This page is a selection of different questions that Jo's Cervical Cancer Trust has received about abnormal cells and treatments. The answers have been reviewed by Jo's Cervical Cancer Trust's medical experts.

This will depend on the abnormality. Usually borderline and mild dyskaryosis or low grade squamous dyskaryosis will not require treatment; instead close monitoring, either with a repeat screening in six months or with referral to a colposcopy clinic (this depends on the country you live in). Moderate and severe dyskaryosis (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.

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

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 of 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.

Cervical abnormalities do not cause symptoms - no pain, no discharge and no bleeding. This is why it is important for you to attend your invitation for a cervical screening (smear) test or to see your doctor if you experience any or all of these symptoms.

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, however, 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 abnormality diagnosed
  • Your choice of treatment options
  • Your colposcopists preference
  • Your age.

The main treatments (if advised) are either to eradicate the abnormal cells or remove the area of abnormality and 95% to 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 and 3 / 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 if you have other gynaecological problems
  • eradication of the abnormal area with heat treatment, using cryotherapy (a cold treatment), laser or cold coagulation (hot treatments)

Once you are sufficiently recovered (your consultant will advise you), none of these treatments should interfere with your sex life.

You should seek advice from your doctor. They will often ask to you to undergo a colposcopy examination to properly assess the change on the cervix so that they can advise 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.


Colposcopy and Punch Biopsy

A punch biopsy is a small sample of the cervix that 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.

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

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.

Yes. A biopsy is often required, one or more biopsies can be taken from the most affected area for analysis.

Women who have an obvious abnormality at colposcopy or a positive biopsy result will proceed to treatment.

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 largely been replaced by the LLETZ. Whereas the equipment for LLETZ is much cheaper to buy, use and easier to maintain than laser generators, it is the safety aspect of sending the tissue of the transformation 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 biopsy/laser.


References

  1. Kitchener HC, Walker P, Nelson L, Hadwin R, Patnick J, Anthony G, Sargent A, Wood J, Moore C , Cruickshank M. 2008. HPV testing as an adjunct to cytology in the follow-up of women treated for cervical intraepithelial neoplasia. BJOG 115(8), 1001-7.