Cervical abnormalities: CIN3 and CGIN

Some women were treated at the same appointment as their colposcopy appointment. Others had to come back later for treatment. Is there any particular reason for that?

It’s such a variation. It depends on the severity of the abnormality, depends on the woman’s wishes. And it depends on the judgement that the doctor makes at the time. The general rules are, if there is an abnormality that’s obvious, the full limit can be seen, and the women’s willing to be treated at the time, she can be offered treatment on the day.

Waiting to go in, very nervous because I wanted to know exactly what was going on. He’d explained everything to me, although I wasn’t quite taking it in at the time because my mind was just elsewhere.

When I went into the actual room where they were doing the treatment, I had to sit on a chair with stirrups up for my legs to go in, and slide my bum down a bit, so I was at a better angle. Very similar to a smear, maybe a bit more comfortable because you’re in a chair than laid on a couch. Which isn’t very pleasant.

And then he came in, obviously you need to be from the waist, stripped from the waist down, so ideally wear a skirt. And then it was, to start off with, it was pretty much like a smear. They insert the speculum, which is never very comfortable, and he explained that he obviously needed to numb the area, and put in a local anaesthetic. My cervix tilts a bit so that was a bit awkward, and it, a little painful. I think that was the most painful part I think for me. But it was bearable.

The nurse obviously then had to put the little plastic thing on your thumb to keep it, finger on to check your pulse. And then they put some plastic, I remember plastic, it felt like plastic stickers on my thighs. I can’t remember what that was for, maybe again to just monitor how I was.

And then you heard a buzzing noise, which I, well I think it was just something that helped them with the treatment when he got the wire rod to insert into me. Didn’t feel anything when it was being done, obviously because the anaesthetic was working.

There was an unpleasant smell in the air, which wasn’t very nice. I could feel myself burning up. I think that was more nerves than anything, feeling a bit light headed but the nurse was there to keep me talking, asking me questions about what I was doing at the weekend, just to keep my mind off it.

Didn’t last very long really, and they have removed everything there. My legs were obviously trembling, and with them being up in stirrups. That obviously make things easier and that he did have to stop at one point because I was getting a bit nervous. But yeah, I think it probably only took about five, ten minutes.

As soon as I got to the hospital, she was, “No, no, it’s fine. Absolutely no problem. I can treat you here and now.” It was very relaxed. My boyfriend came with me as well, and while she was, I mean the procedure probably took about fifteen minutes or something. And it was the loop procedure where they just sort of burn it out with a loop thing.

And we were just chatting about our holiday, you know, it was all very relaxed. The nurse was very relaxed. There was all sorts of, almost a bit of a jokey atmosphere, it was fine. Obviously afterwards I couldn’t really exercise, have sex, swim, and had to take it easy for a month. But other than that it didn’t really affect my life.

You get to see it all on the screen as well, which is interesting. But I tried, I didn’t like to look, particularly during the procedure because it wasn’t very attractive. And I think, like I said, I didn’t feel anything but when you look at something, it’s like when you don’t feel a cut, and then you have blood and suddenly you do. So I didn’t look.

But my boyfriend, being a nurse, was very interested. So it was good having someone there. I think it’s good to take somebody with you because, at the time, there’s a lot of information being thrown at you. It’s just nice to have someone afterwards to be able to discuss things with, and if there was something you weren’t sure with they, because they’re a bit calmer because it’s not them, so yeah.

If someone was going for their very first time, and they don’t know what to expect and they’re a friend of yours, how would you describe what happened?

I think I would just tell them it’s a bit like having a smear, but a bit more uncomfortable. But I don’t know if I’d tell them exactly how it did feel because it was, it was quite painful.

The whole thing? Or…

No, no. Just the anaesthetic I think. That was just the part, unfortunately I did, I fainted. So, it was a bit of a shock yeah.

So when they put the anaesthetic on, that’s when you…?

No, it was, it was actually, that was fine. They did the anaesthetic and I had the colposcopy done, the loop biopsy done, and that was fine. I think it was just, and after that I was still lying down, and then they obviously, they bring you up and as they brought me to sit, I just went. And they just said my blood pressure dropped. So I think it was a bit of a shock. I think that’s what it was.

I had electrical diathermy. I wasn’t given the choice; I wasn’t told you could have a local or a general. So they booked it under local and I found it absolutely horrendous.

And half way through the doctor actually said to me, “Did you not know you could have it under general?” And I said, “No. But if I ever have this again, make sure it’s on my notes that I will be having a general.” Because it was quite painful.

Were you happy with the care when you were there?

Definitely. Except for the fact that I was angry that I wasn’t told about the anaesthetic. Even if I’d known that it, not obviously, not knowing how much it was going to hurt. But if I’d known I would still would have opted for the general anaesthetic because the whole thought of all that sort of thing going on while you’re awake, knowing they’re going to cut bits off you, or burn you and, you know, it’s scary.

And you’d had general anaesthetic before, so…

Yeah, I’d had loads.

…that doesn’t worry you?

No. Not at all. I would much rather and if I, if I do ever, God forbid ever have to go through this again, then I will definitely be having a general. That is one thing I would advise people. And I wouldn’t say I’ve got a low pain threshold because I’ve well, you know, I’ve had three kids and various operations and stuff.

Even though it was a light general anaesthetic, I was just a bit flattened by the whole thing. And I think maybe just the whole sense of relief that I felt while I was there, that I wanted it out of my body, it was actually finally removed, so I just had a huge sense of relief.

So for someone who is looking on the internet and wants to know what will happen on the day of treatment, they know that they’re going to have a general anaesthetic and then a loop diathermy. Could, can you explain what happens on that day?

On that day?

Yeah.

