervical cancer

Hello Doctor, I underwent a cone biopsy for CIN2 last July, and the margins were normal.
I have been following up with Pap smears for a year, all of which were normal.
However, during my Pap smear in August, the doctor noted a lesion on my cervix that appeared abnormal; there was some bleeding during the procedure, but I did not experience pain or any symptoms like postcoital bleeding.
I have been having increased vaginal discharge (the Pap report indicated atypical cells), and I have already undergone a biopsy and am waiting for the results.

My questions are:
1.
Is it possible for the Pap smears to be normal for a year and then suddenly show abnormal changes?
2.
How can there be a discrepancy between my Pap report and the findings during the pelvic exam, where a lesion is visibly apparent but the report indicates only atypical cells?
3.
What is the likelihood of rapidly progressing to cervical cancer in a short time? My doctor mentioned that the visible lesion does not appear to be a precancerous condition since it is clearly observable.
I am very concerned.

Wen, 30~39 year old female. Ask Date: 2018/09/22

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last July, I underwent a cone biopsy for CIN2, and the margins were normal.
I had normal Pap smear results for a year.
However, during the Pap smear in August, the doctor noted a lesion on the cervix that appeared abnormal; the procedure caused some bleeding, but I did not experience pain or postcoital bleeding.
I have had increased vaginal discharge (the Pap report indicated atypical cells), and I have already had a biopsy and am awaiting the results.

Question 1: Is it possible for the Pap smear to be normal for a year and then suddenly show abnormalities?
Answer: The accuracy of Pap smears is about 70%.
Question 2: Why is there a discrepancy between my Pap smear report and the findings during the pelvic exam, where a lesion is visible but the report indicates atypical cells?
Answer: The interpretation should be based on the histological examination of the slides.
Question 3: What is the likelihood of rapidly developing cervical cancer in a short period? My doctor mentioned that the visible lesion does not appear to be precancerous.

Answer: Theoretically, the likelihood of rapidly progressing to cervical cancer in a short time is low.

Reply Date: 2018/09/22

More Info

Understanding cervical changes, particularly in the context of abnormal Pap smears and potential progression to cervical cancer, can be quite complex and concerning for many patients. Based on the information provided, let's address your questions and clarify some important points regarding cervical health.

1. Can a Pap smear show normal results for a year and then suddenly indicate a problem?
Yes, it is possible for a Pap smear to show normal results for an extended period and then later indicate abnormalities. Pap smears are not infallible; they have a sensitivity of about 70-90%. This means that while they are a valuable screening tool, they can miss some abnormalities. Additionally, cervical changes can occur relatively quickly due to various factors, including hormonal changes, infections, or the presence of high-risk strains of human papillomavirus (HPV). It's important to remember that the cervix is a dynamic tissue, and changes can happen over time.

2. Why might there be a discrepancy between the Pap smear results and what the doctor sees during an examination?
The discrepancy between the Pap smear results and the visual examination can occur for several reasons. A Pap smear is a cytological test that examines cells collected from the cervix, while a visual examination (such as colposcopy) allows the doctor to see the cervix directly. Sometimes, lesions or abnormalities may not be fully represented in the sample taken for the Pap test, leading to a situation where the doctor observes a visible lesion that is not reflected in the cytological report. This is why follow-up procedures, such as biopsies, are crucial for accurate diagnosis and management.

3. Is there a high likelihood of rapidly progressing to cervical cancer?
The likelihood of rapidly progressing from atypical cells to cervical cancer is generally low, especially if you have had a history of monitoring and treatment for cervical intraepithelial neoplasia (CIN). The progression from CIN to cervical cancer typically takes several years, and most cases of CIN do not progress to cancer. Your doctor’s assessment that the visible lesion does not appear to be a precancerous change is reassuring. However, it is essential to follow up with the biopsy results, as they will provide definitive information about the nature of the lesion.

In summary, while it is understandable to feel anxious about cervical changes and the potential for cancer, it is important to rely on the results of your medical evaluations and the expertise of your healthcare provider. Regular monitoring, follow-up Pap smears, and appropriate interventions when necessary are key components of managing cervical health. If you have further concerns or experience new symptoms, do not hesitate to reach out to your healthcare provider for guidance and support. Remember, early detection and proactive management are crucial in maintaining cervical health and preventing the progression to cancer.

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