You are likely to be referred for a colposcopy if abnormal cells have
been found after your cervical screening test. Colposcopy is a detailed
examination of the cervix (the neck of the womb) using a special
magnifying instrument called a colposcope. It allows the doctor, or
specialist nurse, to see the extent of the abnormal cells and the
degree of abnormal change in the cells. Using this information, the
doctor or nurse can advise you what, if any, treatment you may need.
What is colposcopy?
Colposcopy is a detailed examination of the cervix (the lower part of
the uterus, also known as the 'neck of the womb'). It is usually
carried out in a colposcopy clinic by a doctor or specialist nurse who
has specific training and experience in colposcopy. The doctor or nurse
use a special magnifier called a colposcope to look at the cells of the
cervix in detail.
A
liquid is painted onto the cervix to show up any abnormal cells. During
colposcopy the doctor or nurse will usually take a small piece of
tissue from the cervix. This is known as a biopsy. The tissue is then
examined in even closer detail in the laboratory to allow further
assessment of the cells. Treatment for any abnormal cells can sometimes
be given at the same time as the colposcopy examination.
What is the difference between colposcopy and a cervical screening test?
A
cervical screening test is offered regularly to all women to look at
the chance of you developing cervical cancer (cancer of the cervix). A
sample of cells is taken from your cervix using a brush or a wooden
instrument called a spatula. The sample is then sent to the laboratory
so that the cells can be examined under a microscope.
Abnormal
changes in the cells are found in some women. These abnormal changes
are known as dyskaryosis. In the vast majority of cases, an abnormal
result does not mean cervical cancer. However, the presence of
dyskaryosis indicates that cancer may develop at some time in the
future. The abnormal cells are essentially 'pre-cancer' cells.
A
cervical screening test shows if abnormal cells are present but does
not show enough detail about the cells. Colposcopy allows a closer and
more detailed look at these abnormal cells.
During colposcopy,
the extent of the area where the abnormal cells are present is shown.
This is done by applying a special solution to your cervix that
'stains' the abnormal cells. Colposcopy also allows a biopsy (a sample
of tissue) to be taken. This sample is then sent to the laboratory for
further tests. This means that the exact type of abnormality in the
cells can be identified.
A cervical screening test can be
performed more quickly and needs less training than colposcopy. This
means that it is a more suitable test to look for pre-cancer changes in
the cervix in large groups of people. There is a separate leaflet on
the Cervical Screening Test.
Why do I need a colposcopy?
The usual reason
for having a colposcopy is because you have had an abnormal cervical
screening test result. This is not something unusual. About one in ten
cervical screening tests are abnormal.
Sometimes you can be
referred for a colposcopy because you have had a number of 'inadequate'
cervical screening tests in a row. This can happen if there was too
much blood or too much mucus present around your cervix at the time of
your cervical screening test. Because of this, the cells could not be
seen clearly under the microscope.
Rarely, you can be referred
for a colposcopy because the doctor or nurse carrying out your cervical
screening test is worried about infection, inflammation or a polyp (a
non-cancerous growth) around the neck of your womb.
Before your colposcopy
There are some things that you should think about before your colposcopy that can help you prepare:
- You
should not have a colposcopy if you have your period. If this is the
case, you should call the clinic and re-arrange the appointment.
- You should avoid sex and not wear a tampon for 24 hours before your colposcopy.
- You should not use any vaginal creams or pessaries for 24 hours before your colposcopy.
- Some people find the colposcopy examination a little uncomfortable.
For this reason, you may choose to take some paracetamol about an hour
before your appointment.
- You may want to wear a skirt on the day of your colposcopy so that you do not have to remove all of your lower clothing.
What should I expect when I have my colposcopy?
The
whole colposcopy procedure normally takes about 15-20 minutes. This may
be longer if you have treatment at the same time (see below).
- The
doctor or nurse will usually start by asking you some questions. These
may include information about your periods, the date of your last
period, what contraception you use and your general health.
- You will then be asked to remove your clothing from the waist down. (You can usually keep a loose skirt on.)
- You will usually be asked to lie in a reclining chair, or on a
couch, in the same position as during a cervical screening test. This
is with your knees bent and your legs apart. In some clinics your legs
may be placed apart in padded supports called stirrups.
- The doctor or nurse will insert an instrument called a speculum
(the same instrument that is used during a cervical screening test)
into your vagina. This gently opens the vagina and means that the
doctor or nurse is able to see the cervix at the top of the vagina.
- The doctor or nurse will then look through the colposcope to get a
good view of your cervix. The colposcope itself does not go inside your
vagina. It is essentially like a big pair of binoculars on a stand that
can be moved around. There is also a light to help the doctor or nurse
see inside your vagina. Sometimes, the colposcope can be attached to
video equipment so that the doctor or nurse (and you if you would like)
can view your examination on a screen.
- The doctor or nurse will then use a long cotton bud to apply a
special solution to your cervix. This solution stains any abnormal
cells that may be present. Two different solutions are normally applied
to your cervix. These solutions are called acetic acid and iodine.
- The doctor or nurse may also take a biopsy (a small sample of
tissue) from your cervix. This will be sent to the laboratory for
further examination. This may be slightly uncomfortable. The biopsy is
only about the size of a pinhead. Some doctors and nurses inject a
local anaesthetic into your cervix before they take a biopsy.
- Sometimes the doctor or nurse may suggest that you have treatment
at the same time as your colposcopy (see below). However, often, you
may be asked to return for the treatment.
After your colposcopy
After your colposcopy
you can usually return to work or carry on with your normal day. You
are likely to have a small amount of bleeding, especially if you have
had a biopsy. This can last for three to five days and you should wear
a sanitary pad. Do not use tampons. You should not have sex or use
vaginal creams or pessaries until the bleeding has stopped. Generally
you should wait for five days.
