Anal Pap smear

Last updated
Anal Pap smear
ICD-9 90.96

An anal Pap smear is the anal counterpart of the cervical Pap smear. [1] It is used for the early detection of anal cancer. Some types of human papillomavirus (HPV) can cause anal cancer. [2] Other HPV types cause anogenital warts. Cigarette smokers, men who have sex with men, individuals with a history of immunosuppression (such as in HIV infection) and women with a history of cervical, vaginal and vulval cancer are at increased risk of getting anal cancer. [3] Vaccination against HPV before initial sexual exposure can reduce the risk of anal cancer.

Contents

Indications

There is no consensus on who should get an anal Pap smear. [4] Some individuals recommend that all men and women who have anal sex should have an anal Pap smear performed regularly. [4] Some recommend it for all men who have had sex with men, [5] for all individuals with HIV and anal warts, [4] or for all individuals with a history of anal warts. [4] Cost-effectiveness studies have reported conflicting conclusions, due to incomplete understanding of the natural history of anal HPV infection and lack of clarity of the efficacy of interventions. [6] An informal survey of local infectious-disease doctors in southeast Michigan suggested that few know where to send patients for an anal Pap smear. The procedure is very simple, and can be easily performed in any doctor's office with a little training. [7] [8]

Procedure

Typically, a small brush or Dacron-tipped rod is inserted into the anus. The cells collected by the brush or rod are smeared onto a glass slide, air-dried, and sealed with an adhesive. Many medical offices prefer to suspend the collected cells in a liquid medium; the suspension is then processed in a laboratory before being plated on a glass slide. The specimen is sent to a pathologist, indicating the source of the smear (anal canal). The liquid in which the cells are suspended can also be used for HPV typing. [9]

The procedure is easily performed in a doctor's office, using the same kit as for cervical cancer detection. It can be performed quickly, as a vaginal speculum or anoscope is not required. [7]

Interpreting an anal Pap smear

The sensitivity and specificity of anal Pap smears are lower than those of their cervical counterparts. [10] This means that a single negative anal Pap smear does not prove that the person is cancer-free, and a positive result does not prove that the person has cancer.[ citation needed ]

There are currently no agreed algorithms for the investigation of abnormal anal Pap smear results. However, referral for High Resolution Anoscopy (HRA) is often considered, if available. HRA allows microscopic visualization and biopsy of potentially abnormal areas. Treatment decisions are then made on the basis of the biopsy results.[ citation needed ]

A person might be referred to a colorectal surgeon, an infectious disease doctor, or a physician trained in colposcopy, examination, or biopsy of this region. At a minimum, a digital rectal exam is performed. A proctoscopic exam might follow. Ultimately, a biopsy might be performed, with or without the aid of a colposcope, [11] a dermatoscope, or high-resolution anoscopy. [11]

Bibliography

Related Research Articles

<span class="mw-page-title-main">Cervix</span> Lower part of the uterus in the human female reproductive system

The cervix or cervix uteri is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long and roughly cylindrical in shape, which changes during pregnancy. The narrow, central cervical canal runs along its entire length, connecting the uterine cavity and the lumen of the vagina. The opening into the uterus is called the internal os, and the opening into the vagina is called the external os. The lower part of the cervix, known as the vaginal portion of the cervix, bulges into the top of the vagina. The cervix has been documented anatomically since at least the time of Hippocrates, over 2,000 years ago.

<span class="mw-page-title-main">Pap test</span> Cervical screening test to detect potential cancers

The Papanicolaou test is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix or colon. Abnormal findings are often followed up by more sensitive diagnostic procedures and, if warranted, interventions that aim to prevent progression to cervical cancer. The test was independently invented in the 1920s by the Greek physician Georgios Papanikolaou and named after him. A simplified version of the test was introduced by the Canadian obstetrician Anna Marion Hilliard in 1957.

<span class="mw-page-title-main">Cervical cancer</span> Cancer arising from the cervix

Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

<span class="mw-page-title-main">Human papillomavirus infection</span> Human disease

Human papillomavirus infection is caused by a DNA virus from the Papillomaviridae family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and results in either warts or precancerous lesions. These lesions, depending on the site affected, increase the risk of cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat. Nearly all cervical cancer is due to HPV and two strains – HPV16 and HPV18 – which account for 70% of cases. HPV16 is responsible for almost 90% of HPV-positive oropharyngeal cancers. Between 60% and 90% of the other cancers listed above are also linked to HPV. HPV6 and HPV11 are common causes of genital warts and laryngeal papillomatosis.

