Abnormal Smears and Colposcopy
What are abnormal smears and colposcopy?
Cervical screening, also known as a smear test, is a routine procedure offered to all UK women aged 25-64. It’s a test designed to assess the health of the cervix, looking for the presence of HPV (human papillomavirus) and any abnormal changes in cells on the neck of the womb. This proactive approach allows us to identify and treat any potential issues before they develop into something more serious.
If your smear test indicates the presence of HPV but no abnormal cell changes, you’ll likely be advised to undergo another smear test within one to two years. If the test at one year still shows the presence of HPV, a colposcopy may be recommended for further investigation.
If you’ve been told that your smear test has shown the presence of HPV and abnormal cells, try not to be alarmed. Having abnormal cells does not mean you have cancer; sometimes, the cells return to normal. The best way to assess what to do next is to have a colposcopy examination.
What is colposcopy?
A colposcopy is a way of closely examining the neck of the womb using a magnifying light called a colposcope. First, a speculum is gently inserted into the vagina to view the cervix. Then, a solution is painted onto the cervix, which makes abnormal cells easier to see.
A sample of the cells may then be taken (known as a biopsy), and local anaesthetic can be offered to numb the area. The tissue samples are sent for laboratory testing to determine the grading of the cell changes, and the results take about a week to come through.
Abnormal cervical cell changes
The terminology of cell changes can be a little confusing, so let’s break it down.
Cervical intraepithelial neoplasia (CIN)
CIN is an abnormal change in the squamous cells on the outer surface of the cervix. It’s graded from 1 to 3 according to how deep the cell changes go into the tissue surface.
CIN1 is sometimes called low-grade. These changes are usually monitored rather than treated because 60% of the cells will return to normal.
CIN2 cell changes are also known as high-grade cell changes. These may be monitored but sometimes treated.
CIN3 cells are also high grade, affecting deep into the tissues, and it’s almost always treated.
Cervical glandular intraepithelial neoplasia (CGIN)
CGIN affects the glandular cells within the cervical canal. Although they are not cancerous, they are usually treated because they are not easy to monitor.
LLETZ
LLETZ stands for ‘large loop excision of the transformation zone’, a procedure to remove an area of the cervix where abnormal cells have been detected. Sometimes, during colposcopy, I will carry out a LLETZ procedure if I see cell changes that I think need treating there and then. LLETZ can also treat areas of abnormal cervical cells after we have the biopsy results.
The neck of the womb is first numbed with a local anaesthetic injection, and the abnormal area is removed using a heated wire in the shape of a small loop. This also seals the tissues, and the entire procedure takes around 15 minutes. Some women choose to have the LLETZ performed under a general anaesthetic.
It’s important to be aware that for 24 hours before the procedure, you should avoid vaginal sex or the use of vaginal creams. It’s nearly always possible to have a colposcopy whilst you have a coil in situ.
After the procedure, you may experience some light bleeding or spotting for up to 4 weeks and some discharge. Light discharge is normal, but you should use a sanitary towel rather than a tampon to reduce the risk of infection. In addition, you should avoid baths, swimming, or sex for four weeks.
How successful is LLETZ at treating abnormal cervical changes?
It’s unlikely that you will need further treatment after a LLETZ procedure, as treatment is successful more than 90% of the time.
Six months after your LLETZ procedure, you will need to undergo a cervical smear, and if no HPV is found, you won’t need another smear for a further three years. If abnormal cells were to return, you may need additional treatment.
Cone biopsy
Sometimes a larger piece of tissue needs to be removed to fully treat the cervix, in which case a cone biopsy may be recommended. This involves a general anaesthetic and sometimes an overnight stay.
HPV vaccination
Around 80% of women will have had an HPV (Human Papilloma Virus) infection at some point in their lives. Many people do not have symptoms or even realise they’ve had the infection because their immune system usually shakes it off. Some women, however, will go on to develop abnormal cells as a result of an HPV infection. There are many strains of HPV, and we now have vaccinations that can protect against some, but not all, of the strains that cause cervical cancers and also genital warts. A recent study has shown that vaccination after colposcopy treatment reduces the risk of recurrence of abnormal cells by around 50%. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143003/
Colposcopy can also be used to examine the cervix when a woman has been experiencing bleeding after sex. It can also be used to look for cervical polyps, which may cause bleeding or spotting in between periods.
If you’re worried about an abnormal smear test result, I’m here to help.
I’m a member of the British Society for Colposcopy and Cervical Pathology and am very experienced in treating cervical conditions.