YOUR HEALTH - MEDICINE 101

PAP TEST

This year, 1300 Canadian women will be diagnosed with cancer of the cervix. But many cases could be avoided with the PAP test.

A pap test looks at cells scraped from the cervix, a part of the uterus. The word cervix means neck in Greek. To the ancient anatomists, this part of the uterus that sits on top of the vagina looked like a neck or a constriction of the womb that sits above. The cervix is hollow, and the cells that line the cervix are the ones that change to produce cancer.

In the 1920’s, a Greek pathologist, Dr. George Papanicolaou was studying the various changes that occurred in the cells of the cervix during the menstrual cycle. He noted that in some women the cells looked perfectly normal, but in others, those with cancer of the cervix, the cells were weird looking – they stained dark black, and were filled with cell divisions.

But, Dr Papanicolaou discovered something else, something far more valuable. In some women, if cells were scraped off the cervix year after year…he could watch them change – from normal to increasingly abnormal. A few years later, the women had cells that were full blown cancer. This was a gradual process most cells went from normal to cancerous in 6 years. He proved that if you could identify which women had the early changes, you could prevent the progression entirely – just by treating the abnormal cells before they got going.
This is the basis for the PAP (the PAP is from his name Papanicolaou) test. Here’s how it’s done. First we have to see the cervix and we do that with this..a speculum. It’s not a torture device. The speculum is Latin for mirror. It spreads the vaginal walls apart revealing the cervix. Next, the outer layer of cells are scraped off the cervix with a wooden spatula, or a brush like this. Then the cells are smeared on a microscope slide and fixed with a preservative and stain. Here’s an example of normal cells, and these are cells which are becoming more and more abnormal, until they reach this type of cell, a cancer cell. Cancer cells divide much more often than normal cells and so the nucleus, the center of the cell involved in cancer, is much more prominent and takes up almost all of the cell.

If we can see that the results of a pap test are beginning to change, women are referred for a biopsy to confirm the findings and then they are treated – the area of abnormality in the cervix and is destroyed (using freezing, laser or other techniques) long before cancer cells can develop. This is how we prevent cancer of the cervix.

So, get your pap test regularly. Don’t dread it, lie back and try to relax. When you do, think of Dr. George Papanicolaou who will be forever “At your cervix, ma’am.”