Treatment if you have abnormal cervical cells
This page tells you about the different types of treatment available after an abnormal smear. There is information on
Treatment for abnormal smear
If you have an abnormal smear, you have pre-cancerous changes in the cells covering the cervix. If they are left, they could develop into cancer. If you have moderate or severe cell changes on your smear, you will have a colposcopy. During a colposcopy, the doctor looks more closely at the abnormal areas of your cervix and may take samples (biopsies). If you have mild changes, you may have a colposcopy straight away, or you may have another smear in 6 months.
There are several different treatments available for pre-cancerous changes in the cervix. They all aim to remove or destroy the abnormal cells. This can be done by freezing, with heat from a laser or hot probe, or by cutting out the affected area.
Laser ablation, cold coagulation and cryotherapy (freezing) treat just the part of the cervix that contains abnormal cells. Or you may have a cone biopsy, diathermy or LLETZ. These remove all of the area where cells can become cancerous.
Hysterectomy
If you are past your menopause or have finished having children, your doctor may suggest removing the whole of your womb (hysterectomy). This is more likely if you have had abnormal cells before, or if the abnormality found was severe.
If you have an abnormal smear, you have pre-cancerous changes in the cells covering the neck of your womb, or cervix. Unless these changes are mild, then you will need treatment for the abnormal cells. If they are left, there is a risk that some of them could go on to develop into cervical cancer. Your smear result may say you have
- Mild or slight cell changes (mild dyskaryosis)
- Moderate cell changes (moderate dyskaryosis)
- Severe cell changes (severe dyskaryosis)
Or you may have been told you have
- CIN 1 - one third of the thickness of the lining (skin-like cells) covering the cervix has abnormal cells
- CIN 2 - two thirds of the thickness of the lining (skin-like cells) covering the cervix has abnormal cells
- CIN 3 - the full thickness of the lining (skin-like cells) covering the cervix has abnormal cells
If you have moderate or severe cell changes on your smear, 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. A colposcope is basically a magnifying glass. It doesn't go inside your vagina. The doctor 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. You may have treatment at the same time as your colposcopy, to save you making two trips to the clinic. There is more about colposcopy in this section of CancerHelp UK.
If you have mild cell changes or CIN 1, your doctor may send you for a colposcopy straight away. Or your doctor may ask you to come back for another smear in six months. If you've had 2 mildly abnormal smears, you will definitely need to go for a colposcopy.
If you smoke and have had a mildly abnormal smear, try to give up at least until your next smear is due. You will increase the chance of your cervical cells recovering. And your lungs will feel healthier too.
Basically all the treatments aim to do the same thing - remove or destroy the abnormal cells. Laser ablation, cold coagulation, and cryotherapy treat just the part of the cervix that contains abnormal cells. This allows normal cells to grow back in their place.
LLETZ, cone biopsy and hysterectomy remove the whole area of the transformation zone - the area containing all the cells that could become precancerous or develop into cervical cancer.
It is a little confusing that the terms LLETZ, LEEP and diathermy all mean basically the same thing - using a small tool and electric current to remove the area containing abnormal cells (the transformation zone) from the cervix. In theory, diathermy can be used to remove just a small area of abnormality. In practice it is the same as LLETZ as the whole transformation zone is usually removed.
These treatments can cause period type pains for a short time. Your usual over the counter painkiller, such as paracetamol or ibuprofen will help.
Laser therapy is sometimes called laser ablation. This just means the laser burns away the abnormal cells. You have this treatment as an out patient. First, you lie on a couch, with your legs in stirrups. The doctor will put a speculum into your vagina to hold it open and then put local anaesthetic onto your cervix to numb it. Then the laser beam will be pointed at the abnormal areas. A laser beam is a very strong, hot beam of light. it burns away the abnormal area. So 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.
This is not treatment with cold as the name suggests. In fact the specialist will use a hot probe to burn away the abnormal cells. You lie on a couch, with your legs in stirrups. The doctor puts a speculum into your vagina to hold it open. Then the doctor uses a hot 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.
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 will use 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.
The advantage of diathermy, LLETZ or LEEP over laser treatment is that the piece of cervical tissue that is removed can be sent for examination under a microscope. It will be checked to confirm the degree of cell changes and to make sure that the area containing the abnormal cells has been removed. With laser ablation, the cells are destroyed, so the pathologist can't examine them after the treatment.
You have this treatment under local anaesthetic. The treatment uses an electric current to destroy 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 LEEP - loop electrosurgical excision. It is basically the same as diathermy. The area of abnormal cells is removed completely. It is an out patient treatment and you would 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 smear 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.
Your doctor may suggest this minor operation to diagnose cervical cancer or treat an abnormal smear. As with LLETZ, the doctor removes the entire area where cells can become abnormal. You may have cone biopsy under general or local anaesthetic. There is more information about cone biopsy in the CancerHelp UK section on diagnosing cervical cancer.
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 found 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 close to becoming cancerous cells. There is more information on hysterectomy in the CancerHelp UK section on treating cervical cancer.
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