Pap Smear: A Pap Smear is a collection of surface cells from the vagina or cervix.  It is a screening test to detect early stages of cell changes (Statistically about 90% effective).   It is interesting to note that 40% of women are not screened on an annual basis.

Dysplasia or CIN: Dysplasia simply means abnormal cell growth.  CIN (cervical intraepithelial neoplasia) is the medical term used for dysplasia.

Levels of Dysplasia

• Mild Dysplasia - CIN 1
• Moderate Dysplasia - CIN 2
• Severe Dysplasia - CIN 3

These abnormal cells are not necessarily cancerous, but if left untreated may become cancerous.

What happens when you have an abnormal reading or positive Pap Smear.  The standard procedure is to have a repeat Pap Smear done in 6 months.  At this time if the Pap Smear is still positive a specialist will be called on to perform another Pap Smear and also a colposcopic examination and a biopsy if necessary.

A colposcopy involves microscopically looking at the cervix to determine exactly where the abnormal cells are located.  A vinegar solution is sprayed on the area so that the abnormalities are more easily seen.

At this time a biopsy (small piece of tissue) from the abnormal cell area may be taken for analysis in a lab.  if the biopsy confirms the results of the Pap Smear and the colposcopy a treatment must be chosen.  This is assuming that the abnormal cells are located in a small area and have not spread farther into the pelvis.

Available Treatments

Cryo Surgery: The cervix is frozen with a gas to destroy the abnormal cells.  This takes about 10 minutes.

Laser Vaporization: This treatment uses a beam of light to destroy the abnormal cells.  Depending on the size of the area of the abnormal cells this procedure will take between 5 and 10 minutes.

Follow-up check ups after either of these procedures are critical.  Three negative Pap Smears (at 6-month intervals) are required before resuming yearly Pap Smears.

My Experience with these Procedures

This sounds like a very logical step-by-step method of dealing with a health problem.  However, in reality the steps may take longer than you might think..

In my particular situation, my annual September check -up had to be postponed until December (due to hospital and doctor schedules).  This meant I got my first positive Pap results in early January of 1998 showing mild dysplasia.   I did not get overly concerned at this point as I had a positive Pap result about ten years ago.  The standard procedure is to have a repeat Pap Smear after six months.  In June I had another Pap Smear which came back worse than the first one in January.

I was then referred to a specialist for another Pap Smear, colposcopic examination and a biopsy (if deemed necessary).  This appointment is scheduled four months in the future which takes us to September of 1998.  Almost one year to the day of my regularly scheduled check-up in 1997.

To make a long story short in September I had another Pap Smear, colposcopy and a biopsy.  I was told at that time, given what the Doctor was seeing (via the microscopic view), that I was either pre-cancerous or cancerous and was booked for Laser surgery in October.

I was also told at this time that it had taken years for the cells to become abnormal, so the time lines would make very little difference.  I then thought back to the Pap Smear that I had 10 years earlier.  You start wondering if that was a fluke or a precursor to the present problem.

I am now entering into the next stage, the follow-up check-ups which can simply be a Pap Smear or all the procedures repeated (10% of patients require further treatment).  As I said earlier you have to have three negative Pap smears in a row at six month intervals before returning to annual check-ups.  So the saga will continue well into the next century.

Looking back all I can say is it is very hard to have this kind of situation sitting in the back of your mind every day for upwards of 9 to 10 months.  Your mind tries to protect you as best as it possibly can but it is hard not to be fearful and wondering if it is escalating at the very moment you are cooking dinner or reading a book.  I also started having what I called "finality thoughts".  For example; what if I'm not here in the spring, who will take care of the garden.  Silly, right?.  These are the things your brain starts churning out if you let it.

I sought help in hypnosis to give me some positive energy and strengthening thoughts.  A positive attitude goes along way in the healing process.  I also started searching the internet for alternative treatments, in case I should need them in the future.  There are lots of choices.   My advice is have a Doctor who you trust and, more importantly, a Doctor whom you can talk to about alternatives and who will help you make an informed choice of treatment.

I also found a report in the Globe and Mail (one of Canada's national newspapers) on a radical change in treatment of spreading (but contained in the pelvic area) cervical cancer.  The radical treatment is the use of radiation simultaneously with chemotherapy.  Five separate studies in the U.S. revealed that the combination treatment reduced the risk of death by about 30 to 50%.  All the reports will be published this spring and I hope they will also appear on the Internet for all those who are interested and concerned.

I will update this site as my treatment continues and also if new information becomes available.

KMC