Glandular abnormalities of the Cervix

Introduction

You have been referred to our colposcopy department with a cervical screening test result reported as ‘Glandular Neoplasia of endocervical origin.’

This leaflet is not to replace the discussion between you and the healthcare team, but may act as a starting point for discussion and allow you to have an informed choice in your care.

What is a glandular abnormality of the cervix?

Cervical Glandular Intraepithelial Neoplasia (CGIN), is named after the parts of the cervix, which are the glandular cells inside the cervical canal.

The types of cells that form the cervix are:

• Squamous cells– flat, thin cells that look like skin and cover the outer surface of the cervix.

• Glandular cells– cells which look like columns that make a fluid called mucous and cover the inside of the cervix.

Abnormalities can occur in both groups of cells but are more common in the outer or squamous cells (called dyskaryosis in cytology (smears) and CIN on a tissue biopsy).

In around 10% of cases changes take place in the glandular cells, which line the inner part of the cervix (the cervical canal).

These may include CGIN and SMILE (Stratified Mucin-producing Intraepithelial Lesions). SMILE changes are thought of and treated in the same way to CGIN. In some occasions CIN (cervical intraepithelial neoplasia) and glandular abnormalities (CGIN) can be found together. This will be explained by the specialist looking after you.

Cervical screening (smears) can usually predict the presence of these abnormalities. If left untreated they may progress to cancer, known as “adenocarcinoma of the cervix.”

Glandular changes on a smear may also be due to changes in the lining of the womb and occasionally from changes in the fallopian tubes or ovary. If this is suspected then further investigations may be required, such as an ultrasound scan, hysteroscopy and endometrial biopsy.

How are glandular abnormalities of the cervix treated?

The cervix is examined with the colposcope (large microscope), but glandular abnormalities may be more difficult to identify as they may lie within the cervical canal and may not look as obvious on examination.

For this reason small biopsies are not usually reliable and a LLETZ (Large Loop Excision of the Transformation Zone) biopsy is recommended as an initial treatment. This is usually sufficient as 95% (95 of 100 women) of glandular abnormalities occur within 25mm of the cervix (when measured from the external point of the cervix).

Follow-up after treatment?

It is important that all women have a follow-up appointment after treatment for glandular abnormalities of the cervix (CGIN) as there is a risk of reoccurrence.

Research has shown however, if LLETZ treatment has removed all the abnormal tissue:

• the risk of recurrence of  CGIN is 2.6% (less than 3 women per 100).
• and the risk of developing a cancer is 0.35% (about 3 women in every 1000).

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

• At 6 months after treatment you will be invited for a cervical smear to be carried out in the community GP practice or Sexual Health Service, if your cervical screen is Human Papillomavirus (HPV) negative (reported as Hr HPV negative).

• You will then, at 12 months (18 months after treatment) require a further cervical smear, if your cervical screen is Hr HPV negative.

• You will then be able to return to a normal 3 yearly (36 month) recall.   

• If however at any time your cervical screen is found to be positive for Hr HPV, a cytology review will be carried out on your sample and you will then be sent an appointment to be seen back in the Colposcopy Clinic.

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

In some women, the first LLETZ may not completely remove all the abnormal tissue and a second LLETZ may be recommended to ensure the abnormal area has been totally removed.

There may be situations where a hysterectomy may be considered the safest option, these include;

• In older women where there is doubt about the upper margin (upper edge of the abnormal cells) and where fertility is no longer required.

• If abnormal cells have not been completely removed during treatment.

• Abnormal (high-grade) cervical screening tests persist, despite treatment.

• Adequate follow-up cervical screening tests are not possible, e.g. due to scarring of the cervix.

If a hysterectomy (an operation to remove part of the cervix/neck of the womb) is carried out and the glandular abnormality (CGIN) of the cervix has been completely removed, a sample will then be taken from the vagina (known as a vault smear) and further samples are required at 6 and 18 months after surgery. The samples will usually be taken in the Colposcopy clinic.

Further Advice:

We hope that you have found the information in this leaflet helpful. If you require any further advice regarding your care, please do not hesitate to ask the clinic staff. They are there to support you and are happy to help with any concerns or anxieties you may have.

Contact numbers:

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

References

Public Health England (2024) NHS Cervical Screening: Programme and Colposcopy Management,  https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management

Lellé, R.J., Küppers, V., (2023) Colposcopy: Comprehensive Textbook and Atlas

Further Information is available from:

NHS website:
www.nhs.uk

Cancer Research UK:
www.cancerhelp.org.uk
www.cancerscreening.nhs.uk

Jo’s Cervical Cancer Trust:
www.jotrust.co.uk

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

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Team is here to try to resolve your concerns. The office is based at the University Hospital of North Tees if you wish to discuss concerns in person. Our contact details are:

Telephone: 01642 624719
Freephone: 0800 092 0084
Opening hours: Monday to Friday, 9:30am to 4:00pm
Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.
Telephone: 01642 617617

Patient, Public and People with Lived Experience

We are looking for patients to share their experiences of healthcare and to join our Involvement Bank. Working with the patients, carers, families and the general population we support in making decisions about their care can lead to better health outcomes, increased patient satisfaction and a better overall experience. We want to listen and work with you in shaping the future of your healthcare services. To find out more about the Involvement Bank go to our website or contact us at:

Website: www.nth.nhs.uk/about/community/people-with-lived-experience
Email: [email protected]

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team at:

Email: [email protected]