Download Colposcopy - Musgrove Park Hospital

menopause assessment of the cervix is made easier if you have used
an oestrogen pessary high in the vagina for 7 nights before your
clinic appointment. You will need to get these from your doctor. If
you are on HRT this will not be necessary.
6. We suggest you have something to eat before you attend.
Help and support
To be told you have an abnormal smear can be an awful shock as
we all expect to have a normal result. It can affect women in many
different ways but it is always a worrying time.
You will be given help and support at the colposcopy clinic and we
hope this leaflet has been useful, but if you feel you need to speak
to someone before your appointment you can ring the clinic on
01823 342053 and a member of staff will be pleased to speak to
you.
Further information
Websites
www.cancerscreening.nhs.uk/cervical
www.bsccp.org.uk
www.nhsdirect.nhs.uk
www.jotrust.co.uk
Clinic number 01823 342053
MPH_PIL_658/D Morgan/Jan13reviewJan14
Colposcopy
We hope this booklet will help you understand a little more about
colposcopy. If you have any further questions, please don’t hesitate
to ask the medical or nursing staff. They will be happy to help you.
Introduction
You have been asked to attend for colposcopy at Taunton &
Somerset NHS Trust because you have an abnormal smear.
This booklet is designed to explain what might happen to you at
the clinic and why it is necessary.
The Cervical Screening Programme has been very successful in
reducing the incidence of cervical cancer. The whole point of
having a smear is to pick up early changes which can be easily
treated to prevent cancer developing in the future.
Having an abnormal smear result is likely to have worried you.
However it is highly likely that the problem with your cervix will be
easily dealt with.
You will be made welcome in our clinic and we will do all we can
to put you at ease and answer your questions. We are here to help
you.
Another risk is scarring of the cervix, which is called cervical
stenosis, so that the opening to your womb becomes very narrow.
This may cause trouble with your period flow and occurs in about
1% of women who have the treatment. We will discuss all these
potential problems with you before any treatment.
Will I be cured?
If CIN 2-3 is left unnoticed and untreated then at least 30% of
women would go on to develop cervix cancer. However the
treatment as described above will give 90% of women a normal
smear.
Will I need further checks?
After treatment you will need close follow up with a smear. The
first follow up smear will be 6 months after your treatment with
your GP. This first smear will be tested for high risk HPV, to see if
the virus has been cleared. This will let us know whether we need
to see you back in colposcopy or whether you can have follow up
smears with your GP.
What happens if I do not require treatment?
Staff
You will be welcomed to the clinic by our Colposcopy receptionist
who will check you in to the clinic.
We have 3 doctors and 2 nurse colposcopists – Miss Jo Morrison, Mr
David Milliken, Dr Penny Trotter, Nurse Practitioner Di Morgan and
Nurse Practitioner Heather Fryer.
In the clinic the colposcopist will be assisted by one or two nurses
and there may be a medical student, practice nurse or student
nurse observing the clinic. If you feel uncomfortable with this,
please let us know.
The colposcopists all train doctors and nurses to become future
colposcopists and so they may also be involved in your care.
You will probably have had a biopsy and the result shows that
the changes are mildly abnormal (CIN1). We will follow you with
smears done at 12 monthly intervals, usually in the colposcopy
clinic.
Practical advice
1. If you wear a skirt you will not need to take it off
2. Bring a pair of socks which you can wear to keep your feet
warm.
3. We suggest you bring someone with you as you may not feel like
driving yourself home.
4. We suggest you bring a sanitary towel or liner with you as you
will need one.
5. If your periods have finished and you have gone through the
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being given, but it works very quickly. Using electric diathermy, a
loop is used to remove the abnormal cells. In order to complete
the electrical circuit we will put a sticky pad on your leg – you may
feel this warms or tingles. As we are removing the cells you may be
aware that something is being done, but it should not be painful.
We send the piece of tissue we have removed to the lab for analysis
and will be in touch with you and your GP in 2-3 weeks with the
results and instructions for follow up.
Sometimes it is not possible to do this treatment in the clinic and it
will then be done under general anaesthetic at a later date.
The colposcopy examination takes about 10 mins. If treatment is
required this will take a little longer – on average 10 - 15 mins.
Borderline or mild abnormalities (CIN1) may be treated or left to
see if they return to normal spontaneously, as half of these mild
changes return to normal as your body clears the HPV infection.
Treatment is advised if the abnormality looks like CIN2 or CIN3,
as these changes are less likely to return to normal and are more
likely to progress, if left untreated.
Are there any risks involved with the treatment?
There is plenty of space in the car parks at the hospital, but please
leave time to park.
The abnormal smear
The cervical smear is a screening test, which is used to detect early
cervical cell abnormalities which, if left untreated, could develop
into cervical cancer in the future. Your abnormal smear result
means that you have been recommended to attend colposcopy
so that you can be examined more carefully and further tests can
be performed to check the smear test. Sometimes, depending
on the smear result, we may recommend a simple and effective
treatment to remove the abnormal area on your cervix to prevent
the development of cancer in the future.
