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Gynaecology

D3

Colposcopy referral guidelines

Overview

The colposcopy clinic is a service dedicated to the care of women in the national cervical screening programme.

An abnormal smear is NOT a cancer test but it can predict changes on the cervix that could, in some cases and many years time, develop into a cancer. The best way to see if the smear is accurate is to look at the cervix using a magnified light. This test is called a colposcopy. 

The colposcopy clinic provides holistic counseling, written information, the colposcopy test and treatment for any abnormalities.

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Waiting Times

Any woman who has been told that she is being referred because her doctor is suspicious that she may have a cancer should be seen within the week (usually on a Wednesday). This is achieved by phoning the colposcopy office and faxing a referral. Any woman can be seen within 24 hours if she is suspected of having cancer and needs to be seen very urgently by contacting the Gynaecological oncologyical clinical nurse specialists.

High grade smear abnormalities suggesting invasion or high grade glandular dyskaryosis will reported by the cytology laboratory who will arrange a colposcopy clinic appointment within two weeks.

Our target is to see women with other screening smear abnormalities within a month of notification by the cytology laboratory.  Other issues such as a request to perform a difficult routine smears will be seen within a target of two months.

Women who prefer to be seen in private practice can do so by phoning the secretary or Mr Luker (Julie 01225 83 8848), Mr Porter (Nikki 01225 83 8828) or Mr Murdoch in Bristol (Sally 07847394507). However, the equipment in Bath is all located at the RUH. You can be seen as a private patient there but there are no special facilities you might normally associate with as private hospital.

Management will follow the recommendations in the NHSCSP Publication No. 20 document (ISBN 1-84-4630-14-5, Published May 2010, 2nd edition).



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Referrals to Colposcopy that fall outside of the Screening Programme

Women with cervical polyps should generally be seen in the general gynaecological programme. Benign looking polyps need no treatment. Small one that cause bleeding ones may be twisted and removed from their pedicle in primary care.

Women with post coital bleeding need a cervical microbiology swab to exclude Chlamydia at the time of referral. This is so that the result is available for the colposcopy consult to save the patient a wasted trip. Women under the age of 40 should not be seen in colposcopy.

The risk of cancer when the cervix looks normal is said to be less than 1:4000. They should be seen in the gynaecology clinic. Women over the age of 40 will be seen within 2 weeks in the colposcopy clinic and may be offered an endometrial biopsy and uterine scan.

Postcoital bleeding due to a benign non infected ectropion can be treated with ablation or cryotherapy.

Women should be warned that the treatment has a high failure rate, is associated with persistent discharge and small risk of bleeding and secondary infection and the scarring of the cervix may affect cervical mucous production.

In general it should be discouraged but it is acknowledged that some women will still want this treatment despite these warnings.

Women with an abnormal cervix should have a visual inspection of the cervix and management directed against any specific anomaly.

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Follow-up

The commissioning authorities have recently changed the follow up protocols for women who have had treatment for CIN. Women are now referred back to primary care for surveillance.

They should be seen six months after treatment with a visual inspection of the cervix using a good light source and a smear.

This smear will automatically be processed for high risk oncogenic material (HPV test of cure) is indicated by the cytology result.

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