Colposcopy Examination One Stops Patient Information Sheet Why do I need a Colposcopy examination at the one stop clinic? You have been asked to come for a Colposcopy examination because your cervical screening test (smear) has shown evidence of abnormal cells. An abnormal result is not unusual and happens in about 7-10% of cases (Cervical Screening Programme 2010-11). An abnormal result usually means that small changes have been found in the cells on your cervix (the neck of your womb). These abnormal changes are known as dyskaryosis and act as early warning signs that cancer might develop in the future. They are usually caused by HPV (human papilloma virus). It is important to remember that it is rare for these abnormalities to be cancer. At the Northern Gynaecological Oncology Centre we have a one stop clinic which allows women with low grade cervical screening test result to have their examination, diagnostic biopsy and if needed treatment biopsy on the same day. The examination you will have is called Colposcopy. It is quick, simple and generally painless and allows the doctor to decide if you need treatment. For some women the small changes in the cervical cells return to normal by themselves. Other women will need a quick outpatient treatment that is virtually 100% effective. What is Colposcopy? Colposcopy is a simple examination that allows the doctor to see your cervix and helps to identify any area on your cervix which may be abnormal. It also lets the doctor decide if you need treatment. It is safe to do a Colposcopy examination during pregnancy, however, if the doctor thinks you need treatment this will not be done until several weeks after your baby has been delivered. At the Northern Gynaecological Oncology Centre we have two ways of performing Colposcopy. One method uses a conventional colposcope and is really just a large magnifying glass which lets the doctor look more closely at changes on your cervix. The other kind of colposcope is known as DySIS. This produces an image of your cervix on a screen using different colours. Any changes will be identified by the colours shown. Is there anything I can do to prepare? You have been given an appointment at our one stop clinic. This means you have an appointment in the morning for the Colposcopy examination and will be able to come back in the afternoon to receive results
of any biopsy which may be taken during that examination. You will also be offered the opportunity to have treatment if your biopsy result indicates you would benefit from treatment. There will be about 4 hours between the morning and afternoon appointments. You are welcome to wait in the coffee/tea bar during this time so may wish to bring a book/magazine/ipod with you. Alternatively you are free to leave the hospital. If you are unable to return for the afternoon you will be able to ring the Colposcopy clinic for your biopsy result. If a treatment is required an appointment will be sent out to for you to attend at a later date for the procedure. You are welcome to bring a friend or relative with you to the Colposcopy clinic and they can also stay with you during your examination if you wish. If your appointment date is on a day when you are on a period and your period is heavy you may need to change your appointment. Please ring the clinic in advance to ask for advice. You may wish to wear a full skirt to avoid removing all of your lower clothing during the examination. If you take medication to thin your blood (anticoagulants) such as warfarin and Clopidogrel, please contact the Colposcopy clinic for advice. You can eat and drink as normal prior to your appointment. You may have a slight discharge after the examination so may want to bring a sanitary towel just in case. What happens before the examination? Before your Colposcopy the doctor will explain what your cytology sample (smear) result means and what will happen during your examination. The doctor will also want to ask you some questions about your periods, what type of contraception you use, your family and if you have had any illnesses or operations in the past. If you have any hip problems or recent hip surgeries please inform the doctor/nurse at your appointment. You will then be guided to a screened area where you will be asked to undress from the waist downwards (though a full skirt need not be removed). What happens during the examination? The Colposcopy nurse will help you to position yourself on a special type of couch. The couch has padded supports on which you rest your legs. When you are comfortably positioned the doctor will gently insert a speculum into your vagina, just like when you had your cervical screening test (smear). The doctor will then look at your cervix using either the conventional colposcope or DySIS colposcope. The doctor will then apply different liquids onto your cervix which help to identify any areas of abnormal cells. Any abnormal areas will appear white. If any abnormal areas are identified the doctor will want to take a small sample of tissue a punch biopsy- from this area.