Well I went in nil by mouth, so I had nothing to eat the night before. And I had to arrive in at 6 o’clock in the morning. So arrived in and just did the registration and, you know, they gave me the gown. And I was the first on the list so there was not too much hanging around, which was nice.

And the anaesthetist came to have a chat with me. Just asked me some general questions about my health. If I was allergic, had any allergies, and then they gave me, they took me down, wheeled me down. And I went into the sort of pre-op room and they gave me, put the needle in just to give me my pre-med. So, you know, needle, not very nice, but that’s fine. And, yeah, and then I had the pre-med which makes you feel quite wonderful actually.

And then, you know, count backwards from 100, and I think I made it to 97. And the gynaecologist surgeon had already come in before that and just said ‘welcome’ to me. And, you know, “Do you understand the procedure, this is what I’m going to do.”

And I came round in the post op and obviously just a bit groggy and very thirsty, and felt fine. And then was up, back up to the room. And had a long sleep, and had a big cup of tea with loads of sugar and a slice of toast. And that was it. My husband came, came back to pick me up and went home then.

No pain whatsoever? There was no discomfort?

No, but I was on, they’d given me just oral painkillers. So I was just having, I think paracetomol or something like that.

Bev' I was nervous because I didn’t really know what to expect. I didn’t really know, I knew a bit about what the LLETZ treatment, that it was a laser, but I didn’t know what it actually did. So again, you know, you’re feeling really nervous, feeling a bit sick. Getting yourself worked up. And he [doctor] was just like, “Oh you know, lets see what we can, lets have a go, let’s have a try at this.”

Did you think at this point you would be having a general anaesthetic?

No, at this point I knew, because I’d fought to have it done as a local, I just thought, you know, he’d be able to do it under the local. And he started to do it, and decided that sort of five minutes into it, he couldn’t do it under the local anaesthetic because again the speculums weren’t right. The needle that they used to anaesthetise, you know for the local anaesthetic, wasn’t long enough. And he just…

Husband' Gave up.

Bev' Gave up. He didn’t even try, and at that point he said, “You know, you’ve got, you have to have it done under a general.” And I was just sort of, “Well I can’t have a general, I don’t want a general anaesthetic.” And he again just then threw a leaflet in my hand and went, “We’ll write to you when you’ve got an appointment date.”

We basically went to Hospital 2. I got called in to the actual room by the nurse, and instead of just calling me into the little side room, I was actually called into the main room. The consultant number 2 was sat at the desk and obviously they had on the letters that I’d been to Hospital 1. And obviously asked me what had happened, so I explained everything to her with regards as to what had happened at Hospital 1. She went through my full medical history with myself, family history of anything like this, so I was able to tell her everything.

She explained everything to me. She explained the colposcopy, what CIN3 is, and she explained the whole lot to me. And actually asked me that if she could do the treatment there and then, would, you know, would I be happy for her to do it that day?

I was like, “Yeah please.” I got asked to sign a consent form to give my consent to having the treatment done. She went through, you know, all the possible complications, and things that you could get after having the treatment done, which nobody else had done with me.

I signed the consent form and then I was shown into another room to get changed, and came back out and admittedly, I was probably in there for a good 40, 45 minutes plus. And she did struggle to do it because my cervix apparently is a bit weird and where it’s located. But she sort of persevered with it. Every time she kept me updated with what she was doing.

I went for the colposcopy on 2nd January. And Mr. the consultant who’s name’s [doctor’s name], he was brilliant. He drew me a picture of what was happening. He asked me if I knew why I was there, and I said, “Well I’ve got severe pre-cancerous cells.” And he said, “No,” he said, “It’s worse than that.” He said, “We think you have cancer.”

And he said, “But,” he said, “We’re going to have a look at you, and,” he said, “We’re going to remove the bad bits.”

So I got undressed. I got onto the chair, and he gave me the local anaesthetic and put the dye on. And the whole of my cervix turned white with the abnormal cells. And he did the LLETZ procedure. Which was completely painless. Didn’t hurt at all. I just felt a bit of pulling. I actually found the colposcopy okay. [Partner’s name], my partner fainted, which was….

But I was fine yeah. The nurse was brilliant. They talked me through it. They told me what was happening at all the stages. And, to be honest, it was such an anti-climax because I thought, “Oh my gosh, this is going to be such an awful procedure.” But it was actually, it was fine, it was fine. You know, it wasn’t the most dignified I would say, but it was okay. And then they explained to me what had happened.

And I was assigned straightaway a cancer nurse, because obviously they expected it to be cancer and I was put into a room with this lady who talked to me about what would happen if I had, if the cancer was confirmed.

And then I got a phone call within a fortnight from [hospital name], and they said that, they said, “I can’t believe it, I’m so relieved to tell you that it is pre-cancer, not cancer.”

They said I would hear the results of the biopsy, what they took away, and I would get a letter to tell me the results of that. And in fact what they did, they sent me another appointment to go in to speak to a nurse to get the results. And she told me that it was clear and to come back in six months for another smear.

I went back in six months for another smear, and that was still under the hospital and when the results come through for that it was abnormal again. When I went, when I was at that appointment they told me then that the first biopsy result wasn’t clear, that I was told.

Right.

It was actually borderline, but they don’t tell you that, they tell you it’s clear. So I was quite annoyed about that because I’d kind of come away from that first appointment feeling very relieved, thinking that’s it, they’ve taken it all away. So I was very upset that second time I went back to find out that I was lied to, well not, perhaps not lied to, but not quite told all the truth.

So after having the second smear abnormal, I then had to go back in for a second loop biopsy, when they said they had to go in deeper. It was, they didn’t go in deep enough. So I had the second one. That was last year, and I’ve had one clear smear since. But obviously, because of what happened before, I don’t know if it was clear or not. So I still feel very apprehensive about my next smear, which is due next month.