Abnormal Pap Test: Surgery

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Surgery

If you have had an abnormal Pap test, surgery may be an option. Surgical treatment may be recommended if:

• Your abnormal test results have been confirmed by colposcopy and a cervical biopsy.
• The cervical biopsy shows you have minor, moderate, or severe cell changes.
• The cervical biopsy shows that you have or may have cervical cancer.

Surgery may be done to destroy or remove the abnormal cells on your cervix, or confirm or rule out the possibility that you have cervical cancer.

Abnormal tissue that can be seen through the magnifying viewing instrument (colposcope) can often be destroyed or removed with cryotherapy, a cone biopsy, a carbon dioxide (CO2) laser, or the loop electrosurgical excision procedure (LEEP).

Abnormal cervical cells that are detected by a Pap test but cannot be seen by colposcopy may be high in the cervix (cervical canal). Before treatment is recommended, the location and type of cell change must be confirmed by a cervical biopsy. Depending on the results of the colposcopy and cervical biopsy, a cone biopsy may be done as the next step.

Surgery Choices

Surgical choices for abnormal cervical cell changes include the following:

Procedures that remove abnormal tissue

• Cone biopsy (conization) removes a cone-shaped wedge of abnormal cells high in the cervical canal. A small amount of normal tissue around the cone-shaped wedge of abnormal tissue is also removed so that a margin free of abnormal cells is left in the cervix.
• Loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal cervical cells. It can also be used to remove a cone-shaped wedge of tissue like a cone biopsy.

Procedures that destroy abnormal tissue

• Cryotherapy destroys abnormal cervical cells by freezing them.
• Carbon dioxide laser uses a laser beam to destroy (vaporize) abnormal cervical cells. It can also be used to remove a cone-shaped wedge of tissue like a cone biopsy.

If the results of a Pap test, colposcopy, and cervical or cone biopsy indicate invasive cervical cancer, then surgery, radiation, chemotherapy, or a combination of treatments will be needed to destroy or remove the cancerous tissue. A diagnosis of cervical cancer will probably be treated under the care of a medical oncologist who specialized in women's cancer (gynecologic oncologist).

Treatment options for cervical cancer that are not discussed in detail in this topic include:

• Total hysterectomy, to surgically remove the cervix, uterus, and other affected pelvic organs.
• Radiation therapy, to destroy cancer cells and shrink tumors with the use of high-dose X-rays.
• Chemotherapy, to destroy cancer cells with the use of medication.

For more information, see the topic Cervical Cancer.

What To Think About

Minor cell changes may not need to be treated with surgery. When deciding on treatment for minor cell changes, consider the following:

• Infections may be cured with medications for the specific cause of the infection.
• Minor cell changes often go away without treatment. Your doctor may suggest a period of watchful waiting before further evaluation or a biopsy is recommended. Surgery may be needed if the cell changes are confirmed by biopsy to be progressing to more severe cell changes. Surgery may also be done if follow-up evaluation is not possible or immediate treatment is wanted.
• Cell changes caused by human papillomavirus (HPV) infection may not progress beyond mild changes. The natural course of most types of HPV is for the cells to change back to normal within 18 months without treatment. Cervical cell changes caused by HPV may be treated because of their degree of abnormality, but treatment does not eliminate the virus; you may still have HPV inside your body's cells.

Treatment choices for moderate to severe cell changes are more likely to include surgery to specifically destroy or remove the abnormal tissue.

Last updated:	January 12, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Ross Berkowitz, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC