How long has it been since your last smear? Let’s face it, it’s definitely one of the less enjoyable parts of being a woman, but the reality is that 1 in 4 women do not bother to attend regular smear tests. This week is cervical cancer prevention week and I wanted to help raise awareness by detailing my experience of the LLETZ procedure after an abnormal smear test. I hope it both raises awareness of the reality that abnormal smears can be relatively common, but also that the treatment is very straightforward if there are problems detected.
In 2013 I went for a regular smear test and received the letter back that no-one wants to get; that I had abnormal cells. Changes to your cervix cells are not cancer itself, but are often the pre-cursor to cervical cancer developing, therefore detecting these changes at an early stage can be crucial in preventing cervical cancer.
In the same letter I was invited for a colposcopy at my nearest hospital to investigate the cell changes in more detail. The colposcopy itself involves using a speculum just like the smear and the sensation is exactly the same, uncomfortable rather than painful. They use a camera to look at the cervix, which is painted with an iodine dye which stains the normal cells, leaving the abnormal cells highlighted.
I was shown on the monitor the two areas on my cervix which had the abnormal cells and the consultant explained that they would need to take a cervical punch biopsy of each area. This involves inserting an instrument through the speculum and snipping tiny cell samples about the size of half a grain of rice from the abnormal cells. Again, I wouldn’t describe this as painful, more of a pinching sensation. But I have to admit that I got very light headed afterwards and came close to fainting. I had no bleeding afterwards, however some slight bleeding can be a consequence of the punch biopsy.
The LLETZ treatment
The tissue sample will be sent to a pathologist for examination. I received a letter after this confirming that the cells had been classed as CIN3 and I would need to undergo the LLETZ procedure to have the abnormal cells removed. There are 3 levels of classification for changes in cells: CIN1, which simply requires a follow-up smear in 6 months to see whether the changes have reverted; CIN2, which indicates moderately abnormal cells; and CIN3, which indicates severely abnormal cells. It’s important to remember that none of these stages are cancer itself, however without treatment these cells may become cancerous.
Because I had nearly fainted after the punch biopsy, my hospital decided to do the LLETZ treatment under general anaesthetic rather than local, which I believe is more common. LLETZ stands for Large Loop Excision of the Transformation Zone and involves using a small wire loop which has an electrical current running through it. In this way it can cut away the abnormal tissue and seal the wound too.
Because I had the procedure under general anaesthetic I can’t comment on the pain level, however the level of pain I had in recovery was minimal. I went home from hospital about an hour after I woke up, and was perfectly able to go back to work the next day. You can expect to experience some bleeding afterwards for a few weeks and it’s recommended to use sanitary towels rather than tampons to minimise any infection risk. You should also avoid swimming and sex until the bleeding has stopped.
The cells which are removed will be sent away for examination. I received a letter back a couple of weeks after my treatment, which downgraded the previous CIN3 to CIN2 based on what they’d seen. Following treatment you will be invited back for another smear in 6 months to check whether any further changes in the cells can be seen. I received the all-clear at this smear and was put down for annual smears for another two years. When I received the all-clear at both of those, I have gone back to the regular 3 year tests.
I found the whole experience to be very straightforward and I’m so grateful that I went for my smear test and had the abnormal cells picked up when they were. The only downside for me has been complications in pregnancy. One of the possible side effects of the Lletz treatment is that it can cause the cervix to become weakened and ‘incompetent’, resulting in very premature labour, or alternatively, that the level of scarring means that it is unable to dilate in labour. Premature labour can be avoided by regular cervical scans to monitor any cervical shortening, and should any severe shortening be detected then a cervical stitch can be put in to prevent premature labour. However, both of these possibilities are rare. My cervix measured on the cusp of where a stitch would be considered, however I made it through pregnancy with no problems and delivered at 39.3 weeks.
Cervical cancer is one of the few cancers where it is possible to detect changes that are a pre-cursor to cancer itself. 75% of cervical cancers can be prevented by regular smear tests. Please don’t let lack of time or embarrassment stop you going for a test which could save your life.
I found Jo’s Cervical Cancer Trust an invaluable source of information when I was going through this. Their site is filled with information, personal stories, and a forum to ask any questions. Every year they run the #Smearforsmear campaign during Cervical Cancer Prevention Week – this year from 21-27 January 2019. Just put on your lipstick, smear, share your #SmearForSmear selfie and nominate a friend.