Your biopsy result may show you have abnormal cell changes called CIN or CGIN. Find out what these mean and the treatment you might have.
What abnormal cells are and why you need treatment
If you have an abnormal cervical screening test result, you have changes in the cells covering the neck of your womb (cervix). This is not cancer. But if these abnormal cells are left untreated, there is a risk that some of them could develop into cervical cancer in the future.
Your screening result may say you have:
- borderline or mild cell changes (low grade dyskaryosis)
- moderate or severe cell changes (high grade dyskaryosis)
After an abnormal screening test result
If you have an abnormal screening test result you might have a referral to the colposcopy clinic for a closer look at your cervix. During this examination, your doctor or specialist nurse (colposcopist) can take samples (biopsies) of any abnormal areas.
The colposcopist might offer you treatment at the same time as your colposcopy. Or you may go back for treatment once they have your biopsy results.
Cervical intraepithelial neoplasia (CIN)
Your biopsy results may show cervical intraepithelial neoplasia (CIN). This is not cancer. There are changes to the cells that cover the outside of the cervix (squamous cells).
There are 3 grades of CIN and they relate to how deeply the abnormal cells have gone into the skin covering the cervix.
- CIN 1 – up to one third of the thickness of the lining covering the cervix has abnormal cells
- CIN 2 – between one third and two thirds of the skin covering the cervix has abnormal cells
- CIN 3 – the full thickness of the lining covering the cervix has abnormal cells
CIN 3 may also be called carcinoma in situ or CIS.
Both the cell abnormality (mild, moderate or severe) and the CIN level are taken into account when deciding which treatment will be best for you. The treatment aims to remove or destroy the abnormal cervical cells.
CIN 1 doesn't normally need treatment as the cell changes often return to normal over time.
Cervical glandular intraepithelial neoplasia (CGIN)
Your biopsy results may show CGIN. This means there are changes to the glandular cells that line the inside of the cervix. Without treatment these cells could develop into a type of cervical cancer called adenocarcinoma.
CGIN is less common than CIN, but is treated in a similar way.
Removing the area of abnormal cells
There are a few different treatments that can remove the area of abnormal cervical cells. The advantage of these treatments is that the piece of cervical tissue that the colposcopist removes can be sent for examination under a microscope.
In the laboratory, the pathologist rechecks the level of cell changes in the piece of tissue to make sure your screening result was accurate. They also closely examine the whole piece of tissue to make sure that the area containing the abnormal cells has been completely removed.
LLETZ stands for large loop excision of the transformation zone. It’s also known as loop electrosurgical excision (LEEP) or loop diathermy. This is the most common treatment for abnormal cervical cells.
Your colposcopist uses a thin wire loop to remove the transformation zone of the cervix. The wire has an electrical current running through it, which cuts the tissue and seals the wound at the same time.
The transformation zone is the area around the opening of the cervix.
LLETZ is an outpatient treatment and takes up to 15 minutes. You usually have it under local anaesthetic.
At the colposcopy clinic, your nurse asks you to undress from the waist down and then to lie on your back on the examination couch. They give you a sheet to cover yourself. Your legs are supported by 2 leg rests.
Your colposcopist gently puts a medical instrument called a speculum into your vagina to hold it open (like when you have a cervical screening test). They look through the colposcope to examine your cervix.
They inject some local anaesthetic into your cervix. This might sting for a short time. The local anaesthetic numbs the area. Your colposcopist can then remove the area of tissue with the abnormal cells. This is not painful but you may feel some pressure.
Your colposcopist then removes the speculum and you can get dressed when you’re ready.
You should bring a sanitary towel with you to the hospital. You'll need one after the treatment as there might be some bleeding.
You might have bleeding and discharge for about 4 weeks after having a LLETZ. You shouldn't use tampons or have sex during this time to reduce your risk of infection.
See your GP or contact your colposcopy nurse if you have:
- bleeding that is heavier than a period or you’re still bleeding after 4 weeks
- discharge that smells unpleasant
NETZ stands for needle excision of the transformation zone. It’s similar to LLETZ but the thin wire the colposcopist uses to cut away the area is straight rather than a loop.
You may be more likely to have this treatment if the abnormal cells are inside the passage that leads from the opening of the cervix to the womb (cervical canal).
Your doctor may suggest this minor operation to remove abnormal cells.
As with LLETZ, your doctor removes the whole area where cells can become abnormal (the transformation zone). It is called a cone biopsy because the doctor removes a cone shaped wedge of tissue from the cervix.
You usually have a cone biopsy under general anaesthetic.
In some cases, if you are past your menopause or have had all the children you want to have, your doctor may suggest removing the whole of your womb (includes the cervix).
This is more likely if you’ve had abnormal cells on your cervix more than once. Or if the abnormality found was severe. In other words, you have not got cervical cancer, but the abnormal cells on your cervix are closer to becoming cancerous cells.
Treatment to destroy abnormal cells
These treatments destroy the cells in the abnormal area. Normal cells can then grow back in their place.
These treatments include:
Laser therapy is sometimes called laser ablation. This just means the laser burns away the abnormal cells. You have this treatment as an outpatient.
A laser beam is a very strong, hot beam of light. It burns away the abnormal area. You may notice a slight burning smell during the treatment. This is nothing to worry about. It is just the laser working. You can go home as soon as this treatment is over.
Despite what the name suggests, this uses a hot probe to burn away abnormal cells.
You have it in a similar way to laser treatment, but your colposcopist puts the probe onto your cervix. You shouldn't be able to feel the probe, but you might get a period type pain while you are being treated and for a short while afterwards.
This is called cryotherapy. The colposcopist uses a cold probe to freeze away the abnormal cells.
You shouldn't be able to feel the probe on your cervix, but you might get a period type pain while you are being treated and for a short while afterwards.