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General: Pap smear tests can detect pre–cancerous cells that may indicate cervical cancer. After an abnormal pap smear, a biopsy may be performed to definitively determine whether the patient has cervical cancer. Pap test: In most cases, cervical cancer is detected after a Pap test is performed as part of a regular pelvic examination. During the procedure, the healthcare provider spreads open the vagina with a tool called a speculum. Then a swab is inserted into the vagina and rubbed against the cervix. The swab removes a small sample of mucus and cells from the cervix. The sample is analyzed under a microscope for pre–cancerous cells. A negative Pap test means that there are no abnormalities in the cervical tissue, while a positive test indicates that abnormalities are present. These abnormalities can be described as either low–grade or high–grade squamous intraepithelial lesion (SIL), depending on the extent of dysplasia (abnormal cells). Researchers estimate that about 5–10% of Pap test show signs of mild abnormalities. However, many factors other than cervical cancer, including inflammation from bacteria or yeast infections, can cause abnormalities to appear. If an infection is present, the Pap test is repeated a few months after the infection is treated. Biopsy: After an abnormal Pap test, the physician may need to perform a procedure called a biopsy. During this procedure, the doctor inserts a magnifying scope into the vagina to view the surface of the cervix. The physician then uses a swab to coat the cervix with an iodine solution, which will turn normal cells brown and abnormal cells white or yellow. This part of the procedure is called a Schiller test. If abnormal cells are seen, a colposcopic biopsy is performed. During a colposcopic biopsy, the doctor removes a small piece of tissue from the cervix with a needle. The tissue is then examined for cancerous cells. This procedure may be performed with a local anesthetic (medication that numbs the region it is applied to). The procedure may cause mild cramping and bleeding, but it does not affect fertility. A procedure called endocervical curettage biopsy may also be used to diagnose cervical cancer. During the procedure, a narrow instrument called a curette is used to scrape tissue from inside the opening of the cervix. A local anesthetic may be applied to the cervix. Patients may experience mild cramping or light bleeding after the procedure, but it does not affect fertility. There are also several different types of cone biopsies, which are used to determine whether the abnormal cells have invaded the surface below the cervix. These procedures may also be used to treat many pre–cancers and very early cancers. A cone biopsy, or conization, is used to remove a cone–shaped piece of tissue from the cervix. During a cold knife cone biopsy, a surgical scalpel or laser is used to remove the tissue sample. A loop electrosurgical excision procedure (LEEP) is a cone biopsy that involves a wire that is heated by an electrical current. Cone biopsies are performed in a hospital, but an overnight stay is unnecessary. Patients may experience some cramping and bleeding for several weeks after the procedure is performed, but it does not affect fertility.
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