You may notice a dark fluid-like
material on the pad. It is sometimes green or looks like coffee
granules. This is normal and is the fluid that is painted onto your
cervix during the examination.
What are the risks or complications of colposcopy?
Colposcopy
is generally a safe procedure. Some women find that is it a little
uncomfortable. Rarely, complications can occur. These can include heavy
bleeding and infection. If you experience any heavy bleeding, smelly
vaginal discharge or severe lower abdominal pain, you should see a
doctor as soon as possible.
If you are pregnant, you should discuss this with the doctor or nurse before you have a colposcopy.
The biopsy results
When a biopsy is taken,
the sample of tissue is sent to the laboratory for further examination
under a microscope. The cell abnormality that can be seen is called
cervical intra-epithelial neoplasia, or CIN. There is a scale from 1 to
3 according to the number of cells in the biopsy sample affected by
CIN. In CIN 1, only a few cells are abnormal. In CIN 3, all of the
cells are abnormal. Very rarely, a biopsy can show changes in your
cells that have already developed into cancer.
How will I know if I need any treatment?
The
results of your colposcopy and biopsy will show if you need any
treatment. Sometimes the doctor or nurse may suggest that you have
treatment at your first visit for colposcopy. However, they may suggest
that they wait for the results of your biopsy before you have any
treatment. This just depends on the clinic that you attend. It can take
a few weeks for the biopsy results.
Not everyone who has a
colposcopy needs treatment. If the doctor or nurse feel that you only
have a mild abnormality, they may just suggest that you have a repeat
colposcopy in 6 to 12 months. The changes in your cervix may return to
normal by themselves and they may just need monitoring.
What are the treatment options available?
There
are a number of different treatments available for CIN. The aim of the
treatment is to destroy or remove all of the abnormal cells on your
cervix without affecting too much normal tissue. Most treatments can be
done as an out-patient. The treatment may cause a little discomfort,
perhaps similar to a period pain.
The treatment that you have
will depend on the extent of your abnormality as well as what treatment
the clinic has available and the preference of the doctor or nurse.
Treatment options include:
-
Cryotherapy: freezing the affected area of the cervix which destroys the abnormal cells.
-
Laser treatment: this destroys or cuts away abnormal cells.
-
Loop diathermy: a thin wire loop cuts through and removes
the abnormal area of cells. This is also known as a Large Loop Excision
of the Transformation Zone (or LLETZ). It is the most common form of
treatment used in the UK.
-
Cold coagulation: a heat source is used to burn away and remove the abnormal cells.
A local anaesthetic is usually given before any treatment. The
treatment is normally very straightforward and quick. There is a small
risk of bleeding at the time of treatment.
Occasionally the
doctor or nurse may suggest that you have a cone biopsy (described
later) or, very rarely, a hysterectomy (removal of your uterus and
cervix) as a treatment for CIN. If this is the case, you will need to
be admitted to hospital.
What should I expect after my treatment?
You
may have some mild discomfort, like a period pain, after your
treatment. Painkillers such as paracetamol may help to ease the pain.
You
are likely to have some bloody vaginal discharge. This can last for up
to six weeks. It is similar to the blood loss during your period. If
you are worried that it is too heavy, or if it becomes smelly, you
should see your usual doctor. You should use sanitary pads and not
tampons. You should avoid sex and not do any heavy exercise until the
discharge has stopped.
Will I need any follow-up?
This depends on
the results of your colposcopy and whether you needed any treatment.
Some women may need a follow-up colposcopy examination. Other women may
just need a follow-up cervical screening test, usually after about four
months. The doctor or nurse who performs your colposcopy will advise
what follow-up you will need. Most colposcopy clinics will see you
again four to six months after your first examination or treatment.
If
all is well at your follow-up appointment, you will be given advice
about when you should have your next cervical screening test. This test
can be carried out by your usual clinic or GP surgery. You will usually
be advised to have a cervical screening test every year for a number of
years. If you have any further abnormal cervical screening test results
you may need to have another colposcopy examination.
What is the prognosis (outlook) if I need treatment?
Treatment of CIN is usually almost 100% effective. In the vast majority of women, it is unlikely that CIN will come back.
Cone biopsy
What is a cone biopsy?
Sometimes all of the
abnormal cells cannot be seen during colposcopy because the cells go
further up into the cervix. If this happens, the doctor or nurse will
usually suggest that you have a minor operation called a cone biopsy.
This is when a cone shaped piece of tissue is removed from your cervix
so that it can be examined under the microscope in the laboratory.
You
will be given a separate appointment to come back for your cone biopsy.
You are usually admitted to hospital overnight. A general anaesthetic
that puts you to sleep is usually given.
What happens after a cone biopsy?
After your
cone biopsy, you may have some gauze packed into your vagina to help
control any bleeding. Some women also have a catheter (a tube to drain
urine) inserted into their bladder at the time of the operation. This
is because the gauze can sometimes press on the bladder and stop it
from emptying properly. The gauze and the catheter will be removed
before you leave hospital.
Most women notice a bloody discharge
for up to four weeks after a cone biopsy. You should wear sanitary pads
and not tampons. If you are worried that the bleeding is too heavy, if
it becomes smelly, or if you develop abdominal pain, you should see
your usual doctor.
After your cone biopsy you should rest for a few days. You should not have sex or do any heavy exercise for 4 to 6 weeks.
If
all of the abnormal cells are removed during your cone biopsy and there
is no sign of any cancer, you do not usually need any more treatment.
However, you will need to have regular cervical screening tests to make
sure that no more abnormal cells develop.
References
© EMIS and PiP 2008 Updated: 22 Feb 2008
