Cervical dysplasia (CIN): abnormal cervical cells, colposcopy and treatment

The NHS says that abnormal cervical cells found at screening are often caused by human papillomavirus (HPV), that the cells are not cancer, and that there is a risk they could eventually turn into cervical cancer if not treated. Doctors use the terms cervical intra-epithelial neoplasia (CIN) and cervical glandular intra-epithelial neoplasia (CGIN), and give abnormal cells a grade: the higher the grade, the more likely it is that the cells will grow and spread.

Cancer Research UK explains that cervical screening is not a test for cancer but a test for HPV, and that if HPV is found further tests look for abnormal cervical cells, which might develop into cancer if left untreated.

According to the NHS, an HPV-negative result means your risk of cervical cancer is very low and you do not need further tests to check for abnormal cell changes, even if you have had them before; you are invited again in 5 years. An unclear (inadequate) result means being asked to repeat the test in 3 months. If HPV is found but there are no abnormal cell changes, you are invited for screening in 1 year and again a year later if you still have HPV, and are asked to have a colposcopy if you still have HPV after 2 years. If HPV and abnormal cell changes are found, you are asked to have a colposcopy.

The NHS adds that a positive HPV result does not mean your partner has had sex with someone else, and you may have HPV even if you have not been sexually active or had a new partner for many years. It also says changes to your cells will not get worse while you wait for a colposcopy appointment, and that you may have to wait up to 6 weeks.

The NHS pages on screening and colposcopy do not describe typical symptoms of abnormal cells, and the usual route to diagnosis is a screening result rather than symptoms. Symptoms such as bleeding between periods, during or after sex, or after menopause, or unusual discharge, are not something to wait for the next screening to report: the NHS says to see a GP without waiting for the next appointment, because they can be symptoms of cervical cancer.

The NHS describes colposcopy as a test to take a closer look at the cervix, usually carried out at a colposcopy unit in a hospital or clinic by a specially trained nurse or sometimes a doctor, taking around 15 to 20 minutes. You undress from the waist down behind a screen, lie back with your legs on a padded support, and a speculum is placed in the vagina so a microscope with a light (the colposcope, which stays outside) can be used to look at the cervix. A liquid is applied to show abnormal cells, which may cause mild tingling or stinging, and a pin-head sized tissue sample (biopsy) may be taken, which may feel like a mild pinch.

It can feel uncomfortable and some people find it painful, and you can ask to stop at any time. The NHS says it is fine to have a colposcopy during your period, that it is safe in pregnancy but you must tell the unit, and that you can ask for a chaperone or interpreter. For 24 hours before, avoid penetrative sex and anything placed in the vagina such as tampons, creams or medicines; with a coil, avoid sex or use a barrier method for the 7 days beforehand, since the coil sometimes needs removing.

If you had a biopsy you may wait 4 to 8 weeks for results. The NHS table of grades is below. A normal biopsy means you are invited for screening in 3 or 5 years depending on your age.

The NHS says abnormal cells are most often removed with large loop excision of the transformation zone (LLETZ), often at the same time as the colposcopy. You have a local anaesthetic injection to numb the cervix, a heated wire loop removes an area of tissue about the size of a fingernail, the procedure takes around 15 minutes and you go home the same day. If a larger piece of tissue needs to come out, a cone biopsy removes a cone-shaped section of the cervix, done under general anaesthetic with a possible overnight stay, at a follow-up appointment. Removing abnormal cells reduces the risk of cervical cancer.

The NHS says you may have mild period-type pain for a few days, for which paracetamol can help, and some bleeding and discharge. After only a colposcopy this may pass after a few days; after a biopsy or LLETZ it can last longer, up to 4 weeks after LLETZ. Avoid penetrative sex and anything inside the vagina (you may be told to avoid sex for 4 weeks after LLETZ), use pads rather than tampons or menstrual cups, and avoid vigorous exercise that makes you breathe hard and fast.

Contact a GP or call NHS 111 if you have heavy bleeding more than you would expect during a heavy period, unpleasant smelly discharge, or stomach pain that does not improve with painkillers or keeps coming back. In rare cases colposcopy and biopsy find cervical cancer, and you are then referred to a specialist team.

The NHS says the HPV vaccine reduces the chance of getting HPV and is offered to all children aged 12 to 13, with catch-up for those who missed it, such as girls aged 24 and under, and boys born after 1 September 2006 until their 25th birthday. It is usually one dose under 25, and the vaccine is given as an injection into the arm. The NHS says screening and vaccination together are the best protection, and quitting smoking can also lower the risk of cervical cancer.