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Does low-grade squamous intraepithelial lesions in a colposcopy a sign of cancer?

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Posted on Tue, 18 Oct 2016
Question: I am a 70 year old woman who had a cone iopsy for cervical cancer in 1985. All Paps and colposcopy (wihout biopsy) since then have been normal. Last year, LSIL cells showed up on my cervix and when I went on Friday for my yearly check-up (with colposcopy - no biopsy - and acetic acid), my gyn told me everything looked normal and if the the low-grade squamous cells were still present in the currentpap, they would not progress to cancer but would usually resolve themselves within a year or two, so not to worry if this pap came back abnormal too. It seems this result is related to HPV and since I have not been sexually active since my husband died in 1991, I am confused. Should I be worried? My gyn has decades of experience and has followed me since 1985 when he did the cone biopsy.
doctor
Answered by Dr. Jacqueline Brown (1 hour later)
Brief Answer:
Low grade dysplasia is not precancerous and you are past the age of risk

Detailed Answer:
Hello, and I hope I can help you today.

The guidelines regarding management of abnormal PAP smears and dysplasia has changed significantly in the past 10 years because of our increased understanding of the biology of the HPV virus. I am going to try to explain your doctor's recommendation as best as I can without reviewing your medical records.

The Pap smear is only a screening test. Having mildly abnormal appearing cells (low grade) on your Pap can be caused by other abnormalities, such as a vaginal infection, or menopausal skin changes. To tell if any of these cells might be dysplasia, we test for HPV and if you tested positive at the time, it is recommended to have a colposcopy to physically look at your cervix to see if there is a patch of visibly abnormal cells to biopsy.

In your case, it seems that you do not have a visible lesion on your cervix. This can mean that the low grade PAP was a false positive (meaning that you have HPV but the irregular appearing cells were not due to dysplasia) or that the area is so small that it was invisible, even under the magnification of the colposcope. The HPV you have is probably the same infection that you were treated for back where you were young.

For that reason, your doctor reassured you that you most likely do not have dysplasia at all and recommended a repeat PAP smear and HPV test in one year, which is the correct management plan.

The reason we wait a year now for re-evaluation of an abnormal PaP test is that we have learned that cervical cancer (and its precursors) take a very long time to develop. Only high-grade dysplasia develops into cancer, and It takes 7-10 years for that to happen. So there is no reason to be concerned about low grade dysplasia as it is not precancerous and as your doctor said, it frequently resolves on its own.

Understanding the biology of HPV and the current U.S. Pap smear guidelines is difficult even for doctors. The updated screening guidelines are available on the website of the ASCCP (www.asccp.org). There is patient information available there as well.

I hope I was able to reassure you that you really do not have to worry and that I was able to answer your question adequately today. If you need any further clarification, please do not hesitiate to contact me. If you do have further questions, it would be helpful to be able to review the reports from your previous PAP and colposcopy to give you the most accurate recommendation.

Best wishes,

Dr. Brown
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Jacqueline Brown (28 hours later)
Thanks for the detailed and accessible info...so just to clarify and calm my own nervousness (read: fear), what my GYN told me is correct. Even if the low-grade LSIL cells are still present in the current Pap sample, there's no need for alarm...and they may still go away within the next year...failing which, he did say that if I was worried, he would cryo them off. In other words, I am not walking around incubating another cervical cancer.
One thing I'm not fully understanding is the recurrence of HPV (which I don't believe I've ever been tested for). Once I had the cone biopsy, all sexual intercourse ceased between my husband and myself and since his death in 1991, I have not gone that route with any one else either (protected or otherwise). Can HPV be transmitted in ways other than unprotected intercourse?
When the cone biopsy was done, I was told that all the edges were clear...no questionable cells at all...and of course, the cervix grew back (it's now stenotic and atrophic, but it's there) So my concern is, what is causing the abnormality in the cells? Or is this not a major problem since the abnormality itself is neither progressive nor life-threatening? Thanks!
doctor
Answered by Dr. Jacqueline Brown (21 minutes later)
Brief Answer:
You may not have dysplasia at all as it has never been proven by biopsy

