By Associate Professor Jeffrey Low, Division of Gynaecologic Oncology,
National University Cancer Institute, Singapore (NCIS)
Q1. Your Pap smear is Abnormal and you have been referred for Colposcopy. What does this mean?
An abnormal PAP smear does not necessarily mean that you have cancer. The Pap smear test detects changes in the cells of the cervix. Such changes include pre-cancerous, cancerous and other non-cancer related changes. Early detection of these changes is important, as treatment is most effective when instituted early. Pre-cancerous changes can be completely cured with early detection and treatment. The most common way to investigate an abnormal Pap smear is using Colposocopy.
Q2. What is Colposcopy?
A colposcope is an instrument that magnifies the view of the cervix. Colposcopy allows the doctor to examine the cervix to see where the cell changes are and to assess the extent of the changes. He will then decide if treatment is necessary, and if so, the most suitable type of treatment.
During the procedure, the colposcope is positioned a short distance away from the vagina. A speculum is inserted into the vagina (just as it is done in the Pap smear test) to hold the walls of the vagina slightly apart. After this, a very mild acetic solution is applied onto the cervix to help visualize any abnormal cells. This should not hurt, although a stinging sensation may be felt. During the examination, the doctor may take a tiny sample (biopsy) of the abnormal area for analysis in the laboratory. This will determine if there is any abnormality.
The colposcopy will take about 10 minutes. This examination will provide your doctor with information that will better allow your doctor to explain and discuss your Pap smear results. If a biopsy has been taken, you will be given another appointment in two to three weeks' time to review the results and discuss the treatment.
Q3. What Treatments are available?
There are several methods of treating pre-cancerous changes in the cervix, including
- Laser Vaporization
- Cold coagulation
- LEEP (Loop Electro-surgical Excision Procedure)
- Cone Biopsy
These procedures may be performed under a local anaesthetic in the Colposcopy Room on an outpatient basis. However, in some instances, it may be necessary to perform the procedure under a general anaesthetic and admission to the hospital may be required..
Laser Vaporization
A laser beam is used to destroy the abnormal cells on the cervix. The treatment is very effective and the healing is excellent.
LEEP
A fine wire loop with an electrical current passing through it is used to excise the abnormal area on the cervix. The excised portion is then sent to the laboratory for examination.
Cone Biopsy
The cone biopsy is a minor operation where a piece of the cervix, including the abnormal cells, is removed using a laser, surgical blade or by electrosurgery. It is usually recommended when:
- The abnormal area extends into the endocervical canal, which is the canal that leads from the vagina through the cervix into the uterus.
- The Pap smear test repeatedly shows abnormal cells but the colposcopy result is normal. This may mean that the abnormal cells are from the endocervical canal.
- The doctor is concerned that the abnormal cells have actually formed a very early cancer.
The biopsy specimen will be sent for pathological examination to confirm the diagnosis and to ensure that all the abnormal cells have been removed.
Q4. How will I feel after the procedure?
There is usually very little discomfort after the procedure. A brown-coloured paste (Monsell's solution) may be used to stop any bleeding. Thus you can expect some spotting or brownish discharge for a few days. You may also experience very mild abdominal cramps (like period pains). Take a mild painkiller, such as Panadol, to relieve it. The treated area will take a few weeks to heal. Your subsequent period may be a little heavier than usual. However, if the bleeding is very heavy, please contact your doctor or the clinic. After office hours, please proceed to the Emergency Department. Avoid sexual intercourse for about 2 weeks.
Q5. What about Follow-Up?
After treatment, follow-up appointments are necessary to ensure that all the abnormal areas have been treated and the cervix has healed well. Your doctor will advise you on the results of your treatment. To ensure that you remain well, regular follow-up is needed.
Q7. What if I am Pregnant?
If you are pregnant at the time when the abnormal Pap smear is found, a colposcopy can be performed without affecting the foetus. The abnormal cells will not harm the foetus and the area will be checked at regular intervals during your pregnancy. Treatment will be recommended if the abnormal cells are still present after you have had your baby.
Should you become pregnant while waiting for treatment, it is important to let your doctor know about it. Treatment of the abnormal cells by laser, diathermy or cone biopsy is usually not done while you are pregnant.
If you have further questions, please consult your doctor.
