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Welcome to week three of Gynaecological Cancer awareness month!

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Figure 1: A LLETZ sample, with the cervical os in the centre. This specimen was sent to histology for dissection and processing.
Figure 1: A LLETZ sample, with the cervical os in the centre. This specimen was sent to histology for dissection and processing.

The transformation zone or squamo-columnar junction was discussed in week two. A large loop excision of the transformation zone (LLETZ) specimen is a common sampling procedure of the transformation zone, performed at a colposcopy clinic to investigate and remove high grade CIN (cervical intraepithelial neoplasia). CIN is graded 1, 2 or 3, depending on how much of the epithelium is affected. Often CIN 1 does not require a LLETZ and can resolve without further treatment. CIN 2 and 3 are classed as high grade so typically require treatment. CGIN (cervical glandular intraepithelial neoplasia), can also be diagnosed by a smear test but would be investigated further by gynaecology not colposcopy. Here the columnar cells are showing dysplasia, indicating a possible lesion higher in the uterus.

At colposcopy, a clinician will use a specialised microscope to view the cervix. If positive or suspicious they may use a specialised hot wire loop to remove the cervix as seen in figure 1. The loop cauterises blood vessels as it removes tissue, to minimise bleeding and the cervix typically fully heals itself in 4-6 weeks after the procedure. The tissue is then sent to histology for dissection and microscopic examination (figure 2), often performed by a Biomedical Scientist. This is a minimally invasive procedure, ensuring good outcomes for a patient and offering an effective method of treating CIN before it can invade the surrounding tissues becoming cervical cancer.

Figure 2: Microscopic cervical cells, stained with a H&E stain. Left, is a normal section of the transformation zone where the squamous cells meet the columnar glandular cells of the endocervix. Right shows CIN 3, which is full thickness of dysplastic cells. Morphological features include abnormal nuclei and chromatin, appearing much darker in staining. Cells also have less cytoplasm as the nucleus grows out of control. Cells have not yet invaded the basement membrane but if left untreated they could, which would increase the stage of disease becoming cervical cancer.

The other gynaecological cancers described in week one are more typically investigated by a gynaecology team. They may use imaging technology such as ultrasound to investigate symptoms before deciding how to best sample any suspicious lesions found. Sampling of the uterus can be done via pipette or curette. A punch biopsy can also be performed for investigations of cervical, vulval or vaginal lesions. The LLETZ procedure is quick, simple, effective and could save a patient’s life!


Figure 1 taken from authors dissection files.

Figure 2 images taken from:

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