Find out about the different types of treatment available after you have an abnormal cervical screening test result.
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). If these abnormal cells are left untreated, there is a risk that some of them could go on to 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 the screening test result
If you have moderate or severe cell changes on your cervix, your doctor will refer you for a colposcopy. Most colposcopy clinics are held in hospital outpatient departments. But they are sometimes held at community hospitals or health centres.
A colposcopy is a close examination of your cervix. The doctor or specialist nurse uses it to look more closely at the abnormal areas on your cervix and may take samples of them (biopsies) to send to the lab.
If your screening test showed you have mild cell changes, your doctor may send you for a colposcopy straight away. Or your doctor may ask you to go for another cervical screening test in 6 months. This is slightly different for women having screening in England and Northern Ireland.
The NHS cervical screening programme in these countries now test the samples of borderline or mild cell changes for the human papilloma virus (HPV). Women who test positive for high risk types of HPV are referred for a colposcopy straight away. If you do not have HPV, the cell changes are likely to go back to normal on their own. So you will continue to have routine screening tests every 3 to 5 years.
If you smoke and have had a mildly abnormal screening test result, it is a good idea to try and give up smoking if you can. You will increase the chance of your cervical cells recovering. And your lungs will feel healthier too.
Cervical intraepithelial neoplasia (CIN)
During a colposcopy, the nurse or doctor may take a small sample of cells (biopsy) from the surface of the cervix. The results may show CIN.
CIN stands for cervical intraepithelial neoplasia and is not cancer. There are 3 grades of CIN and they relate to how deeply the abnormal cells have gone into the skin covering the cervix. These are:
- 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
Both the level of cell abnormality (mild, moderate or severe) and the CIN level are taken into account when deciding which treatment will be best for you.
Treating abnormal cells
Basically all the treatments aim to do the same thing by removing or destroying the abnormal cells.
Some treatments treat the part of the cervix that contains abnormal cells only, so the normal cells can 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.
First, you lie on a couch, with your legs in stirrups. Your doctor will put a speculum into your vagina to hold it open and then puts local anaesthetic onto your cervix to numb it. Then they point the laser beam at the abnormal areas.
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.
There is a another type of treatment called cold coagulation. 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 doctor 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 specialist uses a cold probe to freeze away the abnormal cells.
You lie on a couch, with your legs in stirrups. The doctor will put a speculum into your vagina to hold it open. Then the doctor uses the probe to destroy the abnormal cells. You shouldn't be able to feel the probe on the cervix, but you might get a period type pain while you are being treated and for a short while afterwards.
These treatments can cause period type of pains for a short time. The usual over the counter painkiller such as paracetamol or ibuprofen can help.
Removing the area of abnormal cells
There are a few different treatments doctors may use to remove the area of abnormal cells. The advantage of these treatments is that the piece of cervical tissue that the doctor removes can be sent for examination under a microscope.
In the laboratory, the pathologist will re check the level of cell changes in the piece of tissue to make sure your screening result was accurate. They will also closely examine the whole piece of tissue to make sure that the area containing the abnormal cells has been completely removed.
These treatments include:
You have diathermy under local anaesthetic. The treatment uses an electric current to cut away the tissue containing the abnormal cells. It is quite quick and you will be able to go home afterwards.
Bring a sanitary towel with you. You will have some bleeding or discharge for about 4 weeks after the treatment. You shouldn't wear tampons or have sex for 4 weeks because this will increase your risk of infection.
LLETZ stands for large loop excision of the transformation zone. In the USA, this procedure is called loop electrosurgical excision (LEEP). It is basically the same as diathermy. The area of abnormal cells is removed completely.
LLETZ is an outpatient treatment and you usually have a local anaesthetic. If you need to have a large area of tissue removed, or if you are very anxious about the treatment, you may have a general anaesthetic.
You may have this treatment at the same time as your colposcopy. The transformation zone is an area that is usually inside the endocervical canal. Its exact position varies, depending on your age and whether you've had children. So it cannot always be seen clearly when a screening test is taken. But it can be seen during colposcopy.
It is quite common to have abnormal cells in this area. Some doctors like to treat straight away when they find the abnormal cells, rather than asking you to come back another time.
The transformation zone is cut away using a loop of wire and an electric current. You should bring a sanitary towel with you to the hospital. You will need one after the treatment as there will be some bleeding. You will have some bleeding for about 4 weeks after LLETZ. You shouldn't wear tampons or have sex for 4 weeks because this will increase your risk of infection.
You may also hear the term NETZ or needle excision of the transformation zone. It is similar to LLETZ. But the thin wire doctors use to cut away the area is straight rather than a loop.
The terms LLETZ, NETZ, LEEP and diathermy all mean basically the same thing. Doctors use a small tool and electric current to remove the area containing abnormal cells from the cervix. In theory, doctors use diathermy to remove just a small area of abnormality. In practice, it is the same as LLETZ as the whole transformation zone is usually removed.
Your doctor may suggest this minor operation to diagnose cervical cancer or to treat abnormal cells. As with LLETZ, the doctor removes the entire area where cells can become abnormal (the transformation zone). It is called a cone biopsy because the surgeon removes a cone shaped wedge of tissue from the cervix.
You may have a cone biopsy under general or local anaesthetic.
Surgery to remove your womb (hysterectomy)
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.
This is more likely if you have 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.