Colposcopy/oncology: Women's health Service

Cervical smears are not a test for diagnosing cervical cancer.  It is a test to check the health of the cervix.  All women are offered cervical screening between the ages of 25 and 64.

Generally an abnormal smear indicates that some small changes have been found on the cervix. These abnormal changes are known as dyskaryosis and can act as early warning signs that cancer may develop in the future.

Regular cervical screening is the best way to detect changes to the cervix early. Early detection and treatment can prevent cancer developing in around 75% of cases, but it does not prevent every case.  This is why when your smear indicates that we need to see you in colposcopy, it is important that you attend so we can assess your cervix.

Different Types of Smears.

▫ Inadequate smears – these are not abnormal smears. It basically means that the two types of cells needed to be seen to call your smear normal, are not present.  If you have an inadequate smear then it should be repeated in 3 months.  If repeated sooner it may make the result unreliable.

▫ Borderline/mild dyskaryosis means that only a few cells are mildly abnormal. These may be left to return to normal or may be treated.

▫ Moderate dyskaryosis means that more cells are abnormal, treatment will usually be needed to return the cells to normal.  The changes can also be called pre-cancerous.

▫ Severe dyskaryosis means that cells are significantly abnormal. Treatment will be needed to return the cells to normal.  These are also called pre-cancerous changes.

▫ Glandular changes means that there may be some abnormal cells within the birth canal, treatment may be needed.

The Colposcopy Unit is based in the Women and Child Unit at Peterborough City Hospital, within the Gynaecology Outpatients Department.

Colposcopy is an outpatient procedure in which a special microscope (colposcope) is used to look at the neck of the womb (cervix) and vagina.  It does not go inside you.  For most women this is a painless examination but some may find it as uncomfortable as having a smear taken.

We have clinics throughout the week at Peterborough City Hospital and a satellite clinic in Stamford and Rutland Hospital on a Thursday afternoon

The department receives referral via your GP or directly from our cytology laboratory if your smear has been reported as abnormal and requires colposcopy. 

The following are reasons why we may be seeing you:

• Abnormal cervical smear
• Abnormal persistent vaginal bleeding
• Abnormal appearance of your cervix.

The time frame of the appointment depends on the severity and type of referral.  But we usually see all patients within five weeks.  You will see either a doctor or specialist nurse, who will assess your problem.  We may have to take a biopsy or recommend treatment. 

If you are referred to colposcopy it is extremely important that we see you.  Many women will have a variety of feelings in being referred to us.  These include:

Fear of having cancer — remember the vast majority have early changes that are not cancer

Embarrassment — understandably, many women find the examination embarrassing and frightening. You are not alone. 

You can always talk to your GP, Practice Nurse of Colposcopy Specialist Nurse. You are also very welcome to bring someone with you, and if you would like they can be present during the examination. 

The first part of the examination is very much like having a smear test, with a speculum being inserted into your vagina. It should be no more uncomfortable than a smear test.  At this stage we may take some swabs, and repeat your smear if they are required.

A solution of mild vinegar is then washed over the cervix, which may sting. This makes abnormal areas appear white. In most cases we will take a photograph of the area for our records, in case you return to colposcopy.

If your examination suggests that you have only minor changes, the colposcopist may take some small biopsies (these are samples of tissue approximately 2mm in size, which are taken quickly with only momentary discomfort). These will be done to assess the necessity for treatment.

If the changes seen during the examination are thought to be high grade pre-cancerous changes then we will recommend that you have treatment in the Colposcopy clinic during your first visit, using local anaesthetic, injected into your cervix. This feels like any injection. The treatment is called Diathermy Loop Excision (or LLETZ), which is where a wire loop is used to remove the abnormal cells from your cervix. It is very quick, effective and causes minimal discomfort.

Result can take up to 3-4 weeks, but as soon as we get them we will write to you.  The letter will tell you what we have found and what needs to happen next.  In some cases we may need to discuss your case at a Multidisciplinary Team Meeting.  If this happens we will let you know as there will be a delay in you getting your results letter.

At Peterborough City Hospital there is a specifically designed and dedicated unit to care for oncology patients. This includes inpatient, outpatient and treatment facilities. There is a dedicated car park for patients adjacent to the unit's entrance, at the rear of the hospital site. 

Multi-Disciplinary Team (MDT) Meetings

All patients with a suspected or diagnosed cancer will be discussed at one of these meetings.  This is to confirm diagnosis, stage, what treatment is required and location of treatment.  

Endometrial cancer

Patients diagnosed with an endometrial cancer will normally have their surgery at Peterborough by Mr Ramsay.  In some cases patient will be transferred to the Cambridge University Hospital (Addenbrookes) for their surgery.

Following surgery your case will be reviewed at the MDT again to assess whether you require any further treatment in the form of radiotherapy or chemotherapy or both.

Ovarian Cancer

If ovarian cancer is suspected you will either have primary surgery at Addenbrookes or proceed to a biopsy at Peterborough to confirm the type of cancer.

Primary surgery – following surgery at Addenbrookes your case will be reviewed at the MDT again to confirm the diagnosis, stage and whether you require any further treatment, normally in the form of chemotherapy.

Biopsy first – once ovarian cancer has been confirmed, you will proceed to chemotherapy first, with surgery at Addenbrookes scheduled in the middle of your chemotherapy regime.

Cervical Cancer

Early Cancer – in most early cases you will just have a loop excision performed in the Colposcopy Unit.

In other cases you will either proceed to primary surgery at Addenbrookes or radiotherapy with chemotherapy.  Treatment is dependent on the type and stage of cancer.

Vulval / Vaginal Cancer

Treatment with either be in the form of primary surgery at Addenbrookes or radiotherapy +/- chemotherapy.  Treatment is dependent on the type and stage of cancer.

Treatment Location

Surgery:

• Peterborough (Gynaecology unit) with Mr Ramsay
• Addenbrookes with either Mr Crawford, Mr Latimer, Mr Shaffi or Mr Baldwin

Chemotherapy:

• Peterborough (oncology unit) with Dr Ayers
• Addenbrookes with Dr Earl or Dr Parkinson, for rarer endometrial / ovarian cancers.

Radiotherapy:

This will either be performed at Peterborough or Addenbrookes depending on diagnosis, as some treatment is highly specialised.

Follow up

Follow up of gynaecology cancers id dependant on type and stage.  You will informed of your follow up plan, once you have completed all of your treatment.