Pap Tests & Pelvic Exams

Last Updated: Aug. 1, 2003

If all women had pelvic exams and Pap tests regularly, most precancerous conditions of cervical cancer would be detected and treated before cancer develops. Any invasive cancer of the cervix that does occur would likely be found at an early, curable stage.

In a pelvic exam, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor feels these organs for any abnormality in their shape or size. A speculum is used to widen the vagina so that the doctor can see the upper part of the vagina and the cervix.

The Pap test is a simple, painless test to detect abnormal cells in and around the cervix. A woman should have this test when she is not menstruating; the best time is between 10 and 20 days after the first day of her menstrual period. For about two days before a Pap test, she should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a physician), which may wash away or hide any abnormal cells.

A Pap test can be done in a doctor’s office or a health clinic. A wooden scraper (spatula) and/or a small brush is used to collect a sample of cells from the cervix and upper vagina. The cells are placed on a glass slide and sent to a medical laboratory to be checked for abnormal changes.

If all women had pelvic exams and Pap tests regularly, most precancerous conditions of cervical cancer would be detected and treated before cancer develops.

Cancer of the cervix
The cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in a woman’s lower abdomen, between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.

Polyps, cysts, and genital warts are types of benign growths of the cervix. Benign tumors do not spread to other parts of the body. Benign tumors are not a threat to life.

Most cervical cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that form on the surface of the cervix.

Cells on the surface of the cervix sometimes appear abnormal but not cancerous. Scientists believe that some abnormal changes in cells on the cervix are the first step in a series of slow changes that can lead to cancer years later. That is, some abnormal changes are precancerous; they may become cancerous with time. If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. It occurs most often in women over the age of 40.

Risk factors
Researchers believe that, in many cases, cervical cancer develops when two or more risk factors act together.

Sexual intercourse before age 18: Research has shown that women who began having sexual intercourse before age 18 and women who have had many sexual partners have an increased risk of developing cervical cancer. Women also are at increased risk if their partners began having sexual intercourse at a young age, have had many sexual partners, or were previously married to women who had cervical cancer.

Sexually transmitted viruses: Scientists do not know exactly why the sexual practices of women and their partners affect the risk of developing cervical cancer. However, research suggests that some sexually transmitted viruses can cause cells in the cervix to begin the series of changes that can lead to cancer.

Scientists are studying the effects of sexually transmitted human papillomaviruses (HPVs). Some sexually transmitted HPVs cause genital warts (condylomata acuminata). In addition, scientists believe that some of these viruses may cause the growth of abnormal cells in the cervix and may play a role in cancer development.

Smoking: Smoking also increases the risk of cancer of the cervix, although it is not clear exactly how or why. The risk appears to increase with the number of cigarettes a woman smokes each day and with the number of years she has smoked.

DES: Women whose mothers were given the drug diethylstilbestrol (DES) during pregnancy to prevent miscarriage also are at increased risk. (This drug was used for this purpose from about 1940 to 1970.) A rare type of vaginal and cervical cancer has been found in a small number of women whose mothers used DES.

Weakened immune system: Several reports suggest that women whose immune systems are weakened are more likely than others to develop cervical cancer. Also, organ transplant patients, who receive drugs that suppress the immune system to prevent rejection of the new organ, are more likely than others to develop precancerous lesions.

Birth control pill: Some researchers believe that there is an increased risk of cervical cancer in women who use oral contraceptives (the pill). However, scientists have not found that the pill directly causes cancer of the cervix. This relationship is hard to prove because the two main risk factors for cervical cancer – intercourse at an early age and multiple sex partners – may be more common among women who use the pill than among those who do not. Still, oral contraceptive labels warn of this possible risk and advise women who use them to have yearly Pap tests.

Symptoms of cervical cancer
Precancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms and are not detected unless a woman has a pelvic exam and a Pap test.

Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse, douching, or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause also may be a symptom of cervical cancer. Increased vaginal discharge is another symptom of cervical cancer.

These symptoms may be caused by cancer or by other health problems. Only a doctor can tell for sure. It is important for a woman to see her doctor if she is having any of these symptoms.

Source: National Cancer Institute

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