Abnormal Cervical Cells and Treatment
The cervix is covered with a layer of skin-like cells on its outer surface, called the ectocervix. The results of your cervical screening test are based on the examination of the cells from the surface of the ectocervix. The test detects whether abnormal cells are present.
Cells that are found in the cervical canal are called endocervical cells (glandular cells); these are different from the ectocervix. The transformation zone is the area from where the endocervix meets the ectocervix. This is where glandular cells normally change to squamous cells of the ectocervix. Rarely, some women have endocervix cells that are 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 analyse the cells from the layer beneath the surface, this is called a biopsy. Usually biopsies are only a few millimetres in size. During the colposcopy the doctor or nurse will explain the procedure to you further. In this section we will explain more about colposcopy and give you information on possible treatment for cervical abnormalities.
How it Feels to Have Cervical Abnormalities
Every year, almost 400,000 Canadian women receive a call that their Pap test result is abnormal (http://www.paptestinfo.ca/index_e.html).
Following a diagnosis of cervical abnormalities (and you have been offered treatment) women can feel a range of different emotions and this is perfectly normal. It is quite common for women to question why this has happened to them and whether or not it could have been prevented. Some women feel angry that the abnormal cells weren’t detected earlier or find it difficult to digest a diagnosis of HPV alongside this.
Whilst many women feel absolutely fine and aren’t unduly concerned, some might feel anxious, scared and overwhelmed, and some 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.
Women in Jo’s Cervical Cancer Trust’s community tell us that their feelings often change over time, as they gradually learn more about what having cervical abnormalities actually means for them. As you will see in the Your feelings may change over time section, 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 find more here. You can also submit questions online to a medical professional through our Ask the Expert service.
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 GP. We provide the following service which enables you to speak to someone safely and confidentially:
- You can use our online forums to connect with women who are going through, or have been through, similar experiences.
Your Feelings May Change Over Time
Most women 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 realisation that having abnormal cells does not mean that you have cervical cancer is a milestone for many women, as is finding out that cervical abnormalities are common and affect many other women.
Many women find that being better informed, for example understanding what the treatment procedures will be and what the benefits and possible side effects could be, helps them regain control of their situation and reduces their anxiety.
Some women 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.
Advice and Tips from Other Women
Upon being diagnosed, it can feel as though the world is collapsing in around you, but it’s important to remember that you are not alone. Cervical abnormalities are a lot more common that you may think, and if you chat to friends and work colleagues, you will probably find someone who has been through a similar experience. 400,000 Canadian women receive a call telling them that their Pap test result is abnormal (http://www.paptestinfo.ca/index_e.html).
Many women find it helps to talk about their feelings, rather than bottling up anxieties and worries. Having a strong support network, including your partner, family and friends around you can make your diagnosis easier to come to terms with. And if you can chat to women who have been through the same procedures, or even read about their experiences online or take a look at some of other women’s stories, it may help reduce your anxiety about what lies ahead. Women often use our online forum for this purpose.
When first receiving a diagnosis of a cervical abnormality, it is understandable that you may want to carry out your own research to find out as much information as possible. We would always encourage you to look up information on trusted websites such as HPV Awareness Corporation, the Public Health Agency of Canada, The Canadian Cancer Society, the Society of Obstetricians and Gynaecologists of Canada, the Society of Gynaecologic Oncology of Canada, so that you know you will be accessing reliable information.
- Try to focus on the fact that having a cervical abnormality does not mean that you have cancer.
- Ask questions at every step along the way to make sure you understand what is happening to you – fear of the unknown can be debilitating.
- Ensure that you attend further tests or treatment – they could prevent you developing cancer in the future.
HPV Triage is used when a woman has a cervical screening result of borderline or mild dyskaryosis (or low grade squamous dyskaryosis). The HPV test is important because it allows earlier identification of women who need treatment. Women with minor cervical abnormalities (either borderline or low grade squamous dyskaryosis) have only around a 15-20% chance of having a significant abnormality that requires treatment .
If a woman does not have high risk HPV even though her screening result showed slightly abnormal cells, the risk of these abnormalities turning into cancer are extremely low, thus, the woman can return to normal routine screening.
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 the woman will be invited to attend a colposcopy clinic. If the test is HPV negative the woman will be returned to routine screening every three or five years depending on her age and the country she lives in.
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 at a first visit to Colposcopy. 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 (the grade of CIN and/or the presence of CGIN) and how advanced the changes are. Your colposcopist will advise you on the specific treatment you will require during your colposcopy appointment. CIN1 is usually not treated as these changes often return to normal given time and are not precancerous.
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 in theatre while you are under anaesthetic. This is like a long bandage that puts pressure on the biopsy site and so helps stop any bleeding (a bit like putting pressure on a cut to stop it bleeding). It will be removed before you go home. It is advisable to have some painkillers at home (such as you would take for period pains) as some women experience a deep ache and/or tenderness in their 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 like the end of a period for two to three weeks after your treatment. However this does vary a lot, for example a few women 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 that you can have during your period. 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 GP 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). You might need some pain relief after your treatment, the clinic where you had treatment can advise you on this.
Generally, a single, straightforward treatment to the cervix is very unlikely to adversely affect fertility or the ability to have a normal pregnancy.
After Your Treatment
It is extremely important that you attend your follow up appointment as advised by your local service. Six months after your treatment you will be called back to have a repeat cervical screening test – this will usually be done at your GP surgery. Between 5-10% of women continue to have cervical abnormalities after treatment. Occasionally second and third treatments are required. It is highly important that you attend treatment if further treatment is advised.
Test of Cure
These follow up tests help to identify if the treatment has been successful, the abnormal cervical cells have been removed and the area is now normal.
It will test for high risk HPV, which can cause cervical cancer. Test of cure will only be given to women who have undergone treatment for cervical abnormalities. The test is used in combination with cervical screening cytology (looking at how the cells look under the microscope). Test of cure is done if the abnormality treated was CIN rather than CGIN.
If HPV is not found and your screening test comes back negative (that means the cells appear normal under the microscope), then you have been successfully treated by removing the abnormal cells and you will be returned to your regular screening schedules. You do not need to have another cervical screening test for three or five years depending on your age or upon your country’s screening programme. The HPV test helps to confirm that there is no longer a higher than average risk of developing further cervical abnormalities.
If HPV infection is found (HPV positive) or the screening test shows an abnormality you will again be referred to colposcopy for further investigation. If this happens please try not to be alarmed, it is better to get things checked out. Occasionally cervical abnormalities are not all removed at the first treatment. This is because the treatment is a balance between removing all the abnormal cells, without removing too much normal cervix. Put simply – it is always easier to take a bit more away in the future, than it is too stick a bit back on! If there are still abnormal cells left at follow up, then a further treatment can be done. Using both a cervical screening test and HPV test this provides a more effective way of assessing the success of treatment than a cervical screening test on its own. Many women who come back to the colposcopy clinic do not need further treatment.
There is also a small chance that cervical abnormalities may come back in the future. It is therefore really important to keep going for your cervical screening when invited, so that you can have further treatment if necessary.
Remember if you have been found positive for abnormal cervical cells this is unlikely to be cervical cancer. Treatment for abnormal cervical cells is usually very effective and it is estimated that early detection and treatment can prevent up to 75% of cervical cancers from developing.