Receiving an abnormal Papanicolaou (Pap) smear result can be confusing and even scary. Does finding endometrial cells on a Pap smear necessarily mean you have cancer? In this article, we’ll explore what a Pap smear can and can’t tell you about endometrial cancer. We’ll also discuss what symptoms are concerning, what you should know about how to move forward, and how to follow up with your doctor.

Discuss any symptoms and family history with your provider to determine if endometrial cells on your Pap smear are a cause for concern. Endometrial cancer, a cancer that occurs inside the uterus, can be diagnosed with a few tests as prescribed by your doctor. If you’re concerned, talk to your doctor. Health outcomes for people with endometrial cancer are far better when you can detect the cancer at an early stage.

How Do Pap Smears Work?

A Papanicolaou (Pap) smear (sometimes called a Pap test) is used to screen people for early detection of cervical cancer. “Screening” is a type of medical testing that happens before someone experiences symptoms. According to Cleveland Clinic, anyone ages 21 to 65 with a cervix should get a Pap smear every few years (depending on your age) as a form of preventive healthcare.

Other than cervical cancer screening, a Pap smear can sometimes identify infections or other noncancerous conditions. To perform this test, a doctor uses a tool called a speculum to look inside the vagina. They will then use a brush to swab your cervix, which lies between your vagina and your uterus. This allows the doctor to take tissue samples of your cervical cells to send them off for testing.

Once the sample is tested, the lab will send your doctor a cytology report. This report contains information about what kind of cells the lab found and whether those cells are malignant (cancerous and harmful) or benign (not harmful).

Pap Smear Test Results and Their Meaning

A Pap test can sometimes detect signs of endometrial cancer, but generally, it’s used to screen for cervical cancer. The most common results after a Pap smear are normal, unclear, or abnormal.

Normal Results

A normal result means that the cells gathered during the Pap smear don’t have any irregularities.

Unclear Results

An unclear result could happen if not enough cells were collected from the cervix. You may also have an infection that makes the results hard to read. Many factors can make cervical cells hard to identify.

Abnormal Results

An abnormal Pap smear result means that some cells look irregular in shape or size. These cells could be cancerous or precancerous. Your doctor will be able to tell you how to move forward with treatment, follow-up testing, or monitoring.

The endometrium is the layer of tissue on the inside of the uterus and is made up of endometrial cells. When endometrial cells are found in a Pap smear after menopause, this is an abnormal result. Endometrial cells should be in the uterus, not the cervix.

A Pap smear can’t detect endometrial cancer on its own. Clinicians will have to do a few more tests to determine whether there is a significant concern when endometrial cells are found in a Pap smear.

Why Do Endometrial Cells Show on a Pap Smear?

In general, endometrial cells found in a Pap smear aren’t a cause for concern for people who aren’t experiencing symptoms. However, endometrial cells on a Pap smear, combined with other symptoms, could point toward signs of endometrial cancer — especially after menopause. Endometrial cancer is a type of uterine cancer and one of the more common gynecologic cancers.

Finding endometrial cells in your Pap smear could be entirely normal or a sign of something else, including endometrial cancer or other endometrial conditions. This is why following up with your doctor about the results is important to get the full picture.

When Are Endometrial Cells in a Pap Smear Normal?

If you’re younger than 45, the presence of endometrial cells in your Pap smear alone doesn’t typically mean your doctor will want to do further testing. If the Pap shows that you have benign-appearing endometrial cells (normal cells), your doctor likely won’t recommend further diagnostic tests. If you are 45 or older, your doctor may recommend more tests.

The most common reason to find normal endometrial cells in a Pap smear is that you are close to your period. During your period, the lining of the endometrium sheds from your uterus, causing endometrial cells to flow out of the uterus. So, if you are close to getting your period, this is a likely explanation for why you have endometrial cells in your cervix.

What Warrants Follow-Up When Endometrial Cells Are in a Pap Smear?

The endometrial pathology report will be able to tell you if you have atypical endometrial cells in the Pap smear. If the cells are abnormal, two possible causes are endometrial cancer and endometriosis.

Endometrial Cancer

You should tell your doctor if you have had any of the following high-risk symptoms for endometrial cancer:

• Abnormal uterine bleeding between menstrual periods
• New cramping in your pelvis or below your belly
• Any amount of vaginal bleeding after menopause
• White or clear vaginal discharge after menopause

Your doctor will also assess your other risk factors for endometrial cancer, including:

• Higher age
• Diabetes
• Obesity
• High blood pressure
• Late menopause
• Infertility
• Never giving birth
• Hormonal therapy with estrogen or tamoxifen

• Family history of endometrial cancer

Endometrial cells on a Pap smear combined with any one of these factors could indicate an issue that should be addressed by your doctor.

If you’re older than 50, and especially if you have abnormal or heavy and prolonged vaginal bleeding, you should tell your doctor so they can do tests to assess your endometrial health. Other studies note that these symptoms may be an issue in those as young as 40.

Your healthcare provider will do additional testing if they suspect endometrial cancer. This could include an endometrial biopsy (removing a small amount of tissue for testing in a lab) and a transvaginal ultrasound (using a probe to get images of your uterus). If you have other symptoms listed above, endometrial cancer is the main concern when endometrial cells are found in a Pap smear. There is no screening test recommended for the general population.

Endometriosis

Endometriosis is a condition where your endometrial cells grow outside of the uterus, including in the cervix. This can cause lesions and adhesions to form on your reproductive organs. The main symptom of endometriosis is pain (sometimes extreme pain) in your pelvic area and reproductive organs. You may also have heavy periods or bleeding between periods, much like with endometrial cancer.

Because of the overlapping symptoms between endometriosis and endometrial cancer, your doctor will have to do diagnostic tests to determine what is going on.

Talk With Others Who Understand

MyEndometrialCancerTeam is a social network for people with endometrial cancer and their loved ones. On MyEndometrialCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with endometrial cancer.

Did you receive an abnormal Pap smear result and have risks for endometrial cancer? What questions do you have about the risks and early signs of endometrial cancer? Share your thoughts and experiences by commenting below or by posting on your Activities page.