I have just received a letter asking me to come for LLETZ although no cancer and no pre-cancer has been found during the colposcopy and biopsies taken a couple of months ago. I would like your help in understanding this letter given that the clinic/doctors/nurses have not yet been able to talk to me. In the letter, it states the following:
I am writing to you that your smear and biopsy results were reviewed in our MDT meeting as planned.
When you were initially seen in the Colposcopy Clinic you had been referred with a moderately abnormal smear. You went on to have a colposcopy examination which did show an area of abnormality. However, they did not appear seriously abnormal and we went on to take two biopsies. The results of these biopsies revealed no cancer and no pre-cancer (no CIN and no CGIN). However, it did show some viral change called HPV.
In this situation where we have a discrepancy between the smear and the biopsy, our normal procedure is to perform a further colposcopy and review in 6 months. In view of your concerns however, we discussed your case at our MDT meeting.
At the meeting the slides from the smear and biopsies were reviewed and the smear has now been upgraded to severe dyskariosis rather than moderate and in view of this change from the laboratory, we are now recommending that you should have some treatment. I have arranged for you to come back to clinic to discuss this with me and you may either have it done under local or general anaesthetic. If you are going away on holiday within 4 weeks of this, please could you contact the Women's Unit to arrange an alternative as there is a risk of bleeding and this may obviously spoil your holidays.
Attached there is a leaflet about treatments, with a short parapgraph about the LLETZ procedure.
I would very much appreciate if any of you could share your experiences/thoughs/interpretations, as I am quite confused and distressed about this, given that I have initially been told that there are no pre-cancerous cells found.
What a muddle! It does seem as though they are telling you two opposite things. Severe dyskariosis is the same as cin3, which would be considered precancerous. But they are also saying no precancer. No wonder you are confused and distressed.
to my knowledge, they would not normally do a lletz for hpv.
I m sorry I can't be of more help. I think you should ring around in the morning and try to get some answers, try your own doctor if you don't get any joy from the clinic or your consultant. But chances are they will clear up the muddle for you.
i am convinced letters like these only ever arrive at the weekend. :-(
big hugs, you'll feel better tomorrow when someone can explain it all to you.
It means that they need to remove the whole of the abnormal area because somewhere in the abnormal area there will be CIN 2/3 cells as found in the smear. It must just be a very very small part.
The biopsy only removes a tiny patch from the abnormal area and it sounds like the area that was removed was only affected by HPV and had no abnormal cells.
thank you very much for your kind words! I have now briefly talked to the nurse, who told me that the smear might reach areas higher up the canal than the biopsy - ie the biopsies may have been taken from areas that are not affected (which seems somewhat strange given that an experienced gynacologist and oncologist took the sample after studying the highlighted area in the colposcope). Her advice was to talk to the doc again. I have an appointment in a couple of weeks - let's see what she says. The thing is I am very aware of the potential detrimental consequences of LLETZ particularly when it comes to the risk of preterm delivery and miscarriage (I do not have children yet and I have had a miscarriage before) and therefore unnecessary overtreatment would seem pointless. In any case, I will keep you informed on what's happening. Thanks again, I do appreciate your concern!
