The cervix is covered with a layer of skin-like cells on its outer surface. The results of your cervical screening test are based on the examination of these cells. The test detects whether abnormal cells are present. Rarely, these cells that may be abnormal, and these abnormal areas are called glandular changes.
THE RESULTS OF THE CERVICAL SCREENING TEST
Depending on the results of your screening, you may be referred to a specialist clinic in the hospital (colposcopy) in order to get a more accurate diagnosis and have treatment if needed. You may need to have a small sample taken from your cervix to analyze the cells, this is called a biopsy. Usually, biopsies are only a few millimetres in size.
HOW IT FEELS TO HAVE CERVICAL ABNORMALITIES
Every year, almost 400,000 Canadian women receive a call that their Pap test result is abnormal (.).
Following a diagnosis of cervical abnormalities, it is possible and normal to feel a range of different emotions, and this is perfectly normal. It is quite common to question why this has happened to you and whether or not it could have been prevented. You may feel angry that the abnormal cells weren’t detected earlier or find it difficult to digest a diagnosis of HPV alongside this.
You may feel absolutely fine and aren’t unduly concerned, or feel anxious, scared and overwhelmed, or worry about what will happen . It is common for emotions to rollercoaster – with you feeling calm and untroubled one day, but scared or angry the next.
We have seen that some people’s feelings often change over time, as they gradually learn more about what having cervical abnormalities actually means for them. Understanding your situation and the treatment options that are available to you often helps relieve the anxiety and fear that often accompany diagnosis.
Our community tells us that when they were told they had cervical abnormalities, they wanted information and support to help them understand what cervical abnormalities are, cope with the diagnosis and make decisions about any subsequent treatment.
You might find that you want to know more about cervical abnormalities, cervical cancer and its prevention, HPV testing, and the different treatment options available to you (including what to expect if you need to have treatment). We have a wealth of information on these topics on this website. You can also submit questions to us online here.
Being able to speak with someone who understands what you’re going through can be invaluable. This could be one of the medical professionals responsible for your care, such as your colposcopist or practice nurse or your doctor.
YOUR FEELINGS MAY CHANGE OVER TIME
Most women and people with a cervix gradually find ways that help them deal with what’s happening to them, and their feelings about their diagnosis changes over time .
Information can be key to how you move on from your diagnosis. The realization that having abnormal cells does not mean that you have cervical cancer is a milestone, as is finding out that cervical abnormalities are common.
It is common for many with a diagnosis to find that being better informed. For example, it may help regain control of your situation and reduce anxiety to understand what the treatment procedures will be and the benefits and possible side effects.
Some come to accept the diagnosis as just ‘something that happens to women’, while others remain scared about the future. It’s perfectly normal if you continue to have mixed emotions – feeling anxious, overwhelmed and sad one minute, and calm and untroubled the next.
HPV Triage is used when a cervical screening result is borderline or mild dyskaryosis (or low grade squamous dyskaryosis). The HPV test is important because it allows earlier identification of the need for treatment. For minor cervical abnormalities (either borderline or low grade squamous dyskaryosis), there is only around a 15-20% chance of having a significant abnormality that requires treatment .
If you do not have high-risk HPV even though your screening result showed slightly abnormal cells, the risk of these abnormalities turning into cancer are extremely low, thus, you can return to normal routine screening. To find out more about routine screening in Canada, click here for the guidelines in each province and territory in Canada.
HPV triage is done using the same sample of cells that were taken during your cervical screening test and it will look for any high-risk HPV infections. If the test is HPV positive, you will be invited to a colposcopy clinic. If the test is HPV negative, you will be returned to routine screening every three or five years, the frequency of which depends on your age and where you live.
TREATMENT OF ABNORMAL CERVICAL CELLS
If screening shows that you have abnormal cells in your cervix, the doctor or nurse you see in the colposcopy clinic (colposcopist) may recommend that you have them treated. The aim of treatment is to remove or destroy the abnormal cells in your cervix. However, the first step is to be sent for a colposcopy. Treatment can be offered after a first colposcopy visit. If this is a possibility, you will be advised beforehand.
