Did you know that a Pap test offers much more information than just cervical cancer screening? Besides detecting cancerous and precancerous cervical cells, a pathologist can learn a great deal from this simple cellular scraping taken from the cervix and vagina.
At PathAdvantage, where all MyPathAdvantage tests are analyzed, we also receive Pap tests from doctors’ offices. While the primary focus is determining if a patient is at risk for or already has cervical cancer, a pathologist can make many other important observations and diagnoses from a Pap test.
Here Are Some of the Key Pap Test Insights
Hormonal Status: A woman with low estrogen levels, such as during menopause, will have cells that look completely different from those of a woman with normal estrogen levels. This information can help your clinician determine if you are peri- or postmenopausal. If you are undergoing hormone replacement therapy, it can also indicate the treatment’s effectiveness.
Microorganisms: A variety of microorganisms can be identified on a Pap test, some of which can cause serious health symptoms.
Viruses: While viruses themselves cannot be seen under a microscope, we can identify the unique cellular changes they cause. These include HPV (the main cause of cervical, vaginal, and other cancers), herpes, and cytomegalovirus.
Fungi: Pathologists can detect and identify fungi by their characteristics. Most fungi found in Pap tests are Candida species, which usually cause yeast infections.
Bacteria: Bacteria can often be seen clinging to cells like a sugar coating. Abnormal bacterial coatings suggest a shift from normal to abnormal bacteria, potentially leading to bacterial vaginosis. In such cases, we recommend molecular testing from the Pap vial to identify the bacteria and determine if treatment is needed. Pathologists can also identify Actinomyces species, which are more common in individuals with an IUD. Significant inflammation and symptoms might lead to the removal of the IUD.
Trichomonads: These protozoa cause trichomoniasis, the most common curable sexually transmitted infection, and can be seen on a Pap test if present in high enough density.
Degree of Inflammation: Pathologists grade the degree of inflammation, which can alert the clinician to potential infections that need identification and treatment.
Endometrial Glandular Cells: During menstruation, it’s normal to see endometrial cells (cells from the lining of the uterus) in a Pap test. However, if these cells are seen more than 10 days after the period, it might indicate irregular cycles and necessitate an endometrial biopsy or further treatment. Postmenopausal women should not have endometrial cells in their Pap test, and their presence typically calls for an endometrial biopsy.
Other Concerns Illuminated from a Pap Test
In my long career as a pathologist, I have diagnosed cancers of the endometrium, ovaries, fallopian tubes, bladder, colon, breast, and more, as well as melanoma, lymphomas, and other sarcomas from Pap tests. Some of these cancers directly spread to the cervix or metastasize through the lymph or vascular systems. At PathAdvantage, any detection of cancer prompts an immediate phone call to the clinician from the pathologist.
PathAdvantage reports these various findings on all Pap test results, helping guide your clinician in providing the best care. This comprehensive approach is why pathologists are often called “the doctor’s doctor.”
