Was Sie während eines LLETZ-Verfahrens bei abnormalen Zellen erwarten können

When I received the news I had to have a LLETZ procedure earlier this year, I was terrified. Much of the information available online was related to people's bad experiences - and many of my searches led me to cancer forums, which was anxiety-inducing in and of itself.

In reality, it was nothing like I'd feared.

LLETZ stands for 'large loop excision of the transformation zone'. It's the most common treatment for removing cell changes in the cervix.

Wenn ein Abstrichtest ein abnormales Ergebnis zeigt, werden Sie möglicherweise eingeladen, einen Kolposkopie, eine weitere Untersuchung, bei der ein Arzt Ihren Gebärmutterhals untersucht und oft eine Biopsie, eine kleine Gewebeprobe des Gebärmutterhalses, entnimmt. Wenn diese Biopsie Zellveränderungen zeigt, könnte Ihr Arzt empfehlen, dass Sie eine LLETZ durchführen lassen, erklärt Imogen Pinnell, Gesundheitsinformationsmanagerin bei Jo's Gebärmutterhalskrebs-Stiftung.

"Cell changes aren't cervical cancer, but having LLETZ makes sure the cell changes don't develop any further," she says.

You may also be told how severe the abnormalities are. Abnormal cells are often referred to as CIN (cervical intraepithelial neoplasia) - with CIN1 referring to mild changes, CIN2 to moderate and CIN3 to severe.

"Es hängt von diesem Bereich und der Lage der abnormalen Zellen ab, ob LLETZ als die beste Methode zur Entfernung dieser Zellen vorgeschlagen wird", sagt Pierre Martin Hirsch, Präsident der British Society for Colposcopy and Cervical Pathology und Sprecher der Königliches Kollegium der Geburtshelfer und Gynäkologen.

What is the procedure like?

A LLETZ procedure starts out much like a regular cervical screening, with a speculum inserted into your vagina. A local anaesthetic is then injected into your cervix, meaning you're awake but the area being treated is numb.

A thin wire loop, through which an electric current is running, is then used to remove the area of the cervix where there are cell changes and to seal the cut at the same time. This should take around twenty minutes in total.

The operation shouldn't be painful. "Some people feel slight discomfort from the insertion of the speculum, and may feel some pain when the local anaesthetic injection is administered," says Martin Hirsch. "But you shouldn’t feel any pain during the excision of the cells - and you should let your doctor know if you do."

Martin Hircsh's advice bears out. During my procedure, I started to feel a small amount of pain; when I told my doctor, she immediately gave me another anaesthetic injection and the procedure carried on pain-free.

What are the side effects?

Nach dem Eingriff können Sie Krämpfe verspüren - Pinnell vergleicht dies mit Regelschmerzen. "This is expected for a day or two after treatment," she says. "But it shouldn't be severe. If you're worried, it's important to let your doctor know so you can get the right care and support."

You may also experience bleeding and discharge for up to three to four weeks, though for some people this may stop as early as one to two weeks. You are advised not to have penetrative sex, use tampons or swim after LLETZ until bleeding has stopped. Recommendations vary when it comes to bathing - my doctor told me I was okay to bathe in a clean bath, whilst others recommend you try to avoid it until you've stopped bleeding. Check with your own doctor to work out what's best for you.

"But it’s really important to remember that everyone heals in different ways," Pinnell says. "Some people experience different side effects or for a longer time, and can feel unprepared if they're not made aware this is a possibility."

Other effects can include heavier or longer-lasting bleeding, Pinnell notes, but also "anxiety and changes to sex life".

Aktuell zeigt die Forschung von Jo's Trust fand auch heraus, dass Patienten oft nicht über mögliche Nebenwirkungen, einschließlich der Auswirkungen auf die Libido, informiert wurden. Sie plädieren für bessere Informationen und Unterstützung für diejenigen, die sich Verfahren zur Entfernung abnormaler Zellen unterziehen.

"The diagnosis itself can have a profound psychological impact and there is a low level of awareness about this, despite there being support and treatments available for those affected," Pinnell says.

Aber positiv zu bleiben ist entscheidend.

"It’s important to remember that most people who have LLETZ have a positive experience and the main benefit of having this treatment is that it can prevent the potential development of cervical cancer," she concludes.

Was passiert als Nächstes?

"One of the benefits of LLETZ is that because the cells are removed rather than destroyed, they can be sent for further tests to confirm the extent of the cell changes and make sure all of the affected area has been removed," Pinnell explains.

She also notes that LLETZ is extremely effective - there's a success rate of around 90%, meaning that most people who go through with the procedure will have no further cell changes.

Results should take a few weeks to come back - sometimes slightly longer if additional tests are needed. This shouldn't be cause for concern. My results were even passed to a multidisciplinary team before I was given the all clear.

If the treatment has worked, you'll be asked to book an appointment for a follow-up in six months time; this will take the form of a routine smear test. And if this follow-up shows you're still clear of abnormal cells or HPV, you'll go back to having a smear test every three years.

Pathways can vary if the LLETZ is unsuccessful - sometimes further tests will be done, or the procedure will be repeated. In these cases, Martin Hirsch advocates speaking with your nurse or doctor about the options available to you.