TYPES OF TREATMENT FOR CERVICAL ABNORMALITIES
The treatment you will be offered depends on the type of abnormal cells you have in your cervix and how advanced the changes are. Your colposcopist will advise you on the specific treatment you will require during your colposcopy appointment.
LARGE LOOP EXCISION OF THE TRANSFORMATION ZONE (LLETZ)
Also known as LEEP or diathermy loop biopsy or just a loop, this procedure uses a small wire loop and an electrical current to cut away the affected area of tissue and seal the wound at the same time. The advantage of this treatment is that the cells are removed rather than destroyed, so the tissue can be sent for further tests to confirm the extent of the cell changes and make sure the area of your cervix that contains the cells has been removed.
A cone of tissue is cut away from your cervix to remove all the abnormal cells. It allows the doctor to remove a slightly larger part of the cervix than with a loop (LLETZ) biopsy. A cone biopsy allows for the cells at the edges of the specimen to be seen clearly through a microscope ensuring that all of the biopsy can be examined by a histopathologist.
A cone biopsy is usually carried out under a general anaesthetic (very small cone biopsies can be performed under local anaesthetic). A vaginal pack will sometimes be put in place while you are under anaesthetic. This looks like a long bandage that puts pressure on the biopsy site and helps stop any bleeding (a bit like putting pressure on a cut to stop the bleeding). It will be removed before you go home. It is advisable to have some painkillers at home as you may experience a deep ache and/or tenderness in the pelvis. It is not unusual to feel tired for a few days or even a week or so following a general anaesthetic.
STRAIGHT WIRE EXCISION OF THE TRANSFORMATION ZONE (SWETZ) OR NEEDLEPOINT EXCISION OF THE TRANSFORMATION ZONE (NETZ)
Similar to a cone biopsy, these procedures remove a piece of tissue but use a straight wire or needle diathermy with electricity to cut and seal the tissue like a LLETZ treatment. The procedures are done in a clinic with local anaesthetic (like a LLETZ) or under general anaesthetic (like a cone biopsy). These treatments are usually done if the abnormal cells are inside the cervical canal or are glandular abnormal cells.
A cold probe is used to freeze away the abnormal cells in the cervix. This is sometimes used to treat CIN1.
This is sometimes called laser ablation. Lasers pinpoint and destroy abnormal cells in the cervix. If necessary, a laser can also be used to remove a small piece of the cervix itself. This is called laser excision or laser cone biopsy.
Despite the name of this treatment this procedure involves applying a hot probe to the cervix, which, like laser, destroys the abnormal cells. A local anaesthetic (where the area is numbed but you are still awake) is given before any of the treatments described above. A cone biopsy may require a general anaesthetic (where you are asleep).
Your colposcopist should provide you with additional information on the treatment that you will be having. Remember to ask if you have questions.
Bleeding (at the time of treatment or in the two to three weeks afterwards) or infection (more often 10-14 days after) can occur after treatment for abnormal cells of the cervix. You may experience vaginal discharge or bleeding for two to three weeks after your treatment. However, this does vary a lot. For example, some will have no bleeding at all and some will be bleeding for up to six weeks. After your treatment you may feel some pain, this is because the local anaesthetic used during your treatment will wear off after two to three hours. This pain often feels like cramps. Some women notice pain more the day after the treatment. Sometimes periods can be irregular or more painful for two to three months after treatment. Always contact your healthcare professional or colposcopist if you are experiencing any problems after treatment. There is no reason to put up with discomfort that can easily be treated.
If you are working, you might be advised to take a day or two off from work (your colposcopist will let you know if this is necessary).
Generally, a single, straightforward treatment to the cervix is very unlikely to adversely affect fertility or the ability to have a normal pregnancy.