Undergoing a smear test is very simple from the patient’s point of view. In fact, it is often carried out in conjunction with a routine pelvic examination, which commonly occurs during an antenatal visit, or a check when a repeat prescription of the pill is being requested, or for any other reason.
It is perfectly painless, and adds only a couple of minutes to the routine pelvic check. Most doctors carry out a breast examination at the same time, as it is convenient to combine the two.
A speculum is inserted into the vaginal canal. This instrument allows a clear view of the cervix, located at the far end of the vaginal canal. A good light is necessary. The doctor then inserts a wooden or plastic device called a spatula. By making a rotational movement of the spatula against the cervix through 360 degrees, a thin smear of superficial cells is secured.
These are then transferred to a glass slide, sprayed with a fixing aerosol or placed in a special solution, then packaged ready for dispatch to the pathology laboratory. Here experts will promptly examine the slide, after it has been stained. under the microscope.
The entire exercise takes a very short time as far as the patient is concerned, although the follow-on work is far more time-consuming. Usually the doctor checks a variety of details from the patient, for this assists the pathologists in making their decisions, and alerts them to possible hazards.
Shortly after, the report from the pathologist will be sent to the doctor. Of course, the majority will be perfectly normal. Sometimes other pathology is discovered, quite apart from any suggestion of cancer. General inflammatory changes in the vagina and cervix may he picked up. Infections due to monilia or trichomonas are also commonly found.
This is a bonus extra, and the doctor can recommend treatment for these if they were not previously known.
Sometimes the smear is unsatisfactory for various technical reasons. and a repeat may be recommended.
But the chief result that spells concern is a “positive smear.” This means the pathologist has discovered cells that are either suspicious of cancer (called “dysplasia”), or are downright positive.
If there is any doubt, a repeat should be carried out soon after, either to confirm or deny the possibility.
But if the result is a definite positive, then immediate action is essential. The patient is alerted, and a cone biopsy is recommended.
This means hospital for a short time. In some centers this is preceded by a colposcopic examination. The doctor examines the cervix under the direct vision of a colonoscope, an instrument that gives a greatly magnified on-site enlargement of the cervix.
By this means, it is often possible to actually delineate the abnormal areas. Some doctors paint a special fluid onto the cervix, and note if there is a color change. Today, the “wart virus” (short for papilloma virus) is believed to be the cause of many (probably most) cases of cervical cancer. Entering the superficial cells, it alters the nucleus, turning the entire cells (and subsequent ones) into cancerous ones. This can quickly spread. The presence of wart virus will often increase the chance of the diagnosis of cancer being made because of the relationship between the two.
By the use of a device called the “cerviscope,” a color photograph is made of the cervix. This is kept for later referral, and rechecking at a later date to compare “then” with “now.” In medicine, this is often vital.
This is followed by a cone biopsy. A cone of tissue is removed surgically. In recent times, the laser scalpel is often used. This is claimed to give a cleaner, more precise incision. and greatly reduce bleeding. The biopsy will include the affected part of the cervix. This tissue is then completely examined by the pathologist to ascertain the extent of the possible early cancer. It also indicates if it has been totally removed.
Although smear tests are most commonly carried out by family doctors and general practitioners, further investigations, biopsies and so on are done by gynecologists.