Cervical changes & dysplasia

Dysplasia means the unusual growth of cells in a part of the body. The cervix forms the neck of your uterus (or womb) and sits at the top of your vagina. Changes to the cells in the cervix are known as dysplasia.

A Pap test (or Pap smear) is a test that looks for changes in the cells on the cervix that might show signs of cancer. Most abnormal Pap test results are not due to cancer. Most abnormal Pap test results are because of other health problems that can be easily treated.

If you have had a Pap test that has found signs of changes in the cells on the cervix you will be told to see your doctor or a gynaecologist so they can examine you further.

Normal changes to the cervix

The cervix is covered by two different types of cells: some are on the outer part of the cervix, some are in the cervical canal. The area where the two different types of cells meet is called the transformation zone.

The transformation zone on the cervix is where many changes happen. Some changes are quite normal and happen during puberty and pregnancy.

Changes in the cervix can be due to the human papilloma virus

Abnormal changes to the cervix

A Pap test is an important cancer-screening test because it can find changes to the cells in the cervix. Sometimes these changes can lead to cancer if they are not treated. It can take many years for cancer to start this way.

Your Pap test result may have written on it:

  • Negative/within normal limits. This means everything is normal.
  • Possible low-grade intraepithelial lesion. This is a finding of changes in cells that may show a low-grade (slight) abnormality, but the findings are not clear enough to give a definite diagnosis.
  • Low-grade intraepithelial lesion. This is a finding of minor cell changes that indicate Human Papilloma Virus (HPV) infection.
  • Possible high-grade intraepithelial lesion. A high-grade abnormality is suspected but the changes are not clear enough to give a definite diagnosis. With this result you would be referred for colposcopy (a doctor looks at your cervix through a magnifying machine that sits close to your body).
  • High-grade intraepithelial lesion. A high-grade (strong) abnormality appears to be present. With this result you would be referred for colposcopy.
  • Atypical endocervical (glandular) cells of undetermined significance. This is a finding of changes that are unusual in appearance and their exact nature is unclear. There is no evidence of cancer, you would be referred for colposcopy.
  • Possible high-grade glandular lesion. A high-grade glandular abnormality is suspected but the changes are not clear enough for a definite diagnosis. With this result you would be referred for colposcopy.
  • Adenocarcinoma in situ. This is a rarer high-grade abnormality inside the canal of the cervix.

Very rarely a Pap test may report:

  • Squamous cell carcinoma (SCC). This is a finding of cancer in the squamous cells of the cervix. With this result you would be referred to a specialist gynaecological oncologist.
  • Adenocarcinoma. This is a finding of a rare cancer that affects the glandular cells of the cervix. With this result you would be referred to a specialist gynaecological oncologist.

Further tests

If you have had an abnormal Pap test it is likely your doctor will recommend more tests.

Colposcopy

A colposcopy is an examination of the cervix. The doctor or nurse can see where the cell changes are located. They can also see the type of changes that have occurred

A colposcope is a magnifying machine (it works like binoculars) that is used to look at the cervix. You will be asked to take your clothes off (but you can leave your top and bra on) and given a gown to wear. At the start of the examination your legs will be placed in leg supports. Please tell someone if your legs are uncomfortable as the leg supports can be moved.

A special instrument (a speculum) is put into your vagina to hold the walls slightly apart so the doctor or nurse can see your cervix. This is what happened when you had your Pap test. The colposcope does not go into your vagina, it sits between your legs so the doctor or nurse can see your cervix.

This is uncomfortable but should not be painful and should take from five to ten minutes. If you are pregnant the procedure is safe and will not hurt your baby.

Biopsy

During the colposcopy the doctor or nurse may take a very small bit of cervical tissue. This is called a target biopsy. It is then sent for testing in a laboratory. The tests are to find out the type of cell changes.

Treatment

There are different types of treatment for cervical abnormalities.

Laser ablation treatment

A strong, thin beam of light is focused on the area of the cervix that needs treatment. The heat from the light kills the abnormal cells by burning them off.

Wire loop excision (LEEP or LLETZ)

A wire loop is used to remove the abnormal cells. Some of the tissue is then sent to a laboratory for testing (a loop biopsy).

Cone biopsy

This is a small operation to remove a cone-shaped piece of tissue from the cervix.

Radical diathermy

An electric current is used to produce heat to kill the cells. This treatment is no longer used in many hospitals as it can cause more tissue damage, pain and scarring.



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Disclaimer

The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

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