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Treating cell changes (abnormal cells)

During or after colposcopy, you may be offered treatment for cell changes (abnormal cells). 

Read more about colposcopy > 

It may be difficult to deal with being told you have cell changes and need treatment. Understanding what treatment involves can be overwhelming, but we hope the information on this page helps prepare you and answers some questions.

Remember, our support services are also here for you. Sometimes it can help just to hear from someone who has been through a similar experience, so you may want to call our Helpline on 0808 802 8000 or join our forum. 

Get support >

What treatment will I have?

If you need treatment and didn’t have it at your first colposcopy, you should be invited for it within 4 to 6 weeks. Your colposcopist should be able to help with any questions or concerns about timeframes.

Treatment depends on the type and grade of the cell changes.

Read more about CIN and CGIN > 

Common treatments for cell changes are:

  • large loop excision of the transformation zone (LLETZ) 
  • cone biopsy.

Other treatments for cell changes are laser therapy, cold coagulation (also called thermoablation) and cryotherapy.

Making treatment decisions

Deciding on treatment can be a really personal thing, so before making decisions make sure you understand:

  • why you are being offered treatment
  • what the treatment involves
  • any possible risks or side effects.

Your colposcopist should explain all of this. If they don’t, or you feel like you need more information, you can take the time to gather everything you need. We may be able to help with this if you give our Helpline a call on 0808 802 8000 or submit a question to our Ask the Expert service.

Use our Ask the Expert service >   

Before treatment for cell changes (abnormal cells)

Preparing for treatment can be tough and you may feel many emotions, from relief at having treatment, to anxiety about needing it, or confusion about what it involves. 

Before treatment, you may be especially worried about:

  • the experience of having treatment 
  • whether the treatment will work
  • whether you will go on to develop cervical cancer.

All your concerns, including any we don’t mention here, are valid. Many people feel this way  and it’s important you get the support you need. Talk to your healthcare team, including colposcopist or GP, as well as to support organisations like us.

Call our Helpline on 0808 802 8000

Join our Forum to chat with others affected > 

Types of treatment for cell changes (abnormal cells)

Large loop excision of the transformation zone (LLETZ)

LLETZ is the most common treatment for removing cell changes. It uses a thin wire loop with an electrical current to remove the area of the cervix where there are cell changes. 

You usually have LLETZ as an outpatient. This means you have it in an examination room at a hospital, but can go home afterwards.

Like during cervical screening (smear test), your colposcopist will gently put a new, clean speculum into your vagina. 

Your colposcopist will inject a local anaesthetic into your cervix. This means you are awake, but the area that needs treating is numb (you can’t feel it). The injection might sting for a short time. 

Your colposcopist will also put a sticky pad on your leg. This makes sure the electric current doesn’t shock you or the colposcopist. 

Once your cervix is numb, your colposcopist removes the area of the tissue with cell changes with the loop. It’s normal to notice a slight burning smell and hear a noise like a soft vacuum cleaner. The loop cuts the tissue and seals the cut at the same time. This should not be painful, but you may feel some pressure.

LLETZ treatment

This image shows what happens during LLETZ.The removed area is sent to a laboratory to test:

  • the extent of the cell changes
  • whether all of the cell changes have been removed (there are clear margins).

If you have cell changes up inside your cervical canal (CGIN), you will need a deeper treatment to diagnose and remove abnormal cells there. You may be offered:

  • straight wire excision of the transformation zone (SWETZ)
  • needlepoint excision of the transformation zone (NETZ)
  • cone biopsy. 

SWETZ and NETZ are similar to LLETZ, but the thin wire is straight, rather than a loop. Depending on the results and your situation, you may need another excision or be offered a hysterectomy. If this happens, your colposcopist will talk through all the options with you.

Cone biopsy

A cone biopsy is a small surgery that will remove a cone-shaped piece of tissue from your cervix. 

A cone biopsy is done under general anaesthetic, which means you are asleep and won’t feel anything. The treatment takes about 15 minutes. Afterwards, you may have to stay in hospital overnight.

A cone biopsy can be done with a:

  • scalpel (surgical knife)
  • laser 
  • thin wire loop with an electric current running through it.

After a cone biopsy, your doctor may put a small pack of gauze (like a tampon) in your vagina to stop bleeding. You may also have a tube (a catheter) to drain urine from the bladder while the gauze pack is in place. The gauze and tube are usually removed within 8 hours. Once they have been removed, you can go home.

Read more about what happens after treatment > 

A cone biopsy

This image shows what happens during a cone biopsy.The cone-shaped piece of tissue is sent to a laboratory to test:

  • the extent of the cell changes
  • whether all of the cell changes have been removed (there are clear margins).