The punch biopsy will be about the size of a small freckle. You may feel a slight stinging but it should not be painful. Once the punch biopsy has been taken the doctor will stop any bleeding from that area by either applying a small stick with a chemical on the end which helps to stop bleeding or by applying pressure with a piece of gauze. What happens after the examination? After you have dressed the doctor will discuss what your examination showed. If you did not have a biopsy the doctor will discuss what will happen next and will answer any questions you may have. It you did have a biopsy the doctor will tell you what they think the biopsy result will show. You may have a light blood stained discharge for a few days. This is normal and it should clear by it s self. However it is best to avoid using tampons and to refrain from intercourse for up to five days to allow the biopsy site to heal. You will also be given a contact number should you have any concerns when you are at home and advised what time to return to clinic for your results (usually 01:45 pm) You should feel well enough to continue with your usual routine after your examination. What will my punch biopsy result show? Your punch biopsy result will show how abnormal the area is and will indicate if treatment is needed. The technical term used to refer to abnormal cell changes on the cervix is called cervical intra- epithelial neoplasia, CIN for short. In order to make distinctions between the various stages of abnormality doctors have developed a scale from 1 to 3 according to how many cells are affected. CIN 1 means that only a third of the cells in the abnormal area are affected. These may be left to return to normal and so you would not usually have treatment if your biopsy showed CIN 1. CIN 2 means that up to two thirds of the cells in the abnormal area are affected. We will usually offer you treatment if your punch biopsy shows CIN 2. CIN 3 means that all the cells in the abnormal area are affected and we will advise you to have treatment if your punch biopsy shows CIN 3. Only very rarely will a biopsy show cell changes that have already developed into a cancer. Surgery and more extensive treatments are generally used to treat cervical cancer. What will happen when I return for my results? If your biopsy has shown CIN 1 we are usually able to discharge you from Colposcopy clinic. We will advise you when to have your next cervical sample taken and this can usually be taken at your GP practice. If your biopsy has shown CIN 2 or CIN 3 you will most likely be offered treatment. There are several equally effective ways of treating CIN 2 or 3. At the Northern Gynaecological Oncology Centre we treat women by performing a Loop biopsy, also known as LLETZ. This allows us to remove the cells affected by the virus whilst causing minimal disruption to surrounding normal tissue. It is a procedure which can be easily carried out in the outpatient setting under local anaesthetic. It also has the advantage of allowing us to send a tissue sample to the pathology lab so they can confirm the stage of CIN and if all of the affected area has been removed.
Treatment is nearly always 100% effective and it is unlikely that CIN will recur. Other Colposcopy clinics may use other methods of treatment such as laser treatment but this does not allow for a sample to be sent to pathology. If you do need treatment this may be performed using either the standard machine or the DySIS. Performing a treatment biopsy using the DySIS is relatively new but only differs from the conventional procedure in that modified instruments are used to perform the biopsy. We are currently working with the DySIS company to help them further develop these modified instruments. You may be asked if you will be happy to have your treatment using the DySIS colposcope. If you would prefer to have your treatment using the conventional colposcope please inform the nurse or doctor providing your care on arrival at the department. I do need treatment what will this involve? The loop biopsy procedure is very similar to the Colposcopy examination. It is a quick procedure which can be carried out in clinic under local anaesthetic. It is only uncomfortable while the local anaesthetic is being injected into the cervix. Thereafter the whole procedure should be completely painless. Once the local anaesthetic has had time to take effect the doctor will remove a part of your cervix about the size of your thumb nail, using a wire loop. The doctor will then spend a few minutes ensuring that any bleeding is under control before you are able to get dressed. If I do have treatment what happens afterwards? If you do have a loop biopsy you are likely to have a bloodstained discharge for a few weeks. During this time and when you have your period you will need to use towels rather than tampons. It is also best to avoid heavy exercise, swimming and not to have sexual intercourse. These measures allow the cervix to heal as quickly as possible and reduce the likelihood of infection. You will be told what is normal during the healing process and what may indicate you have an infection/heavy discharge. You will be given contact numbers in case you have any concerns when you are at home. You may wish to let someone else drive you home as occasionally the local anaesthetic can make you feel wobbly. Alternatively you can stay in clinic until you feel safe to drive. Treatment for CIN will have little or no effect on your future fertility. Risk of miscarriage or pre term birth may be slightly raised if women have several treatments. Where can I find other information? If you would like any further information before you come to Colposcopy your practice nurse will be happy to discuss your abnormal cervical sample result or you can contact the nursing staff in Colposcopy on 0191 4456178. There is also information available on the internet such as jostrust.org.uk and healthtalkonline.org. Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be
shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS reviews. Further information is available in the leaflet Disclosure of Confidential Information IL37, via Gateshead Health NHS Foundation Trust website or the PALS Service. Information Leaflet: NoIL418 Version: 1 Title: Colposcopy Examination One stops First Published: June 2013 Review Date: June 2015 Author: Dr R Rangar/Jill McConachie/Faye McClure This leaflet can be made available in other languages and formats upon request