Disorders of the cervix
Treating Cervical Problems
Disorders of the cervix - the lower, narrow end of the uterus - are very common. They can range from fairly mild problems, such as infection and inflammation, to more serious ones, such as cancer. Several types of cervical disorders can develop into cancer or can make it more likely for a woman to develop cancer.
Cancer of the cervix is less common because women are taking care of their health by scheduling annual Wellness exams, which include a pelvic exam and Pap test. The Pap test can detect changes in cells before they turn cancerous. Early detection with a Pap test can save lives.
Dysplasia is a type of cervical disorder that occurs when there is a change in the cells on the surface of the cervix. The normal, non-cancerous cells are replaced by abnormal cells that if left untreated, turn into cancer cells. These changes in the cells are called dysplasia.
Dysplasia is found in women of all ages, but it is becoming more common in women and teenagers. Women at risk for dysplasia include those who have genital warts, those with more than one sexual partner (or whose male partners have had more than one partner), those who first had sex before age 20, and those who smoke. Though dysplasia is not the same as cancer, over the years the dysplasia cells may develop into cancer. The range of dysplasia includes mild, moderate and severe dysplasia, and carcinoma in situ (CIS). CIS, although not a true form of cancer, is the most likely to develop into cancer if not treated.
If your Pap test report fell within an abnormal range, or if you have pain or bleeding with sexual intercourse, we may recommend an office procedure called a colposcopy. This test is done by looking at your cervix using a special microscope, called a colposcope. A colposcope magnifies and focuses an intense light on the cervix, allowing it to be viewed in greater detail. The changes in your cervix that caused the abnormal Pap test results can be easily viewed. Colposcopy is often used to diagnose cervical cancer, dysplasia, genital warts on the cervix, cervicitis, or benign growths such as polyps.
Colposcopy takes 15-20 minutes and is done in our office. It should be done on a day when you are not having your menstrual period. You'll need to avoid sexual intercourse and not use any creams in your vagina the night before your appointment. For the colposcopic exam, a speculum like the one used during a Pap test is placed in the vagina. Then a vinegar-like solution is applied to the cervix. This causes any abnormal areas to turn white. You might feel a slight burning or pressure for a few moments. The cervix is then viewed through the colposcope. If there are any abnormal areas on the cervix, a biopsy may be taken and sent to the lab for further study. Sometimes the area just inside the opening to the cervix cannot be seen clearly. Then a sample may be gently scraped from the inside of the cervix and sent to the lab.
You can return to your normal routine right after your exam. If tissue was taken from the cervix, you may have some mild cramping or light bleeding for a few days. Use sanitary napkins, not tampons. Taking an anti-inflammatory, such as ibuprofen, should relieve any discomfort.
Depending on the colposcopic findings, one or more of the diagnostic and treatment procedures listed below may be used.
When abnormalities of the cervix are seen by colposcopy, a biopsy may be done to diagnose the problem. In this procedure, small pieces of cervical tissue are removed and sent to the lab for study. Often, several areas are biopsied during the procedure. A biopsy can be done in our office and takes approximately 15-20 minutes. It should be done on a day when you are not having your menstrual period. You may feel some mild cramping or a pinching sensation.
You can return to your normal routine right after your exam. You may have some mild cramping or light bleeding for a few days. Use sanitary napkins, not tampons. In some cases, no further treatment is necessary after the biopsy has been performed.
This type of biopsy is used if a larger sample is needed. A cone biopsy is a quick outpatient surgery that is done if one or more pap tests and a colposcopy exam showed abnormal cells on your cervix. During this procedure, a cone-shaped wedge of tissue is removed from the cervix and all possibly abnormal cells are removed. As the cervix heals, new tissue that grows in is usually healthy. Then no more treatment is needed. This procedure serves as a method of treatment for some cervical disorders because often the affected area is removed. Cone biopsy can treat an abnormality as well as determine what is wrong.
A cone biopsy takes less than an hour, but it must be done in a hospital. You will be given anesthesia so that you will be comfortable during the surgery. It is important that you do not eat or drink anything after midnight the night before the procedure. You'll also need to have someone drive you home afterward since you'll be too drowsy to drive safely. During the procedure, aa speculum like the one used during a Pap test is placed in the vagina to allow the doctor to see your cervix. Then a cone shaped piece of tissue is removed from the cervix, as shown in the diagram below. The tissue that is removed is sent to the lab for further study. New tissue grows back in 4-6 weeks.
You will be allowed to rest in the recovery area until you are ready to go home. You should plan to rest at home for a day or two. You may have some bleeding and discharge and mild cramping for a few days after surgery. Use sanitary napkins, not tampons, for at least the first month following this surgery. If you have fever, chills, or heavy bleeding, contact our office at once. Do not have sexual intercourse or play active sports for 4-6 weeks after the conization. Until the cervix has fully healed, the tissue could be injured and then bleed.
When abnormal cell growth, known as dysplasia, is revealed by a Pap test or Colposcopy, a LEEP (Loop Electrosurgical Excision Procedure) may be done to quickly remove the abnormal tissue from your cervix. LEEP may not be the best treatment option for women with pelvic infection, invasive cancer, or pregnancy.
