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More information - types of cervical cells and abnormalities

To better understand abnormal results, it helps to know about the two different sorts of cervical cells – squamous and glandular.


There are two main types of cervical cancer. The Pap smear is most effective at detecting abnormalities that may lead to cancer in the skin-like cells that cover the cervix (called squamous cells). This is the most common type of cervical cancer.

A less common type of cervical cancer arises in the glandular cells found in the cervical canal. This is called adenocarcinoma of the cervix. It is more difficult to get a sample of these cells and less is known about the early changes which may lead to adenocarcinoma. So the Pap smear is less effective at detecting the early signs of this type of cancer.

There are two main categories of squamous abnormalities that can occur in the cervix:

• Low grade squamous intraepithelial lesions (LSIL) are minor abnormalities which normally go away within one year; and
• High grade squamous intraepithelial lesions (HSIL) which are more serious changes that require further investigation and sometimes treatment.

As cervical cancer usually takes up to 10 years to develop there is little advantage in having a Pap smear more frequently than every two years.

Regular Pap smears every two years are the best way to protect yourself against cervical cancer.

Check with your doctor if you have any unusual symptoms such as unexpected bleeding - even if your last Pap smear result was normal.

Type of abnormality	What it means	What happens next
Possible low-grade squamous intraepithelial lesion (possible LSIL)	Changes in cells that may represent a low-grade abnormality, but the changes are not clear enough to justify a ‘definite’ diagnosis.	If you have had previous Pap smears that have been normal, you can simply have another Pap smear in 12 months time. If you are over 30 years of age and have not had a Pap smear at all in the last 2 or 3 years, or have had abnormal results on Pap smears in that time, you can either have a follow up Pap smear in 6 months, or a colposcopy now. If this is your second Pap smear result in a row with a low grade abnormality (definite or possible) your doctor will refer you for a colposcopy.
Low-grade squamous intraepithelial lesion (LSIL)	Minor changes that are consistent with HPV (human papilloma virus) infection.
Possible high-grade squamous lesion (possible HSIL)	A high-grade abnormality is suspected but the changes are not clear enough to justify a ‘definite’ diagnosis.	Your doctor will refer you to a specialist for a colposcopy.
High-grade squamous intraepithelial lesion (HSIL)	A high-grade abnormality is considered to be definite.	Your doctor will refer you to a specialist for colposcopy. You may also need a biopsy.
Atypical endocervical cells of undetermined significance Atypical glandular cells of undetermined significance	Changes that are unusual in appearance and their exact nature is uncertain. There is no evidence of cancer.	Your doctor will refer you to a specialist for a colposcopy.
Possible high grade glandular lesion	A high grade glandular abnormality is suspected but the changes are not clear enough to justify a ‘definite’ diagnosis.	Your doctor will refer you to a specialist for a colposcopy.
Endocervical adenocarcinoma in situ	This describes an uncommon high grade abnormality inside the canal of the cervix. In situ means the abnormal cells have not extended into deeper tissue or surrounding areas.	Your doctor will refer you to a specialist for a colposcopy to confirm the result and to discuss treatment with you.

Low and high grade abnormalities are most often found in women aged between 25 and 35 years. However, they also occur in both younger and older women. For many women, especially those with low grade abnormalities, the abnormality will heal without treatment and the cells of the cervix will return to normal.

For the high grade abnormalities, it is usually more than 10 years before invasive cancer may develop. It is impossible to predict whether the abnormality will return to normal or develop into cancer. Therefore tests are always needed to confirm the diagnosis. Depending on these test results you will be advised of the way in which your condition can best be managed.

It is rare that a Pap smear result will show cells suggestive of cervical cancer, because cervical cancer is a rare disease. If this does happen, your doctor will recommend you see a specialist who will perform a colposcopy and further tests to determine how serious the changes are, before discussing treatment options with you. The terms used are described below.

Type of abnormality	What it means	What happens next
Squamous cell carcinoma	The presence of cancer in the squamous cells of the cervix.	Your doctor will refer you to a specialist or a specialist unit for evaluation and treatment.
Adenocarcinoma	A rare cancer affecting the glandular cells of the cervix rather than squamous cells.	Your doctor will refer you to a specialist or a specialist unit for evaluation and treatment.

If you have any concerns about your results, talk to your doctor. The Cancer Council in your state or territory can also provide information, and contact information can be found in Appendix 5.

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