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Colposcopy Examination Low Grade Cytology Result Colposcopy Examination Low grade cytology result Patient Information Sheet Why do I need a Colposcopy examination? You have been asked to come for a Colposcopy examination because your cervical screening test (smear) has shown evidence of abnormal cells. Alternatively, you may have been referred because you have had a number of inadequate results from your cervical screening test. An abnormal result is not unusual and happens in about 7 - 10% of cases (Cervical Screening Programme England 2010-11) An abnormal result usually means that small changes have been found in the cells on your cervix (the neck of your womb). These abnormal changes are known as dyskaryosis and act as early warning signs that cancer might develop in the future. They are usually caused by HPV (human papilloma virus). It is important to remember that it is rare for these abnormalities to be cancer. The examination you will have is called Colposcopy. It is quick, simple and generally painless and allows the doctor to decide if you need treatment. For some women the small changes in the cervical cells return to normal by themselves. Other women will need a quick outpatient treatment that is virtually 100% effective. What is Colposcopy? Colposcopy is a simple examination that allows the doctor to see your cervix and helps to identify any area on your cervix which may be abnormal. It also lets the doctor decide if you need treatment. It is safe to do a Colposcopy examination during pregnancy, however, if the doctor thinks you need treatment this will not be done until several weeks after your baby has been delivered. At the Northern Gynaecological Oncology Centre we have two ways of performing Colposcopy. One method uses a conventional colposcope and is really just a large magnifying glass which lets the doctor look more closely at changes on your cervix. The other kind of colposcope is known as DySIS. This uses different colour filters and magnification options to create a digital image of your cervix and identifies changes on your cervix by showing a coloured map on a digital screen. Is there anything I can do to prepare? You are welcome to bring a friend or relative with you to the Colposcopy clinic and they can also stay with you during your examination if you wish. If your appointment date is on a day when you are on a period and your period is heavy you may need to change your appointment. Please ring the clinic in advance to ask for advice. If you take medication to thin your blood (anticoagulants) such as warfarin and Clopidogrel, please contact the Colposcopy clinic for advice. You can eat and drink as normal prior to your appointment. You may wish to wear a full skirt to avoid removing all of your lower clothing during the examination. You may have a slight discharge after the examination so may want to bring a sanitary towel just in case. What happens before the examination? Before your Colposcopy the doctor will explain what your cytology sample (smear) result means and what will happen during your examination. The doctor will also want to ask you some questions about your periods, what type of contraception you use, your family and if you have had any illnesses or operations in the past. If you have any hip problems or recent hip surgeries please inform the doctor/nurse at your appointment. You will then be guided to a screened area where you will be asked to undress from the waist downwards (though a full skirt need not be removed). What happens during the examination? The Colposcopy nurse will help you to position yourself on a special type of couch. The couch has padded supports on which you rest your legs. When you are comfortably positioned the doctor will gently insert a speculum into your vagina, just like when you had your cervical screening test (smear). The doctor will then look at your cervix using either the conventional colposcope or DySIS colposcope. The doctor will then apply different liquids onto your cervix which help to identify any areas of abnormal cells. Any abnormal areas will appear white. If any abnormal areas are identified the doctor will want to take a small sample of tissue –a punch biopsy- from this area. The punch biopsy will be about the size of a small freckle. You may feel a slight stinging but it should not be painful. Once the punch biopsy has been taken the doctor will stop any bleeding from that area by either applying a small stick with a chemical on the end which helps to stop bleeding or by applying pressure with a piece of gauze. What happens after the examination? After you have dressed the doctor will discuss what your examination showed. If you did not have a biopsy the doctor will discuss what will happen next and ask if you have any questions. It you did have a punch biopsy the doctor will tell you what they think the punch biopsy result will show but you will need to wait until the punch biopsy result is available before the doctor decides whether or not you need treatment. The biopsy result is usually available about two to three weeks after your examination. If you had a punch biopsy you may have a light blood stained discharge for a few days. This is normal and it should clear by it's self. However it is best to avoid using tampons and to refrain from intercourse for up to five days to allow the biopsy site to heal. You should feel well enough to continue with your usual routine after your examination. What will my biopsy result show? Your biopsy result will show how abnormal the area is and will indicate if treatment is needed. The technical term used to refer to abnormal cell changes on the cervix is called cervical intra- epithelial neoplasia, CIN for short. In order to make distinctions between the various stages of abnormality doctors have developed a scale from 1 to 3 according to how many cells are affected. CIN 1 means that only a third of the cells in the abnormal area are affected. These may be left to return to normal and so you would not usually have treatment if your biopsy showed CIN 1. CIN 2 means that up to two thirds of the cells in the abnormal area are affected. Treatment is usually needed to return your cervical cells to normal. CIN 3 means that all the cells in the abnormal area are affected and treatment will be needed to return the cells to normal. Only very rarely will a biopsy show cell changes that have already developed into a cancer. Surgery and more extensive treatments are generally used to treat cervical cancer. What if I need treatment? If your biopsy has shown CIN 2 or CIN 3 you will most likely be offered a further appointment so we can treat the area. There are several equally effective ways of treating CIN 2 or 3. At the Northern Gynaecological Oncology Centre we treat women by performing a Loop biopsy, also known as LLETZ. This allows us to remove the cells affected by the virus whilst causing minimal disruption to surrounding normal tissue. It is a procedure which can be easily carried out in the outpatient setting under local anaesthetic. It also has the advantage of allowing us to send a tissue sample to the pathology lab so they can confirm the stage of CIN and if all of the affected area has been removed. Treatment is nearly always 100% effective and it is unlikely that CIN will recur. Other Colposcopy clinics may use other methods of treatment such as laser treatment but this does not allow for a sample to be sent to pathology. If I do have treatment what happens afterwards? If you do have a loop biopsy you are likely to have a bloodstained discharge for a few weeks. During this time and when you have your period you will need to use towels rather than tampons. It is also best to avoid heavy exercise, swimming and not to have sexual intercourse. These measures allow the cervix to heal as quickly as possible and reduce the likelihood of infection. You will be told what is normal during the healing process and what may indicate you have an infection/heavy discharge. You will also be given contact numbers after any treatment in case you have any concerns when you are at home. Treatment for CIN will have little or no effect on your future fertility. Risk of miscarriage or pre term birth may be slightly raised but this is usually only if women have had more than one treatment. Where can I find further information? If you would like any further information before you come to Colposcopy your practice nurse will be happy to discuss your abnormal cervical sample result or you can contact the nursing staff in Colposcopy on 0191 4456178. There is also information available on the internet such as jostrust.org.uk and healthtalkonline.org. Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS reviews. Further information is available in the leaflet Disclosure of Confidential Information IL37, via Gateshead Health NHS Foundation trust website or the PALS Service.
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