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Colposcopy and Cervical Screen Abnormalities

Colposcopy & Cervical Screen Abnormalities Treatment
Cervical Screening Tests

Cervical Screening Tests (CST), which replaced the previous Pap Smear test, are typically conducted every 5 years. If you’ve had a previous abnormal result, you may need more frequent testing. The CST takes a sample of cells from your cervix and examines them for the Human Papillomavirus (HPV) and other abnormalities. HPV is a virus which is known to cause almost all cases of cervical cancer.

The Pap Smear test was replaced as we learned more about cervical cancer. Cervical cancer is rare and typically takes at least 10 years for HPV to develop into cervical cancer. The CST is more effective than the pap test at preventing cervical cancer and is just as safe to be done every five years instead of two. However, if you experience any symptoms between tests you should still see your healthcare provider. Symptoms include, pain, discharge or abnormal vaginal bleeding.

I’ve had an abnormal CST result what does that mean?

It is important to remember that an abnormal CST result does not mean you have cancer, or that you will eventually develop cancer. An abnormal result typically means that an HPV infection or abnormal cells have been detected. The results of your test will include which type of HPV you have – Types 16/18 or another type. If HPV is detected the sample will also be screened for any abnormalities present in your cervical cells. These do not always develop into cancer.

Based on your results, you will be placed into a risk category which determines the next steps.

  1. Low risk – High Risk HPV was not detected and you have a low risk of developing cervical cancer. Your next CST will be in 5 years unless anything changes before then.
  2. Intermediate risk – High Risk HPV was detected but it was not HPV 16/18. Your cervical cells may have shown abnormalities too (but this does not mean you have cancer).
    If you have an intermediate risk, and you do not have ‘high-grade’ cell changes then you don’t require any treatment. You will need to repeat the CST in 12 months to see if your body has cleared the HPV infection.
    If after one year, HPV is not detected you will return to having a CST every 5 years. If HPV is detected again you will be referred for a colposcopy and possibly a biopsy.
  3. High risk – A high risk result means that you either have HPV type 16 or 18 (which are associated with cervical cancer) or you have high grade cell changes (cells that have a higher risk of progressing to cancer). You will be referred to have a colposcopy and possibly a biopsy. You may require a treatment called LLETZ.
Colposcopy

A colposcopy is a test that allows your doctor to look closely at your cervix with a special tool called a colposcope. The colposcope has a light and magnifying component so that your doctor can see where the abnormal cells are on your cervix and what they look like. The colposcope does not touch you at all, nor does it go inside your body. It is simply used to look through – like a pair of binoculars. It even looks like binoculars! Your doctor may apply a fluid to your cervix and vagina. This just helps highlight any abnormal areas and does not hurt.

The procedure takes between 10 and 15 minutes. You may feel some mild discomfort during or after the procedure.

If your colposcopy is clear you will likely require another CST in one year. If abnormal cells are identified you may require a biopsy or preventative treatment to stop the abnormalities progressing into cervical cancer. 

Cervical Biopsy

A biopsy can be performed at the same time as the colposcopy. A small sample of issue will be taken from the abnormal areas of the cervix. The biopsy may cause you some discomfort. This will be sent for testing. Many health care professionals will provide you with a sanitary pad, but you may wish to bring your own just in case.

After a biopsy you will need to take some steps to reduce the risk of developing an infection or bleeding:

  • Avoid sexual intercourse for 1-2 days
  • Avoid vigorous exercise for 24 hours
  • Avoid swimming, baths and spas for 1-2 days (you can still shower)
LLETZ

To reduce your risk of developing cervical cancer you may require preventative treatment. One way to do this is with a LLETZ. LLETZ stands for large loop excision of the transformation zone.

During this procedure abnormal cells are removed from your cervix using a wire loop. We perform this procedure under general anaesthetic. The abnormal cells are removed using a heated thin wire loop. Doctors may be able to remove all visible abnormal cells during this procedure which acts as a way of treating the precancerous changes of the cervix. The sample is also sent for examination.

After a LLETZ you may experience cramping and vaginal bleeding for a few days. Some women experience spotting for up to 3-4 weeks. If you notice spotting for longer than this, bleeding increases or has a bad odour you will need to see your doctor.

To prevent infection, and allow your cervix to heal, you need to take some preventative measures afterwards:

  • Avoid sexual intercourse for 4-6 weeks
  • Do not use tampons for 4-6 weeks
Frequently asked questions about CSTs
What is HPV and how did I get it?

HPV is a virus and it is spread during sexual activity via genital skin to skin contact. It is so common that many people will contract it at some point in their life. Many won’t even know that they have it. There are usually no symptoms.

There are many different variant types of HPV and most do not cause cancer. Most infections can be cleared by your immune system without causing any problems. This can take one or two years. In some rare cases, HPV can cause abnormal cervical(neck of the womb) cell changes that can lead to cervical cancer.

What are high-grade abnormalities?

HSIL cells (High-grade squamous intraepithelial lesion) are not cancer. These are moderate to severe changes in the cells of the cervix. They may be precancerous and increase your chance of developing cervical cancer if untreated. This progression from HSIL to precancerous to cancerous is slow – it can take 10 to 15 years. Your colposcopy will reveal more information about these cells and whether or not the lesion needs to be removed. These steps help in the prevention of cervical cancer.

What’s involved in a colposcopy?

You will be asked to lay on your back, in a special chair with stirrups. A speculum will be used to open up the vagina so that your cervix is seen – this is the same tool that would have been used in your CST. Then certain dyes and vinegar like solution is put on your cervix and it is seen with a microscope. If there are any abnormal areas then a biopsy is taken.

Does a cervical biopsy hurt?

The biopsy may cause you some discomfort. After the biopsy you may have some cramping that feels similar to period pain. You may have some spotting or brown discharge for a few hours afterwards.

What is the follow up after a biopsy?

We will advice for you to be followed up in 1-2 weeks. Further treatment will depend upon the biopsy results. In some of you this may involve a procedure called LLETZ as a treatment if abnormal cells of a higher grade are confirmed on biopsy.

Does LLETZ hurt?

This is performed under general anaesthetic and you will not feel anything during the procedure. Afterwards you may be have some pain, but you will be able to go home after a short recovery period (a few hours).  You may experience cramping and vaginal bleeding for a few days. Some women experience spotting for up to 3-4 weeks. If you notice spotting for longer than this, bleeding increases or has a bad odour you will need to see us earlier. Make sure you follow the preventative measures that we give you to avoid infection.