Glandular abnormalities of the Cervix

You have been referred to the Colposcopy Unit after your cervical screening test showed ‘Glandular Neoplasia of Endocervical Origin’.

This leaflet provides information about your result and what to expect. It should be used alongside discussions with your healthcare team to help you make informed choices about your care.

What is a Glandular abnormality of the cervix?

Cervical glandular intraepithelial neoplasia (CGIN) is a precancerous change affecting the glandular cells that line the cervical canal.

The types of cells that form the cervix are:

• Squamous cells– flat, thin cells that cover the outer surface of the cervix.
• Glandular cells – Column-shaped cells that line the inside of the cervix and produce mucus.

Abnormalities may affect both of the above cell types, but are most common in squamous cells.

Around 10% of cervical cell changes occur in the glandular cells lining the cervical canal. These include CGIN and SMILE (Stratified Mucin-producing Intraepithelial Lesion), which is managed similarly to CGIN. CIN and CGIN may sometimes occur together.

Cervical screening (smears) can usually detect these abnormalities. If untreated, they may progress to cervical adenocarcinoma (cervical cancer). Glandular changes on a smear may also arise from the lining of the womb and, less commonly, the fallopian tubes or ovaries. Further investigations, such as ultrasound, hysteroscopy, or endometrial biopsy, may be required if this is suspected.

How are glandular abnormalities of the cervix treated?

Glandular abnormalities are assessed by colposcopy, although they can be harder to identify because they may lie within the cervical canal and be less visible on examination.

Small biopsies are often unreliable, so a LLETZ (Large Loop Excision of the Transformation Zone) is usually recommended for diagnosis and treatment.

Follow-up after treatment/What will my follow-up plan of care look like after a complete excision of glandular abnormalities (CGIN):

Follow-up after treatment for CGIN is important because there is risk of recurrence. However, if LLETZ has completely removed the abnormal tissue, the risk of recurrent CGIN is 2.6% (fewer than 3 in 100 women), and the risk of developing cervical cancer is 0.35% (around 3 in 1,000 women).

• 6 months after treatment – You will be invited for cervical screening at your GP practice or Sexual Health Service. If the result is hrHPV negative, no further action is needed at this stage.
• At 12 month – a further cervical screen is required. If this is also HPV negative you can return to 3 yearly screening.
• If HPV is detected at any stage- you will be referred back to the colposcopy unit for further assessment.

What if my treatment has not completely removed the gWhat if the glandular abnormality has not been completely removed?

In some cases, the initial LLETZ does not remove all abnormal tissue, and a second LLETZ may be recommended.

A hysterectomy may be considered by your consultant in certain situations, including:

• When abnormal cells remain after treatment.
• When there is uncertainty in the complete removal of the abnormal cells, particularly in women who no longer with to preserve their fertility.
• When adequate follow-up cervical screening is not possible for example due to cervical scarring.

If a hysterectomy is performed and the CGIN has been completely removed, follow-up is still required. This is usually arranged by your gynaecologist, as vaginal vault samples (vault smears) which are not part of the routine cervical screening programme, therefore you will have a hospital appointment arranged.

Contact numbers

If you need further advice, or have any problems, please contact the appropriate number below:

University Hospital of North Tees

Outpatients Department:
Monday to Friday, 09.00am to 5.00pm
Telephone: 01642 624172

University Hospital of Hartlepool

Outpatients Department:
Monday to Friday, 09.00am to 5.00pm
Telephone: 01429 522865

You can also contact a Specialist Nurse Colposcopist on the following number:
Colposcopy Hub
Monday to Friday, 8.30am to 4.30pm
Telephone 01429 522268

Email for enquiries: [email protected]

If you have any worries or concerns, you should contact your GP during normal surgery hours. Outside surgery hours, you should contact your GP’s surgery for the Out of Hours Service number.

Further information is available from:

NHS website – www.nhs.uk

www.cancerhelp.org.uk
www.cancerscreening.nhs.uk

The British Society for Colposcopy and Cervical Pathology: www.bsccp.org.uk

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers The University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust
Telephone: 01642 624719
Freephone: 0800 092 0084
Email: [email protected]
Monday to Friday, 9:30 am to 4:00 pm

Out of Hours
If you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).