Detailed Answer:
Hello again,

First of all, once you catch HPV, the virus remains in your body for the rest of your life. The biology of HPV was not well known until at least the late 1990's, and only in the last 10-15 years has HPV testing been available, so it is unlikely you were tested in the past. The disease that HPV causes, namely dysplasia, can be treated, and your cone biopsy years ago likely removed all the abnormal calls, but the virus can remain dormant in your body for years. Reactivation of the HPV you already had can happen from your immune system not being as strong as it once was due to age, cigarette smoking, or any medications or diseases that suppress the immune system, or to chance alone.

However, cells that APPEAR low grade on a PAP test (and I say appear, because the cells are graded on their size and degree of staining under the microscope) can also be due to other things, like atrophy, which you have... But these days, when any abnormal cells are found we perform an HPV test to see if the patient has the virus, and if she does, we have to look for a source of those cells on a colposcopy. But you may just be an HPV carrier and NOT have dysplasia at all, especially because your doctor cannot see any lesion on your cervix at colposcopy.

So the bottom line is- there is no way to know what is making your cervical cells look abnormal on the PAP test, but if there is nothing visible on colposcopy, then you either have microscopic low-grade calls on your cervix that are too small to see, or some other process that makes your cervical cells look dysplastic without actually having anything wrong. Either way, whatever you do have is not going to turn into cervical cancer or progress to anything life-threatening.

I hope that my explanation can reassure you that there is no reason to worry about your situation. As long as you get regular gynecologic care and yearly PAP tests, there is no way that cervical cancer could be missed.

I hope that your upcoming PAP test is normal and that you have no reason to worry about this ever again. If I can clarify anything else about HPV or your current situation, please let me know.

Otherwise, I thank you for using healthcaremagic.com

Warm regards,

Dr. Brown
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Jacqueline Brown

OBGYN

Practicing since :1996

Answered : 1425 Questions

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Does low-grade squamous intraepithelial lesions in a colposcopy a sign of cancer?

Brief Answer: Low grade dysplasia is not precancerous and you are past the age of risk Detailed Answer: Hello, and I hope I can help you today. The guidelines regarding management of abnormal PAP smears and dysplasia has changed significantly in the past 10 years because of our increased understanding of the biology of the HPV virus. I am going to try to explain your doctor's recommendation as best as I can without reviewing your medical records. The Pap smear is only a screening test. Having mildly abnormal appearing cells (low grade) on your Pap can be caused by other abnormalities, such as a vaginal infection, or menopausal skin changes. To tell if any of these cells might be dysplasia, we test for HPV and if you tested positive at the time, it is recommended to have a colposcopy to physically look at your cervix to see if there is a patch of visibly abnormal cells to biopsy. In your case, it seems that you do not have a visible lesion on your cervix. This can mean that the low grade PAP was a false positive (meaning that you have HPV but the irregular appearing cells were not due to dysplasia) or that the area is so small that it was invisible, even under the magnification of the colposcope. The HPV you have is probably the same infection that you were treated for back where you were young. For that reason, your doctor reassured you that you most likely do not have dysplasia at all and recommended a repeat PAP smear and HPV test in one year, which is the correct management plan. The reason we wait a year now for re-evaluation of an abnormal PaP test is that we have learned that cervical cancer (and its precursors) take a very long time to develop. Only high-grade dysplasia develops into cancer, and It takes 7-10 years for that to happen. So there is no reason to be concerned about low grade dysplasia as it is not precancerous and as your doctor said, it frequently resolves on its own. Understanding the biology of HPV and the current U.S. Pap smear guidelines is difficult even for doctors. The updated screening guidelines are available on the website of the ASCCP (www.asccp.org). There is patient information available there as well. I hope I was able to reassure you that you really do not have to worry and that I was able to answer your question adequately today. If you need any further clarification, please do not hesitiate to contact me. If you do have further questions, it would be helpful to be able to review the reports from your previous PAP and colposcopy to give you the most accurate recommendation. Best wishes, Dr. Brown