Cervical cell changes
When doctors perform screening tests such as a Pap smear, they are looking for early precancerous changes in cells of the outer layer of the cervix (ectocervix). These changes are the first step in a series of slow changes that may develop into cancer if left untreated.
Changes in the cervical cells are called squamous intraepithelial lesions.
These are graded depending on the thickness of the layer of abnormal cells.
Early changes are called low-grade squamous intraepithelial lesions (LSIL). In most cases, the abnormal, precancerous cells will disappear without treatment, and treatment is not recommended. Instead, women enter a period of ‘watchful waiting’, where Pap smears are taken annually to ensure the regression of the precancerous cells.
If the abnormal cells continue to change, they are called high-grade squamous intraepithelial lesions (HSIL). These cells are also considered precancerous, but require treatment.
After an abnormal Pap result
If a Pap smear detects changes, more tests and possibly treatment will be needed. You may have some or all of the following:
A colposcopy is a procedure that allows the doctor to see a magnified view of the cervix, vagina and vulva. This procedure can help identify where abnormal or changed cells are located and what they look like. The doctor will probably take a tissue sample (biopsy) during the procedure.
An instrument called a colposcope is used. A colposcope looks like a pair of binoculars sitting on a large stand. It does not enter the body – the doctor inserts an instrument called a speculum into your vagina and then views a magnified picture of the cervix, vagina and vulva through the colposcope.
Before the test, the doctor may coat your vagina and cervix with a special solution that will help highlight any abnormal areas. You may experience some mild discomfort for 15 to 30 minutes when the procedure is being performed.
Some colposcopes are fitted with a camera, which is connected to a TV screen. This may allow you to watch what the doctor is doing. You should feel free to ask the doctor or nurse to explain what is happening.
A cone biopsy is a procedure that is used to determine if the abnormal cells have spread to tissue beneath the surface of the cervix.
A cone biopsy is also used to treat very early and very small tumours. Further treatment is needed for cancers that are larger or have spread.
This procedure removes a cone-shaped piece of tissue containing the abnormal cells from the cervix. It is usually performed under a general anaesthetic and involves a day or overnight admission to hospital.
Cone biopsy results are usually available within a week.
After the cone biopsy, it is common to have some light bleeding or cramping for a few days. You may have a small gauze pack put into your vagina to help stop the bleeding.
When the gauze is removed, you should avoid doing anything physically strenuous for about three weeks, as this could restart your bleeding or make you bleed more heavily. If the bleeding lasts longer than two weeks or has an offensive odour, see your doctor.
To allow your cervix to heal and to prevent infection, you should not have sexual intercourse or use tampons for four to six weeks.
If you would like to become pregnant, talk to your doctor before the cone biopsy, as it may weaken the cervix. You should still be able to become pregnant, but you may be more at risk of miscarriage. You may need to have a stitch inserted into the cervix to strengthen it and to reduce this risk. The stitch would be removed before you give birth.
Large loop excision of the transformation zone
Another method that removes a large sample of the cervix for examination is called a large loop excision of the transformation zone (LLETZ), or loop electrosurgical excision procedure (LEEP). Your transformation zone is partly located in your cervical canal, but its position varies, depending on your age and whether or not you have been pregnant.
In a LLETZ, a loop of wire carrying an electric current is used to cut out abnormal tissue from the cervix. Sometimes the doctor is able to completely remove all visible abnormal cells.
This procedure takes about 10 minutes and may be performed under a local anaesthetic in the doctor’s office or in hospital under general anaesthetic. In some cases, the doctor may perform this procedure at the same time as a colposcopy.
After a LLETZ procedure, you may have some vaginal bleeding and cramping. This will usually ease in about two weeks.
To give your cervix time to heal and to prevent infection, you should not have sexual intercourse or use tampons for four to six weeks. During this time, you should also avoid submerging your pelvic area into a hot spa or sauna, as this can slow the healing process.