Cervical abnormalities

Cervical abnormalities, often called abnormal cervical cells, means that some of the cells covering your cervix (the neck of your womb) have changed and are not quite normal. These changes are not cancer, though a small number of cases can develop into cervical cancer if they're left untreated.

What are cervical abnormalities?

Cervical abnormalities, often called abnormal cervical cells, means that some of the cells covering your cervix (the neck of your womb) have changed and are not quite normal. These changes are not cancer, though a small number of cases can develop into cervical cancer if they're left untreated.

What causes cervical abnormalities?

Cervical abnormalities are caused by certain high-risk types of human papillomavirus (HPV), a very common virus. Your immune system usually clears HPV without you ever knowing you had it, but in some people, the virus stays in the body and causes changes to the cells of the cervix over time.

Cervical screening first tests your sample for high-risk HPV. If HPV is found, the same sample is then checked under a microscope for cell changes, in a test called cytology.

Are there different types of cervical abnormalities?

Yes. Your results letter may describe your cell changes as low-grade or high-grade dyskaryosis, or as borderline changes.

• Low-grade dyskaryosis: Mild changes to the cells
• High-grade dyskaryosis: Moderate or severe changes to the cells
• Borderline changes: Slight changes to the cells (less than mild changes).

If a biopsy is taken during a colposcopy, this may show cervical intraepithelial neoplasia (CIN): a term for changes to the cells on the outer surface of the cervix. 'Intraepithelial' means the changed cells are only on the surface layer and have not grown any deeper, and 'neoplasia' means abnormal cell growth. CIN is graded by how much of the thickness of that surface layer is affected:

• CIN 1 (low grade): Up to one third of the thickness of the lining is affected, and this often returns to normal on its own
• CIN 2 (high grade): Up to two thirds of the thickness is affected
• CIN 3 (high grade): The full thickness of the lining is affected.

A less common finding is CGIN (cervical glandular intraepithelial neoplasia), which affects the glandular cells lining the inside of the cervix rather than the outer surface. Left untreated, CGIN could develop into a type of cervical cancer called adenocarcinoma, so it's treated in a similar way to CIN.

How are cervical abnormalities diagnosed?

If your screening sample tests positive for HPV, a specialist checks the cells under a microscope. If your cell check is normal, you'll usually be invited back for another screening test in a year. If they look abnormal, you'll usually be referred for a closer examination of your cervix, called a colposcopy.

This is what happens during a colposcopy:

1. You undress from the waist down, behind a screen, and lie back with your knees bent and resting on supports
2. A smooth, tube-shaped tool called a speculum is gently put into your vagina so the specialist can see your cervix
3. A microscope with a light is used to look closely at your cervix. It stays outside your body throughout
4. A liquid is put onto your cervix to show up any abnormal areas
5. A small sample of cells (a biopsy) may be taken and sent to a laboratory.

A colposcopy takes around 15–30 minutes. It should not be painful, though you may find it uncomfortable, and you may have some light bleeding or cramping afterwards if you have a biopsy. It can take several weeks to get your results, sent by post or given to you at the hospital.

How are cervical abnormalities treated?

Whether you need treatment depends on your grade of cell changes. Low-grade changes (CIN 1) often go back to normal by themselves and may just be monitored with repeat tests, while high-grade changes (CIN 2 and CIN 3) are usually treated to remove or destroy the abnormal cells.

• LLETZ (large loop excision of the transformation zone): A thin, loop-shaped tool removes the abnormal cells; the tissue removed can be checked in a laboratory
• Cone biopsy: A small operation to remove an area of the cervix
• Laser therapy: A laser beam burns away the abnormal cells, usually under general anaesthetic
• Cold coagulation: Despite the name, this uses a heated probe with local anaesthetic to burn away the abnormal cells
• Cryotherapy: A probe freezes away the abnormal cells, sometimes with local anaesthetic
• Hysterectomy: This is removal of the womb and cervix, which is rarely used, and not a routine treatment for abnormal cells alone.

Most people only need one treatment session to remove the abnormal cells completely. Afterwards, you may have period-like pain and some bleeding or discharge for up to 4–6 weeks, and you'll usually be advised to avoid penetrative sex, tampons and swimming for 4 weeks while your cervix heals.

When should you see a doctor?

You don't need to do anything between cervical screening tests, but you should see your GP if you get any new symptoms such as:

• unexpected bleeding between your periods or any bleeding after intercourse
• heavier bleeding – for example, if it completely soaks a pad within 2 hours
• discharge with an unpleasant smell
• a fever or a high temperature
• severe pain.