Disorders of the Cervix (neck of the womb) – Chapter 21

Q 21. 1 What is the cervix?

The cervix is the neck of the womb (Q2.3 and Figures 2.1 and 21.1). Along its middle is the cervical canal which is the gateway to the endometrial (womb) cavity. Mucus secreted from tiny glands assists the cervix in providing a barrier against infection ascending to the endometrium and Fallopian tubes. Around the time of ovulation (egg release) the mucus becomes thinner allowing sperm to ascend facilitating fertilisation.

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 2 What is a cervical polyp?

A polyp is a small tumour that is connected by a stalk to its tissue of origin (Figure 24.1) which in this case is the cervix. Cervical polyps may be the source of vaginal discharge, irregular bleeding and bleeding after intercourse (post-coital bleeding). They may be removed either in the clinic or in the operating theatre and their base cauterised to reduce the chance of recurrence.

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

The vaginal surface of the cervix has a covering of layers of flat cells (squamous epithelium) (Figures 21.1 & 21.2). The cervical canal is lined by columnar cells that produce mucus. The squamo-columnar junction is where the squamous and columnar epithelia meet.

During puberty, when taking the pill and during pregnancy, the cervix enlarges and the columnar epithelium from the cervical canal seems to move out (almost like a flower opening) to cover part of the vaginal cervix. The clinician looking at the cervix sees a deep pink velvet-like appearance, which has been called erosion, ectropion or an ectopy (Figure 21.3). The majority of women with cervical erosions have no problem but some are troubled by excessive discharge or bleeding after intercourse (post-coital bleeding).

During childbirth or miscarriage, the surface covering of the cervix can be damaged and become inflamed (cervicitis). Evidence of this inflammation can still be found even many years later. Sometimes small mucus filled cysts form on the cervix (Nabothian follicles). Chronic cervicitis may be associated with discharge or bleeding after intercourse. Cervical ectopy and cervicitis are not pre-malignant or malignant conditions.

If it seems that a cervical erosion or cervicitis may be responsible for symptoms, it can be treated by freezing (cryotherapy – Figure 21.4) in the clinic or by cautery or laser in the operating theatre.

A twenty-five year old lady presented with vaginal discharge, intermenstrual bleeding (bleeding between periods), post-coital bleeding (bleeding after sexual intercourse) and occasional deep dyspareunia (pain with intercourse Q23.31). On examination she had florid cervical ectopy. Her cervical smear showed no abnormality and swab tests for infection were negative. There was some noticeable improvement following a course of Acijel (a mildly acidic jelly) but she still had some symptoms. The cervix was treated by cryotherapy and five months later she remains asymptomatic.

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 4 What is the transformation zone?

During puberty the squamo-columnar junction (Q21.3) moves out on to the vaginal surface of the cervix. The exposed columnar epithelium can change into squamous epithelium – a process called metaplasia. This area of change is the transformation zone and it is in this zone that pre-malignant change may commence.

Q 21. 5 What is a “Paptest” (smear test) ?

In 1941, George Papanicolou identified cancer cells from the fluid aspirated from the upper vagina. The test has been modified to a smear taken under direct vision from the cervix (Figure 21.5). It was shown that malignant cells could be seen in the Paptest before the cervix became malignant, indicating that screening could lead to treatment and prevention (Figure 21.6).

References:

Women’s understanding of a ‘normal smear test result’: Experimental questionnaire based study (2001-3348)

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

There is no need for anxiety. Your doctor will probably wish to treat the inflammation and repeat the smear test for you. If your smear tests keep showing inflammation, referral for colposcopy (Q21.13) may be appropriate.

References:

Implications of inflammatory changes on cervical cytology (1990-009)

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

The body is made up largely of tiny “bricks” called cells. Each cell has a control centre called the nucleus (Figure 21.2). Malignant cells show several changes including enlargement of the nucleus and greater variation in the shapes of the nuclei and the cell (Figure 21.7).

References:

The abnormal glandular smear: Cytologic prediction, colposcopic correlation and clinical management (2000-3159)

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Almost certainly not, although, no doubt, this is the anxiety that any woman has on learning that her smear shows an abnormality. Abnormal cells on a smear test usually mean that there may be pre-malignant changes. It is unusual for an abnormal smear to indicate that the cervix has already become malignant. These days pre-malignant conditions of the cervix can be treated before malignancy occurs.

References:

Women’s understanding of abnormal cervical smear test results: A qualitative interview study (1997-1685)

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Fortunately, the cells of the cervix are not normal one day and malignant the next. It probably takes fifteen or more years before a normal cervix gradually becomes malignant. Not all pre-malignant changes progress to cancer: sometimes spontaneous return to normality may occur. Cells scraped from the cervix (cervical smear) can be analysed under the microscope and pre-malignant changes can be recognised. An estimate of the severity of change is generally reported (mild, moderate or severe dyskaryosis or dysplasia). These are the terms used in cytology, the study of cell structure, as a smear is sent for cytological assessment.