A LEEP can be done in our office and takes approximately 30 minutes. It should be done on a day when you are not having your menstrual period. For the LEEP, a speculum like the one used during a Pap test is placed in the vagina. Then your cervix is numbed with a local anesthetic, which also helps reduce bleeding. Then a mild vinegar or iodine solution is applied to the cervix to highlight any dysplasia. You might feel a slight burning or pressure for a few moments. The cervix is then viewed through the colposcope. A thin wire loop carrying an electric current is then used to remove the abnormal areas from the cervix. Because the wire is so thin, there is very little damage to the surrounding tissue. The loop also seals the blood vessels, which decreases bleeding. The tissue sample from your cervix is sent to the lab for further study.
It is unusual to feel more than mild cramps following your LEEP. You can return to your normal routine right after your procedure. As your cervix heals, you can expect some mild cramping or vaginal bleeding, heavier bleeding during your next period, and a thick, brownish-black discharge (a result of the medicated paste used at the end of your LEEP procedure). It is important for you to let your cervix heal, so use sanitary napkins, not tampons, for at least the first month following this procedure. Also, do not have sexual intercourse or play active sports for 4-6 weeks after the LEEP. Call our office if you begin to experience heavy bleeding or bleeding with clots, severe abdominal pain, fever, or a foul smelling discharge.
Cryotherapy is another option for the physician to choose to treat abnormal cells discovered by a Pap test or during a colposcopy. Cryotherapy is done in the office during the first week after your menstrual period and takes only a few minutes. During Cryotherapy, the abnormal tissue is frozen. This tissue dies and the tissue that grows back is most often normal. There is no cutting and no bleeding. For the Cryotherapy, a speculum like the one used during a Pap test is placed in the vagina. Then your cervix is numbed with a local anesthetic. Next, a thin probe is held on the cervix. This probe creates a ball of ice that freezes and kills the tissue. You may feel some cramping as the ice touches the cervix, but this will go away when the treatment is over.
You should be able to return to your normal routine shortly after the procedure. You'll have a thin, watery discharge and some light bleeding for another 2-3 weeks. Then you'll have a thick, yellowish discharge for another 2-3 weeks, which is a sign that your body is shedding the dead tissue. If you have a fever or notice a foul odor with the discharge, call our office. Use sanitary napkins, not tampons, for at least the first month following this procedure. Do not have sexual intercourse or douche for 3-4 weeks after the Cryotherapy. Until the cervix has fully healed, the tissue could be injured and then bleed.
Cervitis is an inflammation of the cervix that may or may not produce symptoms, such as vaginal discharge. It is common in women in their childbearing years. In some cases, the causes of cervitis cannot be found. Cervitis may occur because of an infection passed on during sexual intercourse or irritation from a foreign body, (such as an IUD, a contraceptive sponge, a forgotten tampon, or a pessary.
When symptoms of cervitis do occur, they include a vaginal discharge that may have a bad odor. Another symptom is tenderness or pain in the pelvic region. Slight bleeding between periods or after intercourse may also occur.
Polyps are usually benign (non-cancerous) growths or tumors that often appear on the cervix. They are a common abnormality, second in frequency only to cervitis. These polyps consist of an abnormal growth of the tissue which lines the uterus. They protrude from the opening and are easily seen during a pelvic examination. They vary in size and may cause vaginal bleeding between periods or after menopause.
Although rarely cancerous, they should be completely removed and examined microscopically. This can be done in our office without anesthesia and takes only a few minutes. It should be done on a day when you are not having your menstrual period. You may feel some mild cramping or a pinching sensation.
Genital warts, also called condylomas, are spreading growths that are caused by some types of human papillomavirus (HPV). Like warts on other parts of the body, they are caused by a virus. The virus is usually passed onduring sex and is one of the most common sexually transmitted diseases in America today. These warts may vary in appearance and may develop singly or in clusters. They may appear as raised granules or cauliflower-like growths, or they may be flat and barely visible. Condyloma may be flesh colored, pink, or darker than the surrounding skin. While condyloma is not directly associated with cancer, it may be present along with other types of HPV that are linked to abnormal changes (dysplasia) in the cells of the cervix. Left untreated, these changes may progress to a pre-cancerous state. If you are pregnant, condyloma can be transmitted to your infant during delivery, or the warts may block a vaginal delivery, making a cesarean more likely. Genital warts can best be treated when you and your partner work together with your physician. If you are diagnosed with genital warts, be sure to schedule regular checkups that include Pap tests.
Cancer that has spread beneath the top layer of the cervix or to other parts of the body is called invasive cancer. In the United States, it accounts for nearly 2.4% of all cancers in women. There are approximately 1,113,500 new cases of invasivecervical cancer each year. Cancer results when cells grow out of control and can no longer perform their normal functions. Only malignant (cancerous) cells spread. If these cancerous cells are found before they have spread, treatment is more likely to succeed. The earlier cervical cancer is diagnosed, the better the chance for a permanent cure.
Because cervical cancer usually develops after abnormal cells have been present for several years, it tends to affect older women. Although cervical cancer can occur at any age, it is most common in women ages 35-50. Risk factors for cervical cancer are similar to those for dysplasia. Women who first had sex before 20, who had multiple sex partners or certain sexually transmitted diseases, and those who smoke are especially at risk and should schedule regular checkups that include Pap tests. Often there may be no symptoms of cervical cancer. When symptoms do occur, the first sign may be abnormal bleeding, spotting, or discharge from the vagina. With advanced cancer, there may be pain, problems urinating, and swelling in the legs. These symptoms do not necessarily mean that you have cancer, however, if you have any of these symptoms, call our office to schedule an exam.