I was told after a Pap smear that I have "columnar epithelium surrounding the cervix." Can you explain what this is, what kinds of future problems I may have as a result, and what the treatment is? The doctor asked if my mother took DES while pregnant with me. What is DES, and what is the significance of it?

--Michelle

There are two types of cells on the cervix. Squamous cells, which are flat in shape, are found in multiple layers lining the vagina and outer part of the cervix. Columnar cells are tall, thick cells that line the cervical canal (the tunnel into the uterus) in a single layer. The "line" between the two regions -- the squamous-cell surface on the outside of the cervix and the columnar-cell surface inside the cervix -- can shift over time. In younger women, the columnar cells extend further forward, onto the outer portion of the cervix. This is often most pronounced after a first pregnancy in a woman in her 20s. It is also more pronounced in pregnant women and women on birth control pills. This is perfectly normal. Later, the columnar cells retreat into the cervical canal. In women exposed to DES, however, the columnar cells may extend all the way onto the vagina. This may be what you doctor was referring to.

DES is diethylstilbestrol, an estrogen-like compound that was used until the early 1960s to treat threatened miscarriages. The daughters of women who took DES are at increased risk for a certain type of vaginal cancer (clear cell adenocarcinoma), abnormal Paps and structural abnormalities of the cervix and uterus.

The mere presence of normal columnar cells on the vagina does not require treatment of any sort, but DES daughters do need regular Pap smears of both the cervix and vagina to detect any abnormalities that may arise. Abnormal cells are treated like they are in any other woman -- usually with a colposcopy to examine the vagina and cervix under magnification, accompanied by selective biopsies. Only cancerous or dysplastic (very abnormal) cells require additional treatment. This may involve cutting away or lasering the abnormal areas.