I have an abnormal Pap smear, my family doctor advised me that I need colposcopy. What is colposcopy?
Examination of cervix (neck of the womb) with magnifying binocular and light is called Colposcopy. The Colposcope is a binocular microscope which allows magnification of the cervix.
Will I have anaesthetic?
No anaesthetic is required.
Do I need to be admitted to a Hospital?
No you can have the examination as an office procedure.
How the examination is done?
You will lie on a special couch on your back. Your legs will be supported with your knees apart as in Pap smear. A speculum is introduced and the vagina is stretched with the speculum to expose your cervix. A special solutions; weak acetic acid (vinegar) and Iodine are applied to cervix to highlight the abnormal areas if present. Your Gynaecologist will then take very small samples of tissues (biopsies) from the cervix by special long instrument (punch biopsy forceps). The samples are sent to the laboratory to be examined by a pathologist to assess the problems if present.
Abnormal results are reported as follows
Low Grade Squamous Intraepithelial Lesion (LGSIL) (CIN I : Cervical Intraepithelial Neoplasia Grade I ):
The abnormal cells occupy one third of thickness of skin covering the cervix.
High Grade Squamous Intraepithelial Lesion (HGSIL) (CIN II & III : Cervical Intraepithelial Neoplasia Grade II & III):
The abnormal cells occupy two thirds or full thickness of skin covering the cervix.
The above are not cancer
Microinvasion:
Abnormal cells broke through basement membrane to a minor degree
Invasive Cancer:
Where malignant cells have broke through basement membrane more than 3 mm or involved blood or lymph vessels.
In many cases of CIN 1, cells return to normal without treatment.
With CIN 2 and CIN 3 there is more risk of progression to cervical cancer. But only a proportion of even the most severe cases of CIN will become cervical cancer, and this may take around 10 years.
Sometimes CIN 3 is called carcinoma in situ (CIS). This means that the biopsy showed that the cells were cancerous, but were all contained within the covering skin / mucosa of the cervix. Cancer can still be prevented if the affected area is removed. You will not be diagnosed with cancer itself unless the cells break through the bottom layer of your cervix's skin into the tissue beneath.
How will I be treated ?
There are a number of treatments for abnormal cells.
Most of these treatments take place at an out-patient appointment in a colposcopy clinic. The procedures are done under local anaesthetic that numbs the area but you will be awake.
Other treatments require an overnight stay in hospital and use general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain.
LETZ or loop diathermy
In a LETZ ( loop excision of the transformation zone) procedure, a loop of wire is heated by an electric current will be used to remove the abnormal cells. The cells are not destroyed so the tissue can be sent to a laboratory for testing.
Laser
A laser beam will be pointed at the abnormal area which burns away the abnormal area.
Cold coagulation
Uses heat to destroy abnormal cells. A hot probe will be used to burn away the abnormal cells.
Cryotherapy
Uses a probe to freeze the abnormal area to destroy the cells.
Cone biopsy
This minor operation removes the whole area where there might be abnormal cells. You may have cone biopsy under general or local anaesthetic and occasionally need hospital overnight stay.
Hysterectomy
This is a major operation in which the cervix and womb are removed. Occasionally your gynaecologist recommends a hysterectomy for CIN. It is usually only considered if you are past the menopause, have had all the children you want, your periods are heavy, your uterus have large fibroids, or have been diagnosed with invasive cervical cancer.
Follow up
A follow up colposcopy is sometimes required 4-6 months post surgery.
After treatment, you should be screened every year.
The number of yearly screening tests you should have will depend on how abnormal your cells were and whether they were completely removed.