Abnormal cervical smear test result. What’s next?
17 May 2017
Our questions are answered by Miss Farida Bano MBBS, FRCOG, BSCCP/RCOG Colposcopy accreditation, Consultant Obstetrician and Gynaecologist at Spire Roding Hospital
The cervix is the lower part of the uterus, and is often called the neck of the womb. Cancer can develop slowly over many years, and is preceded by changes in the cells of the cervix, known as cervical intraepithelial neoplasia (CIN). These abnormal cells are not cancerous, and most women with CIN do not develop cancer, but it is a risk if not treated. These changes can then be treated successfully before cancer develops 1.
Around 3,200 women are diagnosed with cervical cancer in the UK each year. About 2 out of every 100 cancers diagnosed in women (2%) are cervical cancers2.
Cervical cancer is more common in younger women. More than half of the cervical cancer cases in the UK each year are diagnosed in women aged 45 or under2.
Regular cervical screening is important to detect abnormalities which can be treated early to prevent cancer developing. Not going for cervical screening is one of the biggest risk factors for developing cervical cancer.
You have had an abnormal result from your cervical smear
Cervical smear is designed to pick up minor changes before any problems develop. Most women's test results show that everything is normal, but for around 1 in 20 women the test shows some abnormal changes in the cells of the cervix3. Most of these changes won't lead to cervical cancer and the cells may go back to normal on their own. However, in some cases, the abnormal cells need to be removed so they can't become cancerous.
What are the symptoms of cervical cancer?
The most common symptom of cervical cancer is abnormal vaginal bleeding, usually
- between periods
- after sex or
- after the menopause once periods have stopped
Symptoms of cervical cancer can also include a smelly vaginal discharge and discomfort during sex. Very early stage of cervical cancer may have no symptoms. This means it’s important to have regular cervical screening so that any cells can be picked up early. Usually these symptoms won’t mean you have cancer, and there are many conditions that can cause these symptoms but it’s important to let the doctor know.
What is HPV?
Human papilloma virus (HPV) is the name for a group of viruses that affect the skin and the moist membranes lining the body (e.g. cervix, vagina, vulva, anus, mouth and throat). The types of HPV that can cause abnormalities of cervix are most commonly passed through sexual contact.
Four out of five (80%) people will be infected with genital HPV at some time during their lives2. High risk HPV infection can cause changes to the cells of the cervix causing abnormalities. Once these abnormalities become severe they can develop into cancer.
High risk HPV does not have any symptoms; most people do not even know they have it. There is no treatment for high risk HPV as the body’s immune system will usually clear the infection.
What is colposcopy?
This is an outpatient clinic procedure to examine the cervix. As an experience it is very similar to having a smear test performed. Colposcopy is a more detailed look at the cervix using a microscope. It does not touch you or go inside you.
Sometimes a biopsy is required. This means taking a tiny piece of skin from the cervix with a special instrument.
What about treatment?
If you need treatment following colposcopy you will usually be treated as an outpatient and there will be no need for you to stay in hospital. Loop cone biopsy or large loop excision of transformation zone (LLETZ) is a procedure that aims to remove abnormal cells from your cervix. In most cases we are removing cells that may be precancerous and removing them now can prevent them progressing to cancer in the future. Most Loop cone biopsies are done under local anaesthetic in the Colposcopy clinic. This means you are awake but the area to be treated is made numb by anaesthetic. When we are sure the cervix is anaesthetised, the abnormal area is removed using an electrically heated loop shaped wire. The piece of tissue that is removed is sent to the laboratory for further testing.
These treatments are relatively easy to perform and effective at getting rid of the problem and returning you to normal test results.
What follow up will I need?
If you do need treatment, you will be asked to have a follow-up smear test six months afterwards to check that all the abnormal cells have gone.
Should I worry about cancer?
Cervical cancer is rare in women who get regular screening tests. It’s very important that if you have been referred to colposcopy you should keep your appointment.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.
Miss Bano holds clinics at The Spire Roding Hospital on Tuesday morning and evening, on alternate Friday morning and Saturdays.
To book an appointment call our Private Patient Executives on 020 8709 7817 or enquire here.
1) Colposcopy and Programme management BNHSCSP Publication 20
2) http://www.cancerresearchuk.org, May 2014