The cervix
The cervix is the neck of the womb which
lies at the top of the vagina. It is covered
by 2 different types of cells – columnar and
squamous cells.
As with any cut/incision there is a risk of bleeding and infection.
Rarely there is heavy bleeding at the time of treatment. If this
happens you may need admission to the Women’s Health Ward.
Usually the bleeding will stop without further intervention, but
rarely examination under a general anaesthetic maybe needed.
Bleeding can also occur in the 2 weeks after treatment. This is
usually manageable but rarely may require hospital admission. It
is usually due to the treated area becoming infected. We will give
you a leaflet after your treatment about signs and symptoms to
look out for and what action to take.
Columnar cells – these are glandular cells
which line the canal leading to the womb
and come from the inside of the cervix.
During the examination we may use iodine and rarely people are
allergic to this, so please tell us if you are.
An abnormal smear test contains cells which suggest that a
pre-cancerous change is beginning to take place on the cervix.
These changes are graded from mild through moderate to severe.
An abnormal smear test does not mean there is cancer of the
cervix.
We now know that after a LLETZ there is a small risk to a future
pregnancy. In a small number of pregnancies labour may start
earlier than if you had not had the treatment. This is not normally
so early as to cause problems for your baby, but very rarely this can
happen.
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Squamous cells – these form the lining of the
vagina and the outside of the cervix.
Where these cells meet is the squamo-columnar junction (SCJ) and
it is here that the abnormal cells can develop.
What does an abnormal smear test mean?
The smear test is a screening test and, although it can give a guide
to the level of the abnormality, it is mainly a way of identifying
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women who require further investigation by colposcopy. Once
there are pre-cancer changes in the cells it would be several years
before these cells would turn into cancer cells, which is why we do
regular smear tests. There are some women whose abnormal cells
will revert to normal with no treatment, but also a very small group
whose changes progress more rapidly.
The changes we are looking for are called cervical intraepithelial
neoplasia (CIN).
Very rarely cancer is detected in a smear.
Why do smears become abnormal?
There are some factors which influence the cells on the cervix.
1. Human papilloma virus (HPV). This is a common virus infection
caused by a family of viruses. There are many different HPVs;
some cause genital warts, some warts on the skin, some abnormal
smears and some cervix cancer. The HPV that affects the cervix is
transmitted by skin-to-skin contact, for example sexual intercourse.
Anyone who has been sexually active can be infected with HPV
including same-sex relationships, and the majority of women will
have been exposed to the virus at some point in their lives (over
80%). Since there are no symptoms for HPV, most people don’t
even know they have been infected by the virus. In most women
the body’s immune system will clear up the infection over a few
months. In a minority of women the body does not effectively deal
with the virus and over time the virus can cause the cervical cells
to develop other abnormalities, leading to CIN and cervical cancer.
Over 99% of cervical cancers are thought to be caused by HPV.
Colposcopy is looking closely at the cervix using a special
microscope. We use this to magnify the skin on the cervix to see
where the abnormal cells are coming from. We use dyes (acetic acid
(weak vinegar) and iodine) to help show up the abnormal areas,
which are invisible without the dyes.
What happens at the appointment?
You will meet the colposcopist who is going to care for you.
You will be asked some questions about your previous smear
results, cervical procedures, allergies, last period, pregnancies,
contraception, the possibility of being pregnant (a pregnancy test
may be done), whether you smoke, and any medications currently
being taken and other medical conditions. You will be able to ask
questions yourself to fully understand the procedure and will be
asked if you are happy to have the procedure performed.
You will be asked to remove your underwear and to sit on the edge
of a special couch, which takes the weight of your legs during the
procedure. The colposcopist will use the light from the colposcope
to view the outside of your vagina (vulva) for abnormalities, before
inserting a speculum (instrument used for taking smear tests) so
that the cervix can be seen. The colposcope will be placed near to
the entrance of the vagina, so that the cervix can be viewed at high
magnification and the dyes applied to your cervix with cotton wool
buds. The view is shown on a video screen, so that you will be able
to see what the colposcopist is looking at, if you would like.
2. Smoking. There is strong evidence that smoking cigarettes
increases the risk of having an abnormal smear, and of preventing
the abnormality returning to normal, as it affects the body’s ability
to clear up the HPV.
Depending on your smear, your preferences and the appearance at
colposcopy, the colposcopist may decide to take biopsies to guide
further treatment, or suggest that treatment is performed, either
at the first visit or bring you back for this to be done in a few
weeks.
How is an abnormal smear investigated?
1. Biopsies: a small piece of tissue (about the size of a grain of rice)
is taken from the cervix and sent to the lab for further analysis.
The next step is colposcopy and you have been sent this
appointment.
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What is colposcopy?
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2. Treatment: this can either be done at the first visit or after a
biopsy. The treatment we routinely use in our clinic is called a large
loop excision of the transformation zone (LLETZ). Local anaesthetic
is used to numb the cervix. This can be a little uncomfortable while
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