Tests and Procedures for Cervical Cancers
If there was no such thing as cervical cancer there would be no need to get pap smears. Pap smears look for HINTS of cervical cancer. A pap smear CAN NOT prove that there are abnormal cells on the cervix. The “proof” comes from a biopsy of the cervix. We use colposcopy to find exactly where to biopsy the cervix. What to do is based on the biopsy result, and may be influenced by the pap smear result, too.
The biopsy is graded just like a pap smear. The system to grade the biopsy is a little different from the pap smear, Bethesda grading system. There is NO “½” in the biopsy grading, so NO Ascus in the biopsies. Level 2 and 3 cells must be removed. These are called CIN II and CIN III. CIN is cervical intraepithelial neoplasia, and simply means abnormal cell on the cervix. Level 1 cells, CIN I, can be left alone, unless there were level 2 or 3 cells on the pap smear (HGSIL – High Grade Squamous Intraepithelial Lesion). A diagnosis of cancer on cervical biopsy will lead us to an entirely different discussion.
There are certain cells which MUST be removed from the cervix before they turn into cancer. These cells include HGSIL pap smear cells, CIN II and CIN III biopsy cells. If we find any of these cells then we must consider a LEEP or CONE procedure. There are Two reasons to remove these cells: to get them out of you before they become cancer, AND to look at them more closely under the microscope to make sure there is no cancer there, already.
This is done in the office, with local anesthesia. It is basically the same experience as the pap smear. It takes just about a long. First a speculum is placed, then numbing medicine is injected into the cervix. Using electricity to cut, we remove the area of abnormal cells on the surface of the cervix. The electricity cuts AND stops bleeding. This is why we can do it in the office. [The cone procedure does not use electricity, and it is done in the hospital in an operating room with anesthesia.] You can expect some cramping after the procedure. You will usually be prescribe narcotic pain medicine, just in case you need it.
LEEP Procedure and Future Pregnancy
Women have a higher chance of early labor if they have Two procedures to the cervix. By procedure I mean LEEP or CONE or CRYO/freezing. One procedure has NOT been associated with pregnancy complications. In women planning for a family I discourage treating level 1/ CIN I cells of the cervix.
LEEP Test Results
The tissue is examined under the microscope after removal. The results may be:
- Cancer – this is rare, and serious, and we will talk about this only if necessary. There can be “a little” cancer OR “a lot” of cancer. The discussion depends upon what is found.
- Abnormal cells found, and none left behind – I recommend (based on the ASCCP guidelines) that you get pap smears every six months until you have three normal pap smears in a row.
- No abnormal cells found – this is JUST LIKE “none left behind.”
- Abnormal cells found, and there may be some cells left behind – the recommendations for this situation depend upon your age, how abnormal the cells are, and whether you are planning to get pregnant in the future.
The most common next step after a LEEP procedure is to get a pap smear in six months. It is Really Important to get a follow-up pap smear, after the LEEP procedure.