Treatment for CIN (cervical intra-epithelial neoplasia)

Transcription

1 Treatment for CIN (cervical intra-epithelial neoplasia) This information is an extract from the booklet Understanding CIN (cervical intra-epithelial neoplasia). You may find the full booklet helpful. We can send you a free copy see page 8. Contents Treating CIN Treatment types Your feelings After treatment Follow-up Treating CIN CIN 1 Often, cells showing CIN 1 will return to normal without any treatment at all. If your colposcopist decides not to treat these minor changes, they will arrange for you to have further screening tests or colposcopy, or both. A colposcopy shows the cervix in detail using a type of microscope called a colposcope. It acts like a magnifying glass, so that the person doing the examination can see the whole cervix clearly. Having these tests makes sure that any further changes are found quickly. CIN 2 and 3 Most doctors and researchers agree that CIN 2 and 3 should be treated. The aim of treatment is to remove the abnormal area, while causing as little damage as possible to surrounding healthy tissue. It s also possible to destroy the abnormal cells, rather than remove them, although this isn t commonly done. Questions about cancer? Ask Macmillan Page 1 of 8

2 Ways of removing the abnormal area include: large loop excision of the transformation zone (LLETZ) (see page 3), which is currently the most commonly used method of treatment a cone biopsy (see page 3) a hysterectomy or trachelectomy, although this is rare (see page 5). Ways of destroying the cells in the abnormal area so that normal cells can grow back in their place (see page 4) include: laser therapy cold coagulation cryotherapy. How treatments are given Most women only need one of the treatments described on the next few pages. All of the treatments are usually very effective at removing the abnormal cells. The type of treatment you have will depend on a number of factors. These include: the facilities available at your local hospital the type of treatment that your doctor thinks is best for you. It may be possible for the treatment to be done at the same time as your initial colposcopy appointment, or you may have to come back at a later date. LLETZ, laser therapy, cryotherapy, cold coagulation and sometimes cone biopsies are usually done in a hospital outpatient clinic using a local anaesthetic. This means that you can go home after treatment. It can be helpful for someone to come with you while you re having treatment or pick you up afterwards. Don t be afraid to ask the colposcopist any questions about your treatment. Before your treatment, the nurse will help you lie comfortably on the couch. The colposcopist will then use a speculum so that they can see your cervix. Try to relax as much as possible. The treatment itself is likely to take around 5 10 minutes. It may be uncomfortable but it isn t painful. Page 2 of 8 Questions about cancer? Ask Macmillan

3 Treatment types Large loop excision of the transformation zone (LLETZ) LLETZ is the most commonly used treatment for removing abnormal cells from the cervix. It s sometimes called LEEP (loop electrosurgical excision procedure). It takes about 5 10 minutes and is usually done under local anaesthetic as an outpatient procedure. Sometimes, if a larger area of the cervix is treated, you may need a general anaesthetic. Once you re in a comfortable position, the colposcopist will put some local anaesthetic into your cervix to numb it. The colposcope helps them to see a magnified image of your cervix. They remove the abnormal tissue using a thin wire loop. The loop is heated with an electric current, which cuts and seals the tissue at the same time. This shouldn t cause any pain although you may feel some pressure inside your cervix. The tissue will be sent off to a laboratory to be checked and to confirm the type of abnormal cell changes. Depending on the result, your colposcopist will decide whether you need to be followed up either at the colposcopy clinic or with your GP. LLETZ is not usually painful. You may feel a period-like pain or a burning sensation. After the treatment, you may have some light bleeding or discharge. This can last for around four weeks. Your doctor or nurse will give you more information about what to expect after your treatment. Cone biopsy This is another treatment for CIN that involves removing abnormal tissue from the cervix. A cone biopsy is usually carried out under a general anaesthetic, but sometimes a local anaesthetic may be given. The doctor uses a scalpel (a sharp tool) to take a small, cone-shaped piece of tissue from the cervix, which will be examined under a microscope. Afterwards, a small pack of gauze (like a tampon) may be put into the vagina to prevent bleeding. This is usually removed within 24 hours before you go home. Some women may also have a tube (catheter) put into the bladder to drain urine while the gauze pack is in place. Questions about cancer? Ask Macmillan Page 3 of 8

4 It s normal to have some light bleeding and discharge for around four weeks. You should avoid any sex and strenuous exercise for at least four weeks to allow the cervix to heal properly. Sex after LLETZ or a cone biopsy Having a LLETZ or a cone biopsy will not affect your ability to enjoy sex once your cervix has healed. You should avoid sex, swimming, tampons and baths until the cervix has healed and any bleeding has stopped. Your colposcopist will give you more information about this. Fertility after LLETZ or a cone biopsy Very rarely, the cervix can become tightly closed after treatment. This is known as stenosis. It can make it harder for the sperm to enter the womb and so can affect your chances of becoming pregnant naturally. Your cervix is not completely closed if you re still bleeding during your periods. Pregnancy after LLETZ or a cone biopsy Sometimes treatment can make the cervix slightly weaker. This is unlikely with a single treatment. But if you need more than one treatment, the cervix may weaken. Very rarely, this may mean that towards the end of a pregnancy, when the baby is bigger, the weakened cervix may start to open early causing a premature birth. To stop this happening, a stitch may be put into the remaining part of the cervix during pregnancy. The stitch is removed before you go into labour. Your doctor will discuss this with you if you re concerned about future pregnancies. Laser therapy or laser ablation Under local anaesthetic, a laser beam is directed at the abnormal areas of your cervix and the cells are destroyed. During the treatment, you may notice a slight burning smell from the laser. This is normal. Cold coagulation This is a misleading name as the abnormal cells are removed by heating, not cooling. Firstly, a local anaesthetic is given to numb your cervix. Then a hot probe is placed onto its surface to destroy the abnormal cells. Page 4 of 8 Questions about cancer? Ask Macmillan

