How are cell changes treated?

If cell changes have been detected, these may return to normal by themselves. If this is not the case, your gynaecologist will take tissue samples for further examination. This can be done with a colposcopy and taking a small biopsy from the area in question. Affected tissue can also be removed surgically in order to prevent cervical cancer.

After your PAP results, what happens next?

If your results indicate slightly abnormal findings but no significantly changed cells, your gynaecologist may suggest regular check-ups. These will depend on your age, the extent of the cellular changes and, if you are over the age of 35, the results of your HPV test.

Treatment is not necessary at this stage. If the results show slight to moderate changes to the mucosal cells, there is a risk that these precursors could develop into a malignant tumour. The tissue may still return to normal on its own. In this case, you should attend regular check-ups at intervals of three to six months. If the cellular changes are somewhat more significant, your gynaecologist may refer you to a specialised dysplasia clinic for a cervical endoscopy. This is either an appointment or an examination with a gynaecologist specialising in oncology.

If changes are detected during the colposcopy, your gynaecologist will take tissue samples from the cervix and mouth of the uterus. These samples will then be examined under a microscope by a pathologist.

Important to know Cell changes can also be caused by other factors such as inflammation. If you have a bacterial infection, your gynaecologist can prescribe antibiotics, while a fungal infection can be treated with antimycotics in the form of a cream or pessary. Cell changes may also be a sign of a hormone deficiency. Local treatment of the vagina with a gel or hormone-based ointment are viable alternatives.

A cone biopsy: diagnostics and treatment combined!

If the diagnosis from a tissue sample is not conclusive, your gynaecologist may opt to perform a cone biopsy. Here, a cone-shaped wedge of tissue is removed from the cervix through the vagina using an electric loop or laser beam. The sample is then examined by a pathologist. This diagnostic method can simultaneously be a means of treatment. If you have been diagnosed with very small tumours at an early stage, this treatment method can be effective. If the cancer is removed with sufficiently wide margins, the risk of the cancer returning is reduced.

Important: following a cone biopsy, you should avoid swimming, bathing, saunas, tampons and sex for three to four weeks.

Fertility following diagnosis of a precancerous condition

If you were diagnosed with a precancerous condition which has since resolved itself, there is no reason why you should not be able to have children. In fact, you can still become pregnant after a cone biopsy, even if this intervention had to be repeated. However, the risk of premature birth is greater. Your gynaecologist will be able to explain the possible risks and monitor your pregnancy closely if necessary.

Consultations for greater peace of mind A second medical opinion can give you greater peace of mind when deciding which treatment is best for you. Dysplasia centres specialise in cervical cancer. Larger gynaecological cancer centres and gynaecological clinics offer specialist consultations. You may find the German-language database OncoMap useful. Tell the gynaecologist treating you about this so that she can provide you with copies of the necessary documents, e.g., medical reports and laboratory findings.

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e. V. (DGGG): S3-Leitlinie. Diagnostik, Therapie und Nachsorge der Patienten mit Zervixkarzinom. Stand: 30.04.2016. Geplante Fertigstellung: 31.12.2020. URL: https://www.awmf.org/leitlinien/detail/anmeldung/1/ll/032-033OL.html (abgerufen am: 11.08.2020).

Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG): Gesundheitsinformation: Wie wird Gebärmutterhalskrebs behandelt?, 18.04.2018. URL: https://www.gesundheitsinformation.de/wie-wird-gebaermutterhalskrebs-behandelt.2109.de.html?part=behandlung-2g (abgerufen am: 11.08.2020).
Krebsinformationsdienst des Deutschen Krebsforschungszentrums: Gebärmutterhalskrebs: Vorstufen von Gebärmutterhalskrebs, 06.03.2020. URL: https://www.krebsinformationsdienst.de/tumorarten/gebaermutterhalskrebs/vorstufen.php (abgerufen am: 11.08.2020).