FURTHER INVESTIGATION AND TREATMENT

Dysplastic changes. The smear test is a screening test. It gives an idea of what is likely to be going on at the cervix, but does not give a definitive diagnosis. It can’t, and no one expects it to. It is, however, good as a screening procedure, with a high rate of accuracy and low rate of failures.

The actual diagnosis of a cancerous or pre-cancerous change of the cervical cells requires another technique. A biopsy (a small piece of cervical tissue rather than a smear of cells) must be examined under the microscope to determine the extent of the problem. In general, all women whose smear tests show any degree of dysplasia will be referred for further investigation.

Having a biopsy taken from your cervix involves a procedure called a ‘colposcopy’. A gynaecologist can use a specialised magnifying instrument to examine the cervix more closely. You need to have a speculum inserted, as for a smear, but often the examination will take place on a chair-type couch designed especially for gynaecological examinations. There can be a little brief ‘stinging’ feeling when the biopsies are actually taken, but in general this is short lived and not too painful. The specimens are examined by pathologists to find out what degree of dysplasia there is, and how much of the cervix it affects. The treatment depends on the results. If treatment is required, it will usually be done on a subsequent visit.

To treat dysplasia one of two different techniques may be used, but they effectively do the same thing: they destroy the abnormal cells. Laser (a special light ray which destroys tissue) and diathermy (burning via an electric needle) both sound like pretty gruesome procedures. They are performed under anaesthetic, which may be general (the patient is asleep) or local (the cervix is made numb by an injection, like the gums are at the dentist). The abnormal tissue is replaced by

healthy tissue in a few weeks as new cells grow. A check up is performed using the colposcope to make sure everything is normal, usually three to six months after treatment. Depending on the degree of abnormality and the effectiveness of the treatment, further colposcopies and more regular smears are likely to be recommended, to closely monitor the cervix. This is because women who have had dysplasia appear to be at greater risk of developing a recurrence, and regular checking can prevent this developing into cancer. Fortunately, it usually works.

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