Cervical cancer: How are precancerous cells treated?

Dyoplasias have cells that have changed only in their very top layer – but they do not yet contain any cancer cells. If cancer cells have developed but haven't yet spread, it is called a “carcinoma in situ” ("in situ" is Latin and means “in its original place”). Cervical cancer is said to be "invasive" if the cancer cells have spread from the uppermost mucous membrane layer to the tissue beneath it.

Whether and when to have surgery to remove abnormal tissue is a personal decision. You are not putting yourself at risk if you don't get a low-grade or moderate grade dysplasia removed immediately. You can wait at first, and have check-ups to see what happens to the abnormal cells. This can avoid potentially unnecessary treatment.

But things are different in women who have high-grade dysplasia. Without treatment, an estimated half of these women will go on to develop cervical cancer. For this reason, doctors recommend removing the precancerous tissue using a procedure known as conization. This is usually enough to get rid of all of the abnormal tissue and prevent cervical cancer.

In conization, a roughly cherry-sized, cone-shaped wedge of tissue is removed from the opening of the cervix and the cervix itself using a laser or a scalpel. This usually removes all of the abnormal tissue. The operation is done through the vagina, under local or general anesthesia. It is usually an outpatient procedure (no need to stay overnight in a hospital).

Women may have mild pain and bleeding immediately afterwards. A reddish discharge and bleeding in the first few days after surgery are possible too. So it's important to take care and rest a lot at first, and to avoid sex in the first few weeks after surgery.

Conization usually doesn't cause any severe side effects. Surgeons should remove as much tissue as necessary, but as little tissue as possible, particularly in women who would still like to have children. Removing tissue weakens the cervix, increasing the risk of preterm birth in women who get pregnant after the procedure. This risk is especially high if a lot of tissue is removed: Conization can cause preterm birth in about 3 out of 100 pregnancies (before 37 weeks of pregnancy). Removing less tissue greatly reduces the risk of preterm birth.

If high-grade dysplasia is discovered during pregnancy, doctors normally recommend waiting and operating after the baby is born, to avoid weakening the opening of the cervix.