How cervical cancer is diagnosed
Usually you begin by seeing your family doctor (GP), who will examine you and refer you to the hospital for any necessary tests and for specialist gynaecological advice and treatment.
If your GP suspects you may have cancer, you should be seen at the hospital within 14 days.
A colposcopy can be carried out by a specialist doctor or a nurse colposcopist and is usually done in a hospital outpatient clinic.
In a colposcopy, a specially adapted type of microscope with a light, called a colposcope, is used to show the cervix in detail. It acts like a magnifying glass so that the nurse or doctor can make a thorough examination of the abnormal cells of the cervix. The test takes about 15-20 minutes.
Before your test you’ll be helped to position yourself on a specially designed chair or examination table. In the same way as when you had the screening test, the nurse or doctor will use a speculum to hold the vagina open. The doctor or nurse may first repeat the screening test. The cervix is then painted with a liquid to make the abnormal areas show up more clearly. A light is shone onto the cervix and the nurse or doctor looks through the colposcope to examine the area in detail.
A small sample of surface cells (a biopsy) will be taken from the cervix and examined under a microscope by a pathologist in the laboratory. It may be slightly painful when the biopsy is taken, and for a short time afterwards. Taking a mild painkiller can help with this. Having a biopsy may also cause a bit of light bleeding for a few days afterwards.
Large loop excision of the transformation zone
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If the abnormal area can’t be seen properly with a colposcope, you may have a LLETZ procedure. Sometimes the LLETZ may be done during your colposcopy appointment.
Abnormal cells are most likely to develop in an area of the cervix known as the transformation zone. A LLETZ is a common procedure that removes the abnormal cells.
Having a LLETZ normally takes about 5-10 minutes. It’s usually done under a local anaesthetic as an outpatient at the hospital.
Once you’re in a comfortable position, the doctor will put some local anaesthetic onto your cervix to numb it. The doctor uses a colposcope to see a magnified image of your cervix. A thin wire, which is shaped in a loop, is then used to cut away the affected area. The procedure may feel uncomfortable and it’s usual to have slight bleeding or discharge, which can last for a few weeks after this treatment. You may be asked not to use tampons or have sex for a month afterwards.
Needle excision of the transformation zone (NETZ)
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This is similar to a LLETZ, except that the thin wire used to cut away the affected area is straight, rather than in a loop. The straight wire acts like a knife and enables the doctor to cut away the precise area of affected tissue.
Sometimes a procedure known as a cone biopsy may be used if the abnormal area in the cervix can’t be seen with a colposcope.
A cone biopsy is usually done under a general anaesthetic, although a local anaesthetic may sometimes be used. You may need to stay in hospital overnight.
A small, cone-shaped section of the cervix is removed, which is large enough to contain the abnormal cells.
If there’s only a very small growth of cancer cells (known as a microinvasive cancer), the cone biopsy may remove it all so that no further treatment is needed. Even if the cone biopsy doesn’t remove all the cancer cells, it’s still useful, as it will help the doctors decide on the right type of treatment for you.
After a cone biopsy a gauze pack, which is like a tampon, may be placed in your vagina to prevent bleeding. This is usually removed within 24 hours, before you go home.
You may also have a thin tube, called a catheter, put into your bladder so that you can pass urine while the gauze pack is in place. It’s normal to have some light bleeding for a few weeks after a cone biopsy. Strenuous physical activity and sex should be avoided for four weeks to allow the cervix to heal.
It may take some time for you to get the results of these tests. You could ask your gynaecologist about when and how you’ll be told about whether you need more tests or treatment. It’s a difficult time for most women and you may need support from family, friends or support organisations while you’re waiting for your results.