An epithelial cell abnormality, detected during a Pap smear, can be a sign of potential precancerous changes in the cervix. According to the American Cancer Society, Pap tests can identify abnormal cells that may develop into cancer if left untreated.
While not all abnormalities are indicative of cancer, it is crucial for women to follow up with their healthcare providers. Further testing, often at intervals of every 3 to 6 months, helps monitor these changes and determine the appropriate course of action. Understanding what an epithelial cell abnormality means empowers women to proactively manage their cervical health.
Types of Abnormalities
Atypical epithelial cells are broken down into two broad categories: squamous cells and glandular cells. Squamous cells are simply smooth, surface layer cells, while glandular cells excrete bodily materials, like hormones or sweat. The most common reasons for a finding of unusual squamous cells are Atypical Squamous Cells (ASC), Squamous Intraepithelial Lesions (SIL), or squamous cell carcinoma. Glandular cell problems are typically categorized as Atypical Glandular Cells (AGCs) or adenocarcinoma. Of both squamous and glandular cell abnormalities, only findings of squamous cell carcinoma and adenocarcinoma almost definitely indicates cancer.
ASC
ASCs are clearly not normal, but it's not entirely clear why. Cells in this category can be either Atypical Squamous Cells of Undetermined Significance (ASCUS) or Atypical Squamous Cells with possible High-Grade Changes (ASC-H). The first type is generally not a cause for concern, although health care providers often recommend a follow-up pap smear just to be sure. The second type indicates that there may be a SIL or other pre-cancerous cells on the surface of the cervix, but it's not entirely certain. In this case, a health care provider will generally call for a colposcopy, which is a diagnostic test in which a gynecologist visually examines the inside of the vagina for other abnormalities or lesions.
SIL
SILs are growths on the surface of the cervix that can lead to cancer. They are categorized as low or high risk depending on how likely they are to cause cancer. After a finding of SIL, a health care provider will usually recommend a colposcopy or biopsy to confirm the level of risk associated with the cell.
Squamous cell carcinoma
Squamous cell carcinoma is the most common type of cervical cancer, and can be fatal if left untreated. If it is indicated by a pap smear, health care providers will usually perform a colposcopy or biopsy to determine what stage the cancer is in, ranging from "in situ," which means that cancerous cells exist, but have not yet spread into the tissue surrounding them; to stage 4, in which the carcinoma has spread beyond the cervix. Once this has been determined, a woman can start a treatment regimen.
AGC
This finding can indicate that the glandular cells in either the cervix or the lining of the uterus, also called the endometrium, may have a problem. About half of the time AGCs are not a cause for concern, similarly to ASCUS. They can, however, be pre-cancerous, so health care providers usually do a biopsy just to be sure.
Adenocarcinoma
This is a fairly rare type of cancer that is similar to squamous cell cancer, but affects glandular cells instead. As with a finding of squamous cell cancer, health care providers generally order further testing to determine the stage of the cancer, and then begin treatment.
Causes
One cause of abnormal epithelial cells is cervical dysplasia. In this case, cervical cells grow abnormally, and they are either shaped oddly or they grow in larger quantities. This cell growth is not malignant, but can develop into cancer over the course of 10 years or longer. Cervical dysplasia occurs more often in women from 25 to 35 years old and typically has no symptoms.
Unusual cells are sometimes reported because of infections such as herpes and human papillomavirus (HPV), one of the primary risk factors for cervical cancer. The presence of parasites or yeast infections can also yield a positive result. A cellular sample can turn up abnormal because of an injury. If an infection or injury is suspected, then there is usually no concern for cancer as a result of finding an epithelial cell abnormality.
Treatment
Treatment for an epithelial cell abnormality depends on the individual problem. If the cells are non-cancerous, there is not usually any immediate treatment, except for future tests. Treatment for cancerous lesions can vary from case to case. If these are found in an early stage, the condition is often treatable with minor procedures; while more advanced cases may require surgery, medication, and radiotherapy. The exact course of treatment often depends on the condition and the advice of multiple health care professionals.