Other treatments for cell changes include:

  • Laser therapy or laser ablation – This uses a focused beam of light to burn  away cell changes. You may notice a slight burning smell during treatment. This is the laser working and is nothing to worry about.
  • Cold coagulation (also called thermoablation) – This uses heat to burn away cell changes using a thin tube (probe). 
  • Cryotherapy – This is more commonly used for cervical ectropion . It uses extreme cold to destroy cell changes using a thin tube (cyroprobe) with liquid nitrogen in it. The treatment may be repeated a couple of times to make sure it works as well as possible. 

Before any of these treatments, you will usually have a local anaesthetic. This means you are awake, but the area that needs treating is numb (you can’t feel it). The injection might sting for a short time.

These treatments are not used as often. You have them as an outpatient, which means you have them in hospital, but can go home afterwards. 

Possible risks of treating cell changes (abnormal cells) 

Treatments for cell changes:

  • are considered safe – they are conventional treatments that have been approved by health organisations in the UK
  • are usually successful – over 8 in 10 people (80%) do not have cell changes again. 

However, as with all treatments, there are some possible risks:

Narrowing of the cervix (cervical stenosis)

After LLETZ or cone biopsy, there is a small chance that the cervix will narrow . If this happens, the passage between the womb and vagina can become partly or fully blocked. This is called cervical stenosis. 

Cervical stenosis is more likely if:

  • you are going through or have been through menopause 
  • you have had more than 1 treatment
  • treatment removes a large area of the cervix 
  • treatment removes cells from inside the cervical canal (endocervix). 

If you are worried about cervical stenosis or think you may have it, speak with your GP. They can offer support and practical ways to help, like using a thin tube (dilator) with lubricant to help open the cervix. 

Miscarriage and premature (early) birth

After LLETZ or cone biopsy, there is a slightly increased risk of miscarriage and giving birth before 37 weeks (prematurely). 

At first, this can sound alarming, but it’s important we try to understand exactly what is meant by this increased risk. In real numbers, after treatment about 2 in every 100 women (2%) will give birth prematurely. When we talk about premature births, in most cases we are talking about births between 32 and 37 weeks  – so not severely premature.

The level of risk will depend on:

  • how much of the cervix is removed
  • whether you have had more than 1 treatment.

However, the following is accepted:

  • If less than 10mm of cervical tissue is removed, your risk of premature birth is only slightly increased (an increased risk of less than 1%). You would not need any extra care from your pregnancy (obstetric) team.
  • If more than 10mm of cervical tissue is removed, or if you have more than 1 treatment, your risk is slightly more increased (an increased risk of between 2% and 10%). 

Most LLETZ and cone biopsy treatments remove less than 10mm of cervical tissue. 

If you are planning on having children, it can be really worrying to read about these slight increased risks. It may help to remember that your healthcare team – both before and during any pregnancy – are there to support you and make sure you have the right care. You may want to speak with your colposcopist before treatment about any concerns, so they can answer your questions and give you support. 

Cervical stitch (cervical cerclage)

If you get pregnant in future, it is important to tell your midwife that you have had LLETZ. They may offer to do an ultrasound scan of your cervix. If they think it is short and there is a risk you may have the baby a bit early, they may offer you a cervical stitch (cervical cerclage). This is an operation where a stitch is placed around the cervix. It is usually done between 12 and 24 weeks of pregnancy, although it may be done later. 

The Royal College of Obstetricians & Gynaecologists have more information about cervical stitches >  

If you are worried, it may help to speak with your colposcopist or midwife. They will be able to answer your questions and offer any support you need. 

More information about treating cell changes (abnormal cells)

As well as leaning on your colposcopist, we are here to answer your questions and talk through any concerns you have: 

After treatment, you may feel worried about what will happen next. This is common and it can help to prepare yourself for any side effects of treatment and the next steps.

Read more about what happens after treatment for cell changes > 

Show references

  1. O'Connor M. et al, Adverse psychological outcomes following colposcopy and related procedures: a systematic review, BJOG: an International Journal of Obstetrics and Gynaecology, 2016
  2. Lili E. et al, Low recurrence rate of high-grade cervical intraepithelial neoplasia after successful excision and routine colposcopy during follow-up, Medicine, 2018.
  3. Katki HA. et al, Five-year risk of recurrence following treatment of CIN2, CIN3, or AIS: performance of HPV and Pap cotesting in post-treatment management, Journal of Lower Genital Tract Disease, 2014.
  4. Suh-Burgmann E J. et al, Risk factors for cervical stenosis after loop electrocautery excision procedure, Obstetrics & Gynecology, 2000.
  5. R. Wuntakal et al, How many preterm births in England are due to excision of the cervical transformation zone? Nested case control study, BMC Pregnancy and Childbirth, 2015.
  6. Sasieni P. et al, Risk of preterm birth following surgical treatment for cervical disease: executive summary of a recent symposium, BJOG, 2016.
  7. Castanon A. et al, Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study, BMJ, 2014.

 

 

Date last updated: 
24 May 2019
Date due for review: 
23 May 2022

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