A Pap test result indicating atypical glandular cells (AGC) does not automatically mean cancer. It signifies that glandular cells collected from your cervix or uterus appear abnormal under a microscope. Further evaluation is needed to determine the precise cause of these cellular changes.
Understanding Atypical Glandular Cells
Atypical glandular cells originate from the glandular tissue lining the endocervical canal, the inner part of the cervix, or from the endometrium, the lining of the uterus. These cells are termed “atypical” because their appearance is abnormal, showing features more concerning than typical changes but not definitively cancerous. While most cervical cancers arise from squamous cells, a smaller proportion develops from glandular cells. AGC is uncommon in routine cervical screenings, detected in less than 1% of Pap test specimens.
What an AGC Result Might Indicate
An AGC result can indicate a range of conditions, from benign changes to precancerous lesions and invasive cancers. Benign causes include inflammation or polyps. AGC can also indicate serious conditions like adenocarcinoma in situ (a precancerous condition) or invasive cancers (e.g., cervical, endometrial, or squamous cell carcinoma).
The risk of high-grade precancer or cancer is higher with AGC, requiring thorough investigation. The risk of invasive malignancy ranges from 2% to 5%, with some studies showing up to 5.2%. Endometrial adenocarcinoma (57.6%) and cervical adenocarcinoma (23.6%) are the most common. For high-risk human papillomavirus (HPV) 16/18 positive AGC, the two-year invasive cancer risk can be as high as 17%.
Diagnostic Steps Following an AGC Finding
Following an AGC finding, diagnostic procedures are recommended to pinpoint the cause of the atypical cells. A colposcopy is performed, involving a magnified examination of the cervix, vagina, and vulva. During colposcopy, directed biopsies may be taken from suspicious areas. Endocervical sampling, also known as endocervical curettage (ECC), involves collecting tissue from the inner cervical canal.
An endometrial biopsy is often performed, especially for women over 35, those with abnormal uterine bleeding, or if the atypical glandular cells appear to be of endometrial origin. Imaging tests, such as ultrasound, may also be considered based on the specific type of AGC or other clinical factors. These evaluations are important because colposcopy alone may not always detect glandular lesions, which can reside deep within the endocervical canal or glandular crypts.
Navigating Your Diagnosis
Understanding the specific diagnosis after AGC testing is important for developing an effective management plan. Adherence to follow-up recommendations is important for favorable outcomes, whether the diagnosis reveals a benign condition, a precancerous lesion, or an invasive cancer. Open communication with your healthcare providers is also encouraged to ensure you understand your condition and treatment options.
For some AGC diagnoses, particularly “AGC, favor neoplasia,” if initial evaluations like colposcopy and endometrial sampling are negative, a cone biopsy may be recommended to rule out malignancy. This surgical procedure removes a cone-shaped piece of tissue from the cervix for detailed examination. Regular follow-up with cervical cytology and HPV testing is often advised, even after initial negative findings, to monitor for recurrence or progression.