'LEEP-ing' into Cervical Cancer Detection and Diagnosis
You dutifully get your regular Pap smear and then you get a call that worries you: Your doctor says you have cervical dysplasia. In other words, abnormal cells have been detected on your cervix, the canal between your uterus and vagina. They may mean nothing—they could be something—but only a doctor can determine if the cells are precancerous.
The most important thing you can do is follow up with your physician and try not to worry too much. You'll likely start with a colposcopy and, depending on the results, maybe progress to a loop electrosurgical excision procedure (LEEP).
Let's walk through what to expect with LEEP.
First, the colposcopy
During a colposcopy, your doctor examines you with a colposcope, a magnifying instrument used to view the cervix. While this might sound scary, there's no need to worry: This exam takes place in the same office as your Pap test with the same routine.
Your doctor asks you to place your feet in the stirrups on the exam table and inserts a speculum into your vagina to guide the colposcope. They are able to view your cervix and biopsy, or remove, any abnormal tissue they see, which helps determine the next steps, such as additional tests or treatment, if necessary.
Doctors' understanding of the progression of cervical cancer and other abnormalities has come a long way in recent years, said Jonathan Schaffir, M.D., a specialist in obstetrics and gynecology at the Ohio State University Wexner Medical Center in Columbus. He explained there is a higher risk of cancer with "high-grade" changes compared with "low-grade" changes, which may clear up on their own.
"With Pap tests, we have learned to describe a spectrum of changes where we can identify abnormal cells before they become cancer," Schaffir said. "We can reduce or eliminate cancer in the first place."
Once your doctor receives the biopsy results, they determine the grade of changes and the diagnosis.
In the past, mild cervical changes were treated more aggressively, but now that it's understood these minor changes can sometimes go away on their own, the approach is based on guidelines that take into account a patient's risk level. These factors include whether the pathology indicated they have an advanced lesion, their previous cytology and HPV test results, or lack thereof if they haven't been keeping up with their regular screening. Schaffir also considers a patient's age when evaluating next steps.
"If a patient is 24 and has low-grade changes, I'll recommend waiting," he said. "Low-grade lesions are not considered precancerous."
If the patient is older or the cells have a high grade of abnormality, your doctor may recommend LEEP.
What to know about LEEP
The lloop electrosurgical excision procedure has been used since the late 1990s. It is considered a superior method of confirming the extent of precancerous cells compared with other methods, which include cervical cryotherapy, laser ablation and cold-knife conization (CKC).
LEEP allows for more precise removal of abnormal cells than the ablative procedures (cryotherapy and laser), while leaving healthy tissue intact. Women who undergo LEEP show a significantly lower rate of abnormal cell recurrence than women who receive cryosurgery, according to a 2018 meta-analysis of more than 1,000 women published in the medical journal Gynecology and Minimally Invasive Therapy.
Additionally, with LEEP and CKC, a tissue sample can be sent to the lab, which can't happen with ablative procedures. While a CKC procedure gives the surgeon more precision, control and accurate margins on a tissue specimen than LEEP, it can also have a higher rate of future obstetrical complications and needs to be done in an operating room with anesthesia. For this reason, LEEP is more commonly performed on patients with typical anatomy who are not done having children.
The "loop" in the name is a small wire with an electric current running through it that is used to remove the abnormal cells from your cervix. The heating process cauterizes the incision as the tissue is removed to prevent excessive bleeding.
The tissue removed from the cervix is sent to a pathology lab for evaluation. The pathologist looks at the tissue under a microscope to assess how abnormal the cells are (low grade, high grade or cancer) and where they are located in respect to the margins to determine if all of the abnormal cells were removed.
If cervical cancer is detected, you're referred to a gynecological oncologist. Cervical cancer can be cured if diagnosed at an early stage and treated promptly.
What to expect during and after the procedure
If the results from the biopsy performed during your colposcopy reveal high-grade cervical dysplasia, and your doctor determines LEEP is the best course of action, this procedure is performed during a follow-up visit. A local anesthetic is administered directly into the cervix to numb it. Your doctor may also recommend you take an over-the-counter pain reliever, such as Tylenol or ibuprofen, before the colposcopy.
During the procedure, some women feel some cramping, while others don't feel anything at all. You don't feel cutting or heat from the loop because of the local anesthetic. You may experience some bleeding afterward. That's normal, and Schaffir recommends using a sanitary pad following the appointment and for a day or so afterward.
In addition to possible cramping and a small amount of bleeding, LEEP can cause cervical scarring that may cause difficulties with becoming pregnant and delivering the baby. Women who are planning to have children following cervical dysplasia should discuss all of their options with their doctor.
Preventing cervical cancer
Cervical cancer is the fourth-most common cancer among women globally, with over 600,000 estimated new cases and 342,000 deaths in 2020. Nearly 95 percent of cervical cancer is caused by the human papillomavirus (HPV).
HPV is the world's most common sexually transmitted virus. Most adults who are sexually active are infected with HPV at some point in their lives. In most healthy people, their immune system eventually clears the infection without treatment. However, there is the risk that an HPV infection will become chronic, with precancerous lesions that can progress to several types of invasive cancer, including cervical cancer.
The best way to avoid the variety of cancers caused by HPV—including cervical, vulvar, vaginal and anal, among others—is to get the HPV vaccine, which is approved by the Food and Drug Administration for adults up to age 45.