What Does an AGC Pap Smear Result Mean, and Why Check the Womb Lining?

An AGC Pap smear result means atypical glandular cells: some glandular cells in the sample did not look normal under the microscope. AGC is not a cancer diagnosis. Because these cells can come from the cervical canal or from higher up inside the womb, the US National Cancer Institute (NCI) says it can be a sign of a problem inside the uterus, so further tests such as colposcopy are usually recommended.

Most screening results describe squamous cells, the flat cells on the outer surface of the cervix. Glandular cells are different: they line the canal of the cervix and the inside of the womb, and they make mucus. AGC is therefore followed up differently from squamous results such as ASC-US or LSIL.

This guide explains the usual pathway for adults with an AGC result. It cannot interpret your sample or decide your care.

Many people with AGC have no symptoms. If you notice any of the following, tell your clinician rather than waiting for a routine appointment:

The NHS notes that these symptoms often have other causes, such as fibroids or endometriosis, and that having them does not definitely mean cancer. They are still worth reporting, because they help your clinician decide which tests to arrange and how quickly. If bleeding is very heavy or you feel faint, use local urgent or emergency services.

• Any vaginal bleeding after the menopause, even a small amount or a single episode. The NHS advises getting this checked.
• Bleeding during or after sex, or between periods.
• Periods that become much heavier than usual for you.
• Changes in vaginal discharge, or pain during sex.
• Pain in the lower back, pelvis or lower tummy that does not go away.
• Symptoms that change, get worse or do not feel normal for you.

No, an AGC result is not a diagnosis of cancer. A Pap test is a screening test, and it cannot show exactly where the cells came from or what is causing the change. AGC is taken seriously because the possible explanations range from harmless changes to precancer or, sometimes, cancer of the cervix or womb lining, so further tests are needed to find out.

Some reports add more detail. "AGC NOS" (not otherwise specified) is the general category. "AGC, favour neoplasia" means the cells look more suspicious. "AIS" (adenocarcinoma in situ) means a precancerous glandular lesion of the cervix that NCI says may become cancer if not treated. In the UK, glandular changes may be called glandular neoplasia, or CGIN on a biopsy. Ask which wording your report uses.

Because atypical glandular cells may come from the lining of the womb (the endometrium), clinicians often check that area as well as the cervix. Endometrial sampling means taking a small sample of the womb lining, usually during a clinic visit.

US guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) recommend endometrial sampling alongside colposcopy for non-pregnant patients aged 35 or over with AGC. For younger patients, they recommend it when there is a higher risk of endometrial problems, such as abnormal uterine bleeding, long-term irregular or absent ovulation, or obesity. If you have symptoms such as bleeding after the menopause, the NHS notes that a specialist may also use a vaginal ultrasound or hysteroscopy (a camera look inside the womb).

Being offered endometrial sampling does not mean something has been found. It is a way of making sure the source of the cells is not missed.

Colposcopy is a closer look at the cervix using a magnifying instrument that stays outside the body. The NHS describes it as similar to a screening test, usually taking around 15 to 20 minutes. A liquid is applied to show abnormal areas, and a small biopsy may be taken.

For AGC, ASCCP recommends colposcopy whatever the HPV result, together with a sample from inside the cervical canal (endocervical sampling), except in pregnancy. Mild cramping and light bleeding afterwards are common. Tell the clinic beforehand if you are or might be pregnant, as some samples are not taken during pregnancy.

What happens next depends on the biopsy and sampling results. If precancerous changes or AIS are found, treatment is usually offered, often by removing a cone-shaped piece of tissue from the cervix. If the report said "favour neoplasia" or AIS but the first tests do not find invasive disease, ASCCP recommends a diagnostic excisional procedure to look more closely.

If no significant changes are found after an AGC NOS result, ASCCP recommends combined HPV and cytology testing at one and two years, then longer intervals if both are normal. Other countries' screening programmes use their own schedules, so confirm your own plan.

Keep going to follow-up appointments even if you feel well, and report any new bleeding in the meantime.

Bring your report and write down the answers.

• Does my report say AGC NOS, AGC favour neoplasia, AIS, or another category? Was HPV tested?
• Which tests are planned: colposcopy, endocervical sampling, endometrial sampling, ultrasound or something else?
• Why is endometrial sampling being recommended, or not recommended, for me?
• How will the samples be taken, and do I need any preparation or pain relief?
• I am pregnant, or might be. How does that change which tests are done?
• When and how will I get each result?
• Will the results of all the tests be reviewed together, and who will explain them to me?
• Should I report any new bleeding before my appointment, and to whom?
• If the results are normal, what follow-up testing will I have and when?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with an AGC result were investigated can help you understand the range of tests people are offered and spot questions to raise, such as why endometrial sampling was or was not suggested.

Other people's cases cannot tell you what your result means or what you will be found to have. Use them to prepare for your appointment, and rely on your own care team for decisions.