Download Women`s questions answered

COLPOSCOPY
Women's questions answered
Do smears work?
The numbers of cases of cervical cancer has been falling dramatically since the
introduction of computerised call and recall for women to regularly have their cervical
smears. Since 1988 there has been a reduction of more than 40% in the registration
of new cases and the rate has continued to fall by about 7% per year. This however
depends upon all eligible women attending for their smears when invited and in
England means that all women aged 25-65 years should have a smear every 3 years
until they are 50 then every 5 years thereafter. The frequency of smear taking is
slightly different in Northern Ireland, Wales and Scotland.
More cervical cancers are detected at a microscopic stage and can be treated in
some cases without major surgery. Surgeons have also improved surgical
techniques involving vaginal and laparoscopic (keyhole) procedures. Radiotherapy
techniques have also improved.
The cervical screening story in the UK is a success story but there is no room for
complacency and the most important message, is to ensure that you attend for your
smear is taken when it is due.
I have an abnormal smear. What is the chance that I have
cancer?
Whilst about 1 in 20 women will have an abnormal smear after a given test only
about 1 in 2000 will have cervical cancer. That means approximately 1% of women
with any grade of abnormal smear will have a cancer. So statistically speaking the
risk that you have already developed cervical cancer is very small even if your smear
is abnormal.
We realise though that women worry about this possibility and this is where
colposcopy is really helpful. In the majority of women the colposcopy is really
reassuring as it documents more clearly what the situation is. So the advice is if you
have been referred to colposcopy it is important that you keep your appointment.
Hiding from clinic will not make the abnormal cells get better!
I have had an abnormal smear test result and I am pregnant.
What should I do?
This will depend on the smear test result. If you have had just one abnormal smear
with a low grade abnormality it might get better by itself and colposcopy may not be
necessary - you will simply need to have the smear test repeated three months
following the pregnancy. It is important to remember that pregnancy has no
adverse effect in the progression of abnormal cells (CIN) or the development of
cervical cancer.
If a colposcopy has been recommended and an appointment has been made with
a colposcopy clinic then you should attend. Colposcopy will not in any way harm the
pregnancy and can provide valuable and reassuring information. In many cases
treatment and even biopsy s deferred until after the pregnancy. It is very important
though, to follow through with the suggested plan, to make sure you return to having
normal smear tests.
Can treatment for abnormal cells cause me problems in future
pregnancy?
Any treatment involves a balance between removing abnormal cells on the one hand
and minimising any possible harm on the other hand. Clearly the more of your cervix
which has been removed then the less supporting tissue for future pregnancies. Your
colposcopist will recognise the importance of the cervix to support future pregnancies
and will tend to remove as little tissue as possible while making sure the treatment is
successful.
Women who have had treatment for abnormal cells by loop excision may be at minor
increased risk to deliver prematurely or preterm in later pregnancies. Or those who
have had repeated treatments may also result in early delivery. If you have had
multiple treatments and are pregnant or considering a pregnancy then you should
speak to your GP or obstetrician.
While there currently appears to be no ideal way to judge this risk, your obstetrician
or gynaecologist may advise a special scan early in pregnancy to measure the length
of your cervix. In most cases this is normal but if not your doctor may recommend a
cervical stitch (or cerclage) to provide additional support. This is generally fitted when
you are pregnant with a short general anaesthetic and removed whilst you are awake
shortly before your baby is due.
Will treatment to my cervix alter my periods?
There is no evidence that the flow at menstruation is increased or that cycle
regularity is altered by treatment. Rarely periods may disappear particularly after a
cone biopsy (this is the treatment that is usually performed with a general
anaesthetic) but this is due to a rare complication called cervical stenosis, where the
cervix becomes blocked and cramp like period pains, continue because of blood
becoming trapped in the uterus (or womb). This can usually be dealt with by a
procedure to open the cervix and release the trapped blood.
