What is cervical intraepithelial neoplasia?


Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells (neoplasia) or lesions on the outer wall of the cervix (intraepithelial). CIN can be detected during your routine Papillomavirus test and is most often caused by one of the 100 subtypes of human papillomavirus (HPV).

CIN is also considered a “precancerous” cancer because having CIN is a risk factor for developing cervical cancer at a later time. Depending on your age, risk factors for cervical cancer, and your condition, treatment protocols may vary.

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Symptoms of cervical intraepithelial neoplasia (CIN)

Cervical intraepithelial neoplasia can occur without your knowledge, as there are usually no symptoms. This is why it is so important to perform routine smears: only a smear will show the abnormal cells.

Another classification will take place after diagnosis to specify the amount of tissue affected. The three levels of the CIN include:

  • Low grade neoplasia (CIN 1) concerns about a third of the thickness of the epithelium.
  • CIN 2 refers to abnormal changes in about one-third to two-thirds of the epithelial layer.
  • CIN 3 (the most severe form) affects more than two-thirds of the epithelium.

Postcoital bleeding could signal CIN

If you have vaginal bleeding or spotting after penetrating or oral sex, talk to your doctor. While this is not a hard and fast rule, research suggests it may be a predictor or sign of CIN. It can also indicate an infection like HPV that causes CIN. While there could be many other reasons, it is best to get it checked out, especially if you are due for a Pap or HPV test.

Causes

Cervical intraepithelial neoplasia is most often caused by variations in HPV (i.e., HPV16 and HPV18) infecting a woman’s reproductive system. The World Health Organization claims that these two types of HPV (16 and 18) are responsible for 70% of cervical cancer and precancerous lesions of the cervix.

Certain risk factors also increase your likelihood of coming into contact with HPV, but you should be aware that this is a fairly common virus. Estimates indicate that more than three-quarters of all sexually active women will be infected with HPV at some point in their lives.

Additional risk factors include:

  • Age (approximately 50% of HPV infections occur in girls and women aged 15 to 25)
  • Smoking cigarettes
  • Take immunosuppressive drugs
  • Having unprotected sex
  • Having sex with more than one person
  • Sexual activity before age 18

You can protect yourself against HPV infection by getting the vaccine.

Diagnostic

If your smear results show abnormal cells, your doctor or their office will contact you to discuss the next steps. Although this is a naturally overwhelming experience, precancerous cells usually don’t become cancerous for years, if at all.

The next step is often to get a real picture of what is going on with colposcopy so that your doctor can examine the cervical area under a microscope.

Colposcopy can be done in your doctor’s office and can also be used to look at:

  • Growths or lesions
  • Inflammation
  • Warts

From this, your doctor can decide whether to perform a biopsy or whether close monitoring (smears more frequently) is sufficient at this time. DNA tests may also be done to see if you have a high risk form of HPV.

If your HPV status is unknown, be aware that the screening guidelines recognize the HPV test as a method of detecting and preventing CIN and cervical cancer (in women 30 years of age and older). Getting tested is part of determining your overall risk and the most appropriate method of treatment.

The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) consensus risk-based management guidelines for the management of cervical cancer screening abnormalities indicate that recommendations for specific tests, including including colposcopy, are based on a risk assessment, not the smear results.

Processing

Treatment may not be necessary for low-grade CIN 1, as the underlying infection often goes away on its own. For higher grade disease, cells may need to be destroyed or removed to prevent them from multiplying or mutating over the years.

If you have a more severe grade of CIN (2 or 3), treatment options include:

  • Cone biopsy remove abnormal tissue; used for therapeutic and diagnostic purposes
  • Cryotherapy (cold therapy) to freeze and remove abnormal tissue
  • Laser therapy or laser ablation to destroy abnormal cells
  • Loop electrosurgical procedure (LEEP), which uses a thin, electrically heated metal loop to remove abnormal tissue from the cervix

Research on alternative treatments or potential contributing factors that can be manipulated for therapeutic purposes is also ongoing.

One of these studies examined how the presence or absence of Lactobacilli spp. (a common probiotic) has changed the vaginal environment. Lower levels were associated with lower disease regression rates at 12 and 24 month follow-ups, suggesting a link that requires further investigation.

Prognosis

The prognosis for CIN will depend on two factors:

  • The severity level of the abnormal cell coverage on your cervix when the smear is found. This is why it is best to detect these cells as early as possible (the cells are less likely to multiply or mutate).
  • Your ability and willingness to follow ASCCP recommendations

What are the recommendations of the ASCCP?

The ASCCP recommends using one of six clinical actions to manage cervical cancer screening abnormalities based on the risk of developing CIN 3. These include:

  • Processing
  • Optional treatment or colposcopy / biopsy
  • Colposcopy / biopsy
  • One year monitoring
  • Three-year surveillance
  • Return to regular screening after five years

Seen all the details on the recommendations depending on the risks.

Although CIN is not cancer, it is still a medical issue requiring your attention to support a positive prognosis. If you are not sure when your last pap was or how to get one, call your doctor’s office, a community health clinic, local health department, or your local Planned Parenthood health center.

A word from Verywell

It can be scary when you get a Pap test with abnormal results, but most of the time it’s nothing to worry about. Especially when they are discovered early, the risk of these cells turning into cancer is quite low.

Still, leaving something like this untreated is not recommended. You can protect yourself by making a pap smear part of your health care routine and following your doctor’s recommendations.

Frequently Asked Questions


  • Can you get pregnant after a LEEP?

    You will need time to recover (full recovery of the cervix takes six months) before you try to get pregnant. The LEEP procedure has a low risk of scarring above the cervical opening, which can be an additional challenge for the passage of sperm, but this is rare.


  • Is CIN contagious?

    No, CIN is not contagious. It cannot be passed on to other people.


  • How did I get HPV?

    People can become infected with HPV by having vaginal, anal, or oral sex with someone who has the virus. You may not see any signs or symptoms, but the virus can still be transmitted. You don’t need to have multiple sex partners to get HPV. This can happen even if you have only had sex with one person.


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