Frequently asked questions for Abnormal cells and treatment

This will depend on the abnormality. Usually low grade squamous dyskaryosis will not require treatment; instead it will be closely monitored, either with a repeat screening in six months or with referral to a colposcopy clinic (this depends on the country you live in). High grade squamous dyskaryosis will require further investigation at a colposcopy clinic and may require treatment.

Some hospitals have a longer waiting list for treatments than others. If you are concerned about the timing of your appointment (short or long) do speak to your doctor.

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No. If your results show you have cervical intraepithelial neoplasia (CIN) this means that you have abnormal/precancerous changes to cells in your cervix. These changes are not cancerous, but without treatment these cells could change into cancerous cells.

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Although cervical abnormalities are not a cancer, the reason treatment is offered is to reduce the risk of a cancer developing in the future. Cervical abnormalities are changes to the cells on the surface of the cervix caused by high risk HPV. Without treatment there is a chance that, over time, these changes could turn into cancer. Research has shown that changes in abnormalities do not usually escalate quickly and it can take between 10 to 15 years for a cancer to develop.

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Cervical abnormalities do not cause symptoms – no pain, no discharge and no bleeding. This is why it is important for you to attend your cervical screening (smear test) appointment when invited or to see your doctor if you experience any or all of the symptoms of cervical cancer.

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If your cervical screening result is abnormal you may be required to attend an outpatient colposcopy clinic where your cervix can be examined more closely. It is important to remember that abnormal cells can be treated. Treatment is usually given as an outpatient. Cervical abnormalities (CIN and CGIN) are largely treated in the same way.

Treatment can be dependent on:

• The grade and size of the abnormality diagnosed
• Your choice of treatment options
• Your colposcopists preference and recommendations
• Your age.

The main treatments (if advised) are either to eradicate the abnormal cells or remove the area of abnormality, and 95–98% of women are cured after one treatment. Between 2 and 5% of women do have recurrence of abnormalities, which will require further treatment [1].

The main treatments for CIN2, CIN3 and CGIN are:

• Removal of abnormal area, using either large loop excision of the transformation zone (LLETZ),SWETZ, NETZ, cone biopsy, laser therapy or, very occasionally, a hysterectomy (usually only if you have other gynaecological problems)
• Eradication of the abnormal area with using cryotherapy (a cold treatment), laser therapy orcold coagulation (hot treatments).

If you have any concerns or experience any side effects, either physical or emotional, after your treatment that are worrying you or affecting your quality of life, please raise them with your colposcopy team or GP.

References

1. 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. 

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You should seek advice from your doctor. They will often ask you to undergo a colposcopy examination to properly assess the change on the cervix so that they can advise you with regard to any treatment that may be required. A colposcopy examination will not cause any risk to the pregnancy. If you are asked to attend a colposcopy examination do remember to tell your colposcopist that you are pregnant just in case they are not aware.

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In research studies, most people with a healthy immune system who test positive for a high risk genital HPV infection do eventually clear the infection (test negative), often within a year or two [1]. Unfortunately, because HPV is symptomless (making it difficult to identify and study in healthy individuals) and since an infection can persist in some cases over many years and may result in recurrent abnormalities (though this is rare) it hard to give a solid 'yes' or 'no' answer to this question. However, it does seem that your body will eventually clear the infection and the high risk HPV will not always be active.

References

1. Safaeian M et al., 2008. Determinants of incidence and clearance of high-risk HPV infections in rural Rakai, Uganda. Cancer Epidemiology, Biomarkers & Prevention 17 (6), 1300–1307. 

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A punch biopsy is when a small sample of the cervix is taken at the time of a colposcopy examination, usually after the application of solutions to the cervix (used to highlight the abnormal area or areas). More than one punch biopsy may be taken. It is purely for diagnostic purposes. The biopsy is sent to the histopathology department who will report on the type of abnormality present. Some women do not feel anything when a punch biopsy is taken while others experience a little discomfort (tenderness or an ache) during and/or after the biopsy. You may experience a small amount of bleeding and/or discharge for a few days following a punch biopsy. You may get cramps like a period pain.

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Your colposcopist will often write to you with your results. It may take four to eight weeks for you to get the letter with your results. If the colposcopist is concerned that you may have cancer, then a telephone call or a clinic visit may be offered within two to three weeks.

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Not necessarily – it will depend on the size, position and appearance of any abnormality seen. If there are any highly suspicious areas seen at colposcopy, then a biopsy may be recommended.

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This will depend on the grade of abnormality. If the colposcopy or biopsy show CIN1, then treatment is rarely required, instead you will be monitored in either colposcopy or back at your GP practice. However, if CIN2 or CIN3 is identified then treatment may be required. In the UK, the most common form of treatment is called large loop excision of the transformation zone (LLETZ).

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Before the introduction of the LLETZ treatment in the early 1990's, laser treatment was the preferred method to remove pre-cancerous cells from the cervix. After confirming the presence of CIN with a small punch biopsy, a laser beam (high-energy light) was used to vaporise the abnormal area, or the laser beam was used to cut a cone of tissue out, similar to the LLETZ procedure. Tissue healing after laser treatment was very good.

However, laser treatment has now largely been replaced by LLETZ. The equipment for LLETZ is much cheaper to buy, use and easier to maintain than laser generators; however, it is the safety aspects of sending the tissue of the transformation zone for pathological analysis after a LLETZ procedure to ensure that a small, invasive cancer has not been missed which attracts gynaecologists to favour LLETZ over small biopsies/lasers.

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You can usually expect some bleeding and discharge for about three to four weeks after treatment. In order to help avoid any possible infections it is recommended that you only use sanitary towels during this time, avoiding tampons and sex, until any bleeding and discharge has settled. Every woman’s experience is different, so the amount and colour of any bleeding/discharge can vary a lot depending on how quickly the woman heals, the size of the area treated and treatment method used. Some women start to get bleeding or discharge from the day the treatment is performed and for other women this is very slight or absent during the first week or so.

After treatment, a soft healing scab forms on the cervix. Over time this slowly dissolves away, which is what often causes the discharge and some bleeding. This can vary a lot from woman to women. The bleeding experienced can be red or brown in colour and it can vary in heaviness from light spotting to slightly heavier bleeding. Sometimes the discharge can be a yellowy colour, and it can be heavy or watery. Some women find that their next monthly period comes slightly earlier than normal and it may be slightly heavier. This is thought to be caused by the increased blood supply around this area.

All of the above symptoms are very normal after a LLETZ procedure. However, if the bleeding seems particularly heavy (eg. your sanitary towels are soaking every hour) or if the discharge smells really offensive and/or you feel unwell (which could be a sign of infection) you should contact a health care professional. This could be your colposcopist, your GP, NHS direct or any other health care professional you feel comfortable talking to about this.

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