When the cytology indicates pre-malignancy of the cervix (Figure 21.7), a magnified assessment of the cervix (colposcopy Figure 21.8) may indicate where the abnormality is located (Figure 21.9) and a biopsy of the cervix may be obtained. The biopsies are sent for histological examination (high powered magnification of tissue; Figure 21.10). The cytological abnormalities mild, moderate and severe dyskaryosis tend to correspond to CIN I, II and III respectively (cervical intra-epithelial neoplasia (a neoplasm is a tumour). Mild, moderate and severe dysplasia are another set of histology terms for CIN I, II and III respectively). Just to complete the terminology, we sometimes call severe dysplasia (CIN III) – Carcinoma-in-situ). The important feature of pre-malignancy is that the abnormal cells are confined to the surface (epithelium).

If a CIN III abnormality progresses, the abnormal cells penetrate through the basal layer. Provided they have not become deeper than 5mm, this abnormality (micro-invasive) can still be regarded as pre-malignant.

References:

A 5-year follow up of mildly dyskaryotic smears, comparing colposcopy with expectant management (1999-2899)

Glandular lesions of the cervix: diagnostic and therapeutic dilemmas (1995-3227)

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

There are none! Symptoms only appear if the cervix has become frankly malignant. Even when a doctor examines the cervix, it is not possible to recognise pre-malignancy without the aid of special screening tests.

Q 21. 11 What are benign and malignant tumours?

A tumour is essentially a swelling. The cells of a benign (innocent) tumour look normal under the microscope and there is no suggestion of them invading other tissues. The individual cells and their nuclei have similar shapes to that of normal cells. Malignant cells and their nuclei have different shapes and they invade and destroy surrounding tissues.

There are many specialised cells in the body, each having its own function. Each can form innocent or malignant tumours. There are a large variety of tumours with different causes and thus cancer is not one disease. Each cancer may have its own set of symptoms. The different cancers respond to treatment in different ways.

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Pre-malignancy and malignancy of the cervix tend to be associated with sexual activity suggesting the possibility of transmission of a causative organism. Starting sexual activity at a young age, multiple partners and smoking are known factors.

It took many years to fathom out the culprit which proves to be the wart virus (Human Papillomavirus -HPV). From 1997, it has been possible to screen for the presence of this virus in routine clinical practice. The test is slightly expensive.

References:

Bacterial vaginosis and cervical intraepithelial neoplasia – Cause or coincidence? (1998 – 2548)

International incidence rates of invasive cervical cancer after introduction of cytological screening (1997-2091a)

Serologically diagnosed infection with human papillomavirus type 16 and risk for subsequent development of cervical carcinoma: Nested case-control study (1996-1977)

Cancer associated human papillomaviruses: perinatal transmission and persistence (1994-434)

Q 21. 13 What is colposcopy?

A special microscope (colposcope; Figure 21.8) allows the gynaecologist to magnify the cervix and define the area of abnormality. The cervix is visualised as when taking a smear. Dilute acetic acid is applied and this makes the abnormal area appear white (aceto-white). The colposcopist then looks at the blood vessel pattern (a green filter assists visualisation). Areas of mosaicism and punctation are examples of commonly seen abnormality (Figure 21.9). With local anaesthetic, tiny biopsies may be taken. These are sent to the laboratory where the pathologist can advise further about the severity (Figure 21.10).

References:

“See and treat” at colposcopy – Achieving the standard (2001-3289)

Randomised trial of immediate versus deferred treatment strategies for the management of minor cervical cytological abnormalities (1997-1744)

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

From the information obtained from the smear, colposcopy and biopsy, the gynaecologist can advise on appropriate treatment options. Mild degrees of abnormality (mild dyskaryosis / CIN I) may return to normal and there are times when they may be left untreated but kept under careful review by repeated smears and colposcopy.

The more severe abnormal areas will probably need to be destroyed. This can be achieved by removing them surgically (knife cone biopsy) or with a heated loop removing a cone (LLETZ is a large loop excision of the transformation zone- Figure 21.11). The cervix may be frozen (cryotherapy; Figure 21.4) or destroyed by cautery, cold coagulation (this still involves heat) or laser.

After treatment you will probably receive a local antibiotic vaginal cream to be used for about 10 days; this reduces the chance of infection and promotes healthy healing. Sexual activity should be avoided for at least three weeks and internal sanitary protection for four weeks.

References:

A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia (1997-1755)

Management of women with mild and moderate cervical dyskaryosis (1994-484)

Colposcopic diagnosis and treatment of cervical dysplasia at a single clinic visit. Experience of low-voltage diathermy loop in 1000 patients (1990-79)

Gynaecology: Loop diathermy excision of the cervical transformation zone in the management of cervical intraepithelial neoplasia (1990-411)

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Pre-malignant changes are invariably cured by destroying the abnormal area as described above. Sometimes treatment may have to be repeated. Unfortunately, it is not possible to remove every Human Papilloma Virus, the cause of the abnormality, from the lower genital tract. After treatment, the virus usually lies dormant but it can become active again.

References:

Topical antiseptic agent after large loop excision of the transformation zone: Results of a randomised controlled trial. (1999-2898)

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Your gynaecologist will recommend a plan for checking by cervical smears and colposcopy. The frequency and duration of repeat screening will depend on the severity of the treated pre-malignancy and the protocol of your clinic.

