Recurrent cervical abnormalities

It is still unclear why some people are able to clear high-risk HPV infections, while in others the virus can remain persistent within their body for many years and, sometimes, decades. The persistence of the virus can be upsetting, but it isn’t directly a problem. It is the high-risk HPV related cellular abnormalities, also called cervical intraepithelial neoplasia (CIN) or glandular cervical intraepithelial neoplasia (CGIN), depending on which cervical cells are affected, that may be problematic and need treatment.

This page covers: 

Recurrent cervical abnormalities and their treatment

In 85–95% of women, their cervical abnormalities (CIN or CGIN) are successfully cleared after one treatment, but between 5 and 15% of women will still be affected by CIN or CGIN after treatment [1]. This is sometimes called recurrent CIN or CGIN.

If the test-of-cure screening, which is usually done around six months after treatment, shows that high-risk HPV is still present or you have a recurrence of cervical abnormalities, you will be asked to attend a further colposcopy appointment. At this colposcopy you may need a biopsy to be taken if there are any visible abnormalities. This biopsy will help your health care team to decide if further treatment is needed. It is very important to attend if further treatment is advised [2].

If the recurrent CIN is low-grade (also called mild cell changes or CIN1) and does not currently need treatment, then you may be asked to return in one year for a follow-up screening appointment to monitor the abnormalities.

Further treatment normally involves a second large loop excision of the transformation zone (LLETZ). More rarely, you may be offered a different kind of treatment, such as a cone biopsy, straight wire or needlepoint excision of the transformation zone, cryotherapy, laser treatment, or cold coagulation.

It is unlikely that a repeat procedure will have any negative effects, other than the normal side effects of having a LLETZ procedure. However, in rare cases it can have an effect on a woman’s fertility. A small number of women who have undergone multiple treatments, or who have had a deeper or larger section of their cervix removed could be at risk of delivering their baby early. Your colposcopist will take this into account, as well as any other risk factors, when planning any further treatment. Women who are felt to have an increased risk of premature birth may be watched more closely during their pregnancy or a stitch may be placed around the cervix to support it during any future pregnancies.

Several repeat procedures may also make it difficult to have cervical screening (smear test) and to examine the cervix in the colposcopy clinic. This means that you and your colposcopist may need to carefully consider other options.

In very rare cases, a woman may be advised to have more extensive surgery in order to help prevent the abnormalities from returning or developing into cervical cancer. If she has completed her family, she may be offered a hysterectomy, where the whole of the cervix and uterus are removed [3]. Your health care professional team will discuss these options with you if they feel they are necessary. They are there to help you and want to offer you the best treatment possible. If you have questions or concerns, please bring these up so that they can help address your worries and you can work together to find the best treatment plan for you. There are no stupid questions and you have to right to be involved in planning your treatment.

Once the treatment for your cervix is complete your cervix needs to heal. See our pages on what to expect after a LLETZ treatment and a cone biopsy . Symptoms of discharge and bleeding are normal for up to 6 weeks after treatment. Often women worry that these normal side effects are a symptoms of a recurrence of the CIN or even a progression to cancer, but this is highly unlikely. CIN rarely causes any symptoms. However, if you are concerned about symptoms after treatment then consider making an appointment with your GP to investigate and reassure you.

How you might feel

It is perfectly normal to feel a whole range of emotions after being told you have cervical abnormalities again, or that they have not cleared after treatment. You may feel frustrated or angry that this is happening to you again, or upset that you are not able to clear the infection. For some women it can also affect their relationships and intimacy with others, and having recurrent abnormalities may make you feel isolated, even from other women who have experience of CIN or CGIN. These feelings are totally normal. It is important to remember that you are not alone and your feelings, whatever they are, are valid and important. Being able to speak with someone who understands what you're going through can be invaluable during you diagnosis, treatment and beyond.

There are many options open to you, including:

  • Chat to women who have had personal or professional experience of cervical abnormalities using our free Helpline on 0808 802 8000 
  • Use our online Forum to connect with women who are going through, or have been through, similar experiences
  • Watch films featuring women and health care professionals talking about their experiences with recurrent abnormalities on HealthTalk.org [4]
  • Discuss your feelings with one of the medical professionals responsible for your care, this can be anyone you feel comfortable talking to
  • Ask to be referred to a councillor to help you talk about and deal with the feelings you are having.

Ways to protect yourself

Despite the fact that it is still not clear why some women are not able to clear high-risk HPV and experience recurrent CIN or CGIN, there are some practical things you can do to help reduce your chance of developing recurrent abnormalities.

  • Quitting smoking (smoking cessation): if you are a smoker it is very important to try and quit. Women who smoke have, on average, double the risk of developing cervical abnormalities and cancer than women who do not smoke. Evidence shows that women who have successfully stopped smoking for at least ten years can half their risk of developing cervical cancer and precancer compared to women who currently smoke [5]. For support in helping you quit, visit the NHS Smokefree website.
  • Leading a healthy lifestyle: this can help to keep your immune system (your body's natural defence against disease and infection) strong. A weakened immune system could mean your body is less able to protect you from and fight off high-risk HPV infections. 
  • Practicing safe sex through the regular use of condoms: this can help reduce the risk of being re-infected with high-risk HPV, though it will not completely eradicate the risk, as HPV lives on the skin in and around the whole genital area [5].

 

References

  1. Onuki M et al, 2016. Post treatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis. The Journal of Gynaecological Oncology 27(1), e3. www.ncbi.nlm.nih.gov/pmc/articles/PMC4695453/. Accessed: 11.01.2017.
  2. Kitchener HC et al., 2008. HPV testing as an adjunct to cytology in the follow-up of women treated for cervical intraepithelial neoplasia. BJOG: An International Journal of Obstetrics & Gynaecology 115(8), 1001-1007.
  3. CRUK Forum, 2015. Concerns about recurring CIN. www.cancerresearchuk.org/about-cancer/cancer-chat/thread/concerns-about-recurring-cin. Accessed: 11.01.2017.
  4. HealthTalk.org, 2014. Recurrence of abnormal cells. www.healthtalk.org/peoples-experiences/cancer/cervical-abnormalities-cin3-and-cgin/recurrence-abnormal-cells. Accessed: 11.01.2017.
  5. Roura E et al, 2014. Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort. International Journal of Cancer 135, 453-466.
Date last updated: 
11 Jan 2017
Date due for review: 
11 Jan 2019

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