5 Cryotherapy You may be given a local anaesthetic, and a probe will be put on your cervix to freeze the abnormal cells. Cryotherapy has a slightly lower success rate than the other treatments for CIN, so it is not often used. Hysterectomy or trachelectomy These types of surgery are rarely needed for CIN. Hysterectomy This is an operation to remove the womb and cervix. It is sometimes done for recurrent, persistent or high-grade CIN if you have other gynaecological problems. You will usually have a hysterectomy if you are past childbearing age, or don t want to have more children. Your doctor may discuss with you whether to remove your ovaries during the surgery. Removing the ovaries will cause an early menopause if you haven t had the menopause already. We can send you more information on having a hysterectomy. Trachelectomy It s sometimes possible with a very early cancer to have an operation where the cervix is removed and the womb is left in place. This is called a trachelectomy. Because the womb is left in place, you can still become pregnant after this operation. A trachelectomy is mainly carried out in younger women with cervical cancer who still want to have children. Your doctor will be able to give you more information about whether this type of surgery is suitable for you. Your feelings Embarrassment You may find the treatments for CIN embarrassing and possibly frightening. Don t be afraid to ask your doctor or nurse as many questions as you like, as this may help to put your mind at rest. Questions about cancer? Ask Macmillan Page 5 of 8

6 After treatment Unless you ve had a hysterectomy, trachelectomy, or possibly a LLETZ or cone biopsy under a general anaesthetic, you ll be able to go home on the day that you re treated. Most women feel fine after treatment to the cervix with a local anaesthetic, but some women feel slightly unwell for a few hours. It s a good idea to have the day off work, in case you need to go home and rest. You may find it helps to bring a relative or friend to support you and drive you home. If you had treatment under local anaesthetic, you may have some period-like pains for the rest of the day once the anaesthetic has worn off. You should expect to have some bleeding or discharge after treatment. This usually stops within four weeks but may last up to six weeks. The bleeding shouldn t be heavier than a moderate period and should get steadily lighter. You should contact your GP or the clinic where you had your treatment if: the bleeding starts to get heavier for example, completely soaking a pad within two hours the discharge starts to smell unpleasant, which can mean that you have an infection you develop a temperature you have severe pain you have any other concerns. Your doctor or nurse will probably advise you not to have sex for at least four weeks after your treatment to allow the cervix to heal properly. You may also be advised not to use tampons for four weeks. You should feel completely back to normal within six weeks. Research has shown that treatments for CIN are usually very successful. Although most women will have no further problems and the CIN will not come back, all women still need to continue with regular cervical screening tests. Page 6 of 8 Questions about cancer? Ask Macmillan

7 Follow-up If you have no treatment If your colposcopy shows you have CIN 1 and your colposcopist decides not to treat these minor changes, you ll usually have a repeat screening test or colposcopy after six or twelve months. This is to make sure that the minor changes have gone and that no more cell changes develop. If you have treatment You ll be invited to have a follow-up screening test six months after your treatment. This is to make sure that the treatment has been successful and that the abnormal cells haven t come back. Moderate or severe cell changes If your follow-up screening test shows that abnormal cells have come back, and you have moderate or severe cell changes, you ll be referred for another colposcopy. Normal, borderline or mild cell changes If your follow-up screening test shows that you have normal, borderline or mild cell changes, what happens next depends on whether HPV testing is carried out where you live. If HPV testing isn t available where you live After your follow-up screening test, you ll usually have a further screening test 12 months after treatment. If both these tests are normal, you may continue with yearly screening tests for a period of time and then go back to routine tests every 3 5 years (depending on your age). If any of your tests show abnormal cells, you ll be referred back to the colposcopy clinic. If HPV testing is available where you live Your sample from your follow-up screening test will be checked to see if the HPV infection has gone. If high-risk HPV is found, you ll be referred for another colposcopy. If it isn t, you ll be screened again in three years time. Treating abnormal cells that come back Most treatment for CIN is very successful. But for some women the abnormal cells can come back. If this happens, you ll be invited for another colposcopy and further treatment if necessary. Questions about cancer? Ask Macmillan Page 7 of 8

8 Very occasionally, if the abnormal cells continue to come back after treatment, some women are advised to have a hysterectomy or trachelectomy to prevent them from developing cervical cancer. A hysterectomy is an operation to remove the womb and cervix and a trachelectomy is where the cervix is removed and the womb is left in place. These types of surgery are rarely needed for CIN. Your doctor will discuss the most suitable treatment options with you. We have more information on these treatments. Even if you ve had a hysterectomy, you may still need to have a few more smear tests. The sample of cells will be taken from the top of the vagina. This is sometimes called a vaginal vault smear. Your GP or gynaecologist can organise this for you, as vault smears aren t done as part of the NHS Cervical Screening Programmes. More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding CIN (cervical intraepithelial neoplasia) or any other cancer information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN MAY 2015 Planned review in 2017 Page 8 of 8 Questions about cancer? Ask Macmillan