What is HPV and is my abnormal smear due to sex?
There are 2 questions here. HPV or human papilloma virus is an extremely common
virus that is almost always caught by sexual intercourse. Approximately 8 out of 10
adults have had the infection at some time and rarely produce any effects but about
5% of women have abnormal smears. 1-2% will develop pre-cancerous cells (CIN)
and a tiny minority of these progress to get cervical cancer despite the efforts of the
screening programme. So although HPV is sexually transmitted it is not a sexually
transmitted disease that requires a visit to a Sexual Health Clinic. Some abnormal
smears with mild changes may not be due to HPV but most abnormal smears are
due to the effects of HPV on the cervix. There is no blame to attach to your current or
any other partner or to yourself.
The one visible abnormality some types of HPV can produce is warts on the vulva or
the anus. This is a slightly different situation. These can be treated by the
local Sexual Health Clinic. If you have these then your partner would also need
examination and possible treatment. Usually a topical cream or freezing of warts is all
that is required.
What about my coil?
If you have a coil (or IUCD/ Mirena IUS) then this need not be removed, if you are
expecting treatment in colposcopy clinic. Practice amongst colposcopists is divided.
Some colposcopists will consider removing it if you not had sexual intercourse for the
preceding 5 days, but some colposcopists will perform a colposcopy and if a loop
excision form of treatment is needed, then consider performing the loop ‘around’ the
coil and coil threads. Sometimes the threads are inadvertently cut but this is not a
problem as a coil can be removed (when you no longer wish to use it) without the
threads.
My pill and cervical cancer
The combined oral contraceptive pill is associated with a very slightly increased risk
of cervical cancer. A recent series of publications found this to be in women that have
HPV. This is not very helpful, as HPV almost always has no symptoms (except rarely
causing genital warts due to some types of HPV) and most adults at some stage of
their lives do have HPV, although in most cases the infection is short lasting (a
matter of months). Family planning doctors strongly recommend that women
requiring contraception should use a reliable method. The combined pill is a good
method of contraception. If you have an abnormal smear and are taking the
combined pill, you should continue to take the pill. It has no effect on making any
changes occur any faster.
Does cervical cancer run in the family?
No. There is no evidence that daughters and other female relatives of women with
abnormal smears, pre-cancerous cells (CIN) or cervical cancer have an increased
risk of abnormal smears, pre-cancerous cells or cervical cancer. Cervical smear
abnormalities are common and it is not unusual for one or more family members to
have had an abnormal smear, but there is no inherited predisposition to cervical
abnormalities, CIN or cervical cancer.
Is a hysterectomy the answer?
A hysterectomy is rarely of any help to women with abnormal smears. Studies have
shown that women who have hysterectomies (having the uterus or womb and the
cervix removed) for pre-cancerous cells (CIN) are less likely to have pre-cancerous
cells on the vagina but are not less likely to get a cancer (as the cervix will have been
removed this would then be in the vagina).
Gynaecologists are therefore careful before considering a hysterectomy for women
with pre-cancerous changes in the cervix. It may be recommended after 2 or 3 local
treatments have failed to remove a pre-cancerous problem, or if for technical reasons
further smears cannot be taken from a cervix having had multiple treatments. Other
women suitable for hysterectomy may have other difficulties such as heavy periods
and abnormal cells making a hysterectomy a practical common solution. A
hysterectomy may be recommended for an early cervical cancer. In all cases detailed
discussion with your gynaecologist is required to decide whether you can have
the hysterectomy as a vaginal, abdominal or laparoscopic (or keyhole) procedure
and whether you should keep your ovaries or have them removed
Contacts/Further Information
Snr Sr Nurse Colposcopist 01245 513090 Monday and Thursdays 730- 6
Colposcopy Secretary 01245 513090 Monday – Friday 0800-1630
Gynaecology Ward 01245 514921 24 Hours
Sc/Ckp June 2011