Tests and Treatment

Pap Tests and HPV Tests: What's the Difference?

I have recently been diagnosed with genital warts. My wife had her Pap test a month or so later and it was normal. My question is will the Pap detect all types of HPV?

Pap tests don't look directly for HPV infections. Rather, they can find abnormal cell changes (such as those caused by HPV). Paps can often detect cells that are suggestive of what you'd expect an HPV-infected cell to look like, then, but still won’t find the virus. A woman with HPV who has no abnormal cell changes will have a normal Pap test result, even though she has the virus. Keep in mind that the vast majority of women with HPV never have even a single abnormal Pap as a result!

An HPV test, on the other hand, can detect the virus itself. These tests are only approved, though, for use in combination with a Pap as part of cervical cancer screening for women age 30 and over. The tests can also be used for women over age 21 who have slightly abnormal or unclear Pap test results (although repeating the Pap at 12 months is preferred for women ages 21-24 with unclear test results).

Keep in mind that external, visible genital warts are almost always caused by “low risk” types of HPV that aren’t linked to cervical cancer. Since an HPV test done clinically will be looking for “high risk” types of the virus, your wife is not likely to have an abnormal test due to your warts diagnosis.

It is likely you and your wife both share HPV, even though she may well never be diagnosed with either the virus or a related condition. Couples typically clear the virus over time; some studies indicated that condom use helps couples clear the virus more quickly.

--The NCCC Staff

When is a LEEP Needed?

I have a question regarding Loop Electrosurgical Excision Procedure which is called (LEEP Surgery). I would like to know when is this procedure necessary? A couple of years ago I had a high-grade PAP test result, and last year my PAP was normal. My healthcare provider also did an HPV test, which was negative. Should I have had the LEEP?

LEEP (also known as LOOP), cuts away abnormal cervical cell using a thin wire through which electrical current is briefly passed. It’s difficult to speak directly to your specific situation, as there are numerous factors that influence specific follow-up (depending on their medical history and other details, recommended “next steps” may be very different for women with the same Pap test results).

So in many cases, there is no one size fits all approach to follow-up care and management of women with abnormal PAPs. Keep in mind that in addition to being a treatment option, a LEEP is also a considered a diagnostic procedure (the tissue removed can be sent to a lab for additional evaluation). There are several acceptable “next steps” for women with Pap results that indicate high-grade abnormalities (often called HSIL Pap results, or High-grade Squamous Intraepithelial Lesion), and a LEEP is one of them (whether done immediately following the abnormal Pap or later).

In general terms, then, LEEP is common as a treatment and/or diagnostic option for women with significantly abnormal PAPs, even if their colposcopy/biopsy does not indicate any cervical pre-cancer is present. The health care provider who diagnosed should be able to address any questions you might have as to why he or she chose one approach over another.

--The NCCC Staff

Endocervical Curretage

I was wondering if someone could shed some light on the ECC procedure. If I get one, will I be able to tell exactly what types of the high-risk HPV I have? I can’t seem to figure out what information it gives the patient.

 Endocervical curretage (ECC) is a diagnostic procedure where clinicians use a small, spoon-shaped tool to scrape tissue from inside the cervical canal which is then sent to a lab and analyzed (similar to what is done with a biopsy sample). ECC is most often done as part of a colposocopy and can help confirm or rule out the presence of high-grade lesions. This is in turn guides the healthcare provider in determining what treatment, if any, is indicated. 

ECC is not a specific test for HPV itself, so it won't pinpoint which high-risk HPV types might be present, just whether or not there are lesions within the cervical canal.

--The NCCC Staff

What’s the difference between internal and external radiation therapy? When treating cervical cancer, when is one chosen over the other?

The main difference between these two modalities is the way in which radiation is delivered.  The term 'external' implies that the radiation is traveling from outside in.  With this form of treatment, which is most commonly what one thinks of with radiation, the patient is usually lying on a flat table and the radiation delivery machine is rotating around the patient.  The machine never actually makes any physical contact with the patient. 

'Internal' radiation, also known as brachytherapy, means that the radiation is delivered from inside out.  This usually involves a brief outpatient procedure because the radioactive source needs to be placed inside the patient. As it is a relatively invasive procedure, not everyone is medically fit to undergo such treatment.

Although it is ultimately dependent on the stage and overall health of the patient, the majority of cervical cancer patients will ideally undergo a combination of external and internal radiation therapy.  This is the best way we have to get as much radiation dose to the tumor, thereby maximizing our ability to cure disease.

--Mamta Singhvi, MD