Q 21. 17 How can we prevent cancer of the cervix?

The purpose of cervical screening is to prevent the appearance of invasive disease by the detection and appropriate treatment of pre-cancerous abnormalities.

There is compelling evidence that carcinoma of the cervix is associated with the human papilloma virus (HPV), which is transmitted during sexual intercourse. There are many strains of HPV. Types 16 and 18 are the two most commonly found in association with pre-malignancy and malignancy. When both partners enter marriage as virgins and remain faithful to each other, carcinoma of the cervix is rare. This explains why the disease is uncommon in religious communities that adhere to these principles. The sheath provides protection against sexually transmitted disease.

Cells have the potential to become malignant. This probably happens fairly frequently but the immune system usually destroy the abnormal ones (Q32.1).

The principles of screening are discussed in Q32.9. Carcinoma of the cervix is a ‘surface’ disease. With a vaginal speculum the cervix can be readily visualised and cells sampled. There can be little doubt that screening has reduced the incidence of carcinoma of the cervix. Studies suggest that since the introduction of screening there has been a reduction of about 70%. Despite screening with cytology there remains a 30% incidence of malignancy. There is, therefore, a need for further improvement.

References:

International incidence rates of invasive cervical cancer after introduction of cytological screening (1997-2091b)

Treatment of pre-invasive conditions during opportunistic screening and its effectiveness on cervical cancer incidence in one Norwegian county (1997-2091c)

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 18 Is there a reason to screen for HPV?

It is now possible to screen for human papillomavirus which is the culprit for pre-malignant and malignant conditions of the cervix. This has only recently become available for clinical practice although it has been under investigation for more than ten years. There has been scepticism about the clinical value of HPV testing particularly on the part of those who may be required to provide funding. Studies indicate that when the HPV test is positive there is a 50% chance that there will be a high grade of CIN.

Those responsible for funding healthcare perceive an additional expenditure should HPV testing be widely adopted. They point out that 20% of young women are likely to be infected with the virus but the majority will not go on to develop pre-malignancy.

About 1-2% of smears are reported to be unsatisfactory and a repeat test is requested by the laboratory. This causes stress for the patient who assumes that there is a major problem. It has been estimated that the annual cost of repeat smears in the USA amounts to $3 billion. Those with experience of combined cytological and HPV testing suggest that the referral rate for colposcopy may be reduced by 30%. They also suggest that, from an economic point of view, the combination of cytology and HPV testing results in a cost reduction. In Switzerland, there has been a 10% reduction in the overall cost of screening since the introduction of HPV testing. In the UK it has been estimated that the worst scenario of introducing routine HPV screening in conjunction with cervical smears would be a neutral effect on funding but there could be a £30 million saving.

In the UK 5.5million smears are taken annually. It would seem that if the combination (cervical smear and HPV test) results in fewer false negative results and less unnecessary intervention, HPV testing would prove to be cost-effective. The value to the patient of better reassurance that she is having more effective screening cannot be measured. My initial impression is that HPV testing is likely to be seen as an advance in the prevention of cervical cancer.

Currently cervical smears are usually read by trained technicians. A typical slide sent by the doctor will include about 30,000 cervical cells. Large numbers of cells are assessed under low power microscopy and the majority of cells are evaluated. Abnormal cells are more obvious under higher magnification but time precludes checking all the cells. Computer systems such as Papnet are under investigation to see if they could improve accuracy.

It is possible that a vaccine may be developed to destroy the human papillomavirus.

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 19 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page

Q 21. 20 Are there any support groups?

References:

The provision of information leaflets before colposcopy beneficial? A prospective randomised study. (1999 – 2702)

Q 21. 1 What is the cervix?

Q 21. 2 What is a cervical polyp?

Q 21. 3 What is meant by cervical erosion (ectopy) and cervicitis?

Q 21. 4 What is the transformation zone?

Q 21. 5 What is a “Paptest” (smear test) ?

Q 21. 6 My cervical smear shows inflammation. Should I be worried?

Q 21. 7 What are cells and what is an abnormal (pre- malignant) cell?

Q 21. 8 My cervical smear shows abnormal cells. Does this mean that I have cancer?

Q 21. 9 What is meant by the terms pre-malignant cells, dyskaryosis, dysplasia and CIN?

Q 21. 10 What are the symptoms of pre-malignancy of the cervix?

Q 21. 11 What are benign and malignant tumours?

Q 21. 12 Why have I developed a pre-malignant condition of my cervix?

Q 21. 13 What is colposcopy?

Q 21. 14 What treatments are available for pre-malignant conditions of the cervix?

Q 21. 15 Can pre-malignant conditions of the cervix be cured?

Q 21. 16 How can I be re-assured that the pre-malignant changes will not recur?

Q 21. 17 How can we prevent carcinoma of the cervix?

Q 21. 18 Is there a reason to screen for HPV?

Q 21. 19 Could I have some useful Web sites?

Q 21. 20 Are there any support groups?

Women’s Health – Home Page