<span class="mw-page-title-main">Cytopathology</span> A branch of pathology that studies and diagnoses diseases on the cellular level

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in 1928. Cytopathology is generally used on samples of free cells or tissue fragments, in contrast to histopathology, which studies whole tissues. Cytopathology is frequently, less precisely, called "cytology", which means "the study of cells".

<span class="mw-page-title-main">Colposcopy</span> Medical examination of the cervix

Colposcopy is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope. Numbing should be requested prior to procedure.

<span class="mw-page-title-main">Anal cancer</span> Medical condition

Anal cancer is a cancer which arises from the anus, the distal opening of the gastrointestinal tract. Symptoms may include bleeding from the anus or a lump near the anus. Other symptoms may include pain, itchiness, or discharge from the anus. A change in bowel movements may also occur.

<span class="mw-page-title-main">Precancerous condition</span> Medical condition

A precancerous condition is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer. Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased risk of developing into cancer. Some of the most common precancerous conditions include certain colon polyps, which can progress into colon cancer, monoclonal gammopathy of undetermined significance, which can progress into multiple myeloma or myelodysplastic syndrome. and cervical dysplasia, which can progress into cervical cancer. Bronchial premalignant lesions can progress to squamous cell carcinoma of the lung.

<span class="mw-page-title-main">Cervical intraepithelial neoplasia</span> Medical condition

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. More specifically, CIN refers to the potentially precancerous transformation of cells of the cervix.

<span class="mw-page-title-main">HPV vaccine</span> Class of vaccines against human papillomavirus

Human papillomavirus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus (HPV). Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HPV types 16 and 18, which cause the greatest risk of cervical cancer. It is estimated that HPV vaccines may prevent 70% of cervical cancer, 80% of anal cancer, 60% of vaginal cancer, 40% of vulvar cancer, and show more than 90% efficacy in preventing HPV-positive oropharyngeal cancers. They additionally prevent some genital warts, with the quadrivalent and nonavalent vaccines that protect against HPV types HPV-6 and HPV-11 providing greater protection.

<span class="mw-page-title-main">Koilocyte</span>

A koilocyte is a squamous epithelial cell that has undergone a number of structural changes, which occur as a result of infection of the cell by human papillomavirus (HPV). Identification of these cells by pathologists can be useful in diagnosing various HPV-associated lesions.

<span class="mw-page-title-main">Gardasil</span> Human papillomavirus vaccine

Gardasil is an HPV vaccine for use in the prevention of certain strains of human papillomavirus (HPV). It was developed by Merck & Co. High-risk human papilloma virus (hr-HPV) genital infection is the most common sexually transmitted infection among women. The HPV strains that Gardasil protects against are sexually transmitted, specifically HPV types 6, 11, 16 and 18. HPV types 16 and 18 cause an estimated 70% of cervical cancers, and are responsible for most HPV-induced anal, vulvar, vaginal, and penile cancer cases. HPV types 6 and 11 cause an estimated 90% of genital warts cases. HPV type 16 is responsible for almost 90% of HPV-positive oropharyngeal cancers, and the prevalence is higher in males than females. Though Gardasil does not treat existing infection, vaccination is still recommended for HPV-positive individuals, as it may protect against one or more different strains of the disease.

HspE7 is an investigational therapeutic vaccine candidate being developed by Nventa Biopharmaceuticals for the treatment of precancerous and cancerous lesions caused by the human papillomavirus (HPV). HspE7 uses recombinant DNA technology to covalently fuse a heat shock protein (Hsp) to a target antigen, thereby stimulating cellular immune system responses to specific diseases. HspE7 is a patented construct consisting of the HPV Type 16 E7 protein and heat shock protein 65 (Hsp65) and is currently the only candidate using Hsp technology to target the over 20 million Americans already infected with HPV.

The Bethesda system (TBS), officially called The Bethesda System for Reporting Cervical Cytology, is a system for reporting cervical or vaginal cytologic diagnoses, used for reporting Pap smear results. It was introduced in 1988 and revised in 1991, 2001, and 2014. The name comes from the location of the conference, sponsored by the National Institutes of Health, that established the system.

Cervicography is a diagnostic medical procedure in which a non-physician takes pictures of the cervix and submits them to a physician for interpretation. Other related procedures are speculoscopy and colposcopy. The procedure is considered a screening test for cervical cancer and is complementary to Pap smear. The technique was initially developed by Adolf Stafl, MD, of Medical College of Wisconsin in 1981.

Anal dysplasia is a pre-cancerous condition which occurs when the lining of the anal canal undergoes abnormal changes. It can be classified as low grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL). Most cases are not associated with symptoms, but people may notice lumps in and around the anus.

Epithelial dysplasia, a term becoming increasingly referred to as intraepithelial neoplasia, is the sum of various disturbances of epithelial proliferation and differentiation as seen microscopically. Individual cellular features of dysplasia are called epithelial atypia.

<span class="mw-page-title-main">Squamous intraepithelial lesion</span>

A squamous intraepithelial lesion (SIL) is an abnormal growth of epithelial cells on the surface of the cervix, commonly called squamous cells. This condition can lead to cervical cancer, but can be diagnosed using a Pap smear or a colposcopy. It can be treated by using methods that remove the abnormal cells, allowing normal cells to grow in their place. In the Bethesda system, the cytology can be graded as LSIL or HSIL.

<span class="mw-page-title-main">Cervical screening</span> Type of medical screening

Cervical cancer screening is a medical screening test designed to identify risk of cervical cancer. Cervical screening may involve looking for viral DNA, and/or to identify abnormal, potentially precancerous cells within the cervix as well as cells that have progressed to early stages of cervical cancer. One goal of cervical screening is to allow for intervention and treatment so abnormal lesions can be removed prior to progression to cancer. An additional goal is to decrease mortality from cervical cancer by identifying cancerous lesions in their early stages and providing treatment prior to progression to more invasive disease.

Pamela Toliman is a medical researcher from Papua New Guinea (PNG) who has researched areas such as sexually transmitted diseases, HIV/AIDS, cervical cancer and COVID-19.

References

  1. ↑ Arain, Shehla; Walts, Ann E.; Thomas, Premi; Bose, Shikha (2005). "The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions". CytoJournal. 2 (1): 4. doi:10.1186/1742-6413-2-4. ISSN   1742-6413. PMC   551597 . PMID   15715910.
  2. ↑ "Anal cancer". aidsmap. London: NAM Publications. Archived from the original on 5 June 2011. Retrieved 2011-06-01.
  3. ↑ Grulich, Andrew (2012). "The epidemiology of anal cancer". Sexual Health. 9 (6): 504–8. doi:10.1071/SH12070. PMID   22958581. S2CID   12141130.
  4. 1 2 3 4 Evans, David (2008-06-10). "Pap Smears for Anal Cancer?". AIDSmeds. New York: Smart + Strong. Archived from the original on 7 July 2011. Retrieved 2011-06-01.
  5. ↑ Boskey, Elizabeth (2010-04-10). "The Anal Pap Smear: Who, When, & Why". About.com: Sexually Transmitted Diseases (STDs). New York: The New York Times Company. Archived from the original on 7 July 2011. Retrieved 2011-06-01.
  6. ↑ Howard, Kirsten (2012). "The cost-effectiveness of screening for anal cancer in men who have sex with men: a systematic review". Sexual Health. 9 (6): 610–619. doi:10.1071/SH12017. PMID   22951072.
  7. 1 2 Daskalakis, Demetre. "The Anal Pap: a guide for primary care providers". hivcouncil.org. New Haven, CT: New Haven HIV Consumer Council. Archived from the original on 2011-07-26. Retrieved 2011-06-01.
  8. ↑ "Human Papilloma Virus (HPV, genital warts, anal/cervical dysplasia/cancer". AIDSmeds. Smart + Strong. 2011-01-06. Retrieved 2011-06-01.
  9. ↑ Darragh, Teresa (2012). "Screening for anal neoplasia: anal cytology – sampling, processing and reporting". Sexual Health. 5 (6): 556–561. doi:10.1071/SH12003. PMID   22950982.
  10. ↑ Roberts JM, Thurloe JK (2012). "Comparison of the performance of anal cytology and cervical cytology as screening tests". Sexual Health. 9 (6): 568–573. doi:10.1071/SH11178. PMID   22951325.
  11. 1 2 Kesic, Vesna (2004). "Chapter 14: Colposcopy of the vulva, perineum, and anal canal" (PDF). In Bősze, Péter; Luesley, David M. (eds.). EAGC Course Book on Colposcopy. European Academy of Gynaecological Cancer (EAGC). Primed-X Press. pp. 126–163. ISBN   978-963-00-7356-1 . Retrieved 2011-06-01.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.