Cervical intraepithelial neoplasia, or CIN for short, describes characteristic changes in tissue cells in the cervix. They are considered a precursor (precancerous) of cervical cancer (cervical carcinoma).
What is cervical intraepithelial neoplasia
In cervical intraepithelial neoplasia, the tissue cells on the cervix change. This change is considered the most common trigger for cervical cancer. Approximately 80% of the population is infected with HPV. Cervical intraepithelial neoplasia often occurs before menopause, so younger women in particular are at increased risk. The CIN is divided into 3 stages. For meanings of liver cirrhosis, please visit polyhobbies.com.
CIN 1: mild dysplasia
This is where the first changes in the cells occur. At this stage, an initial observation is made. If there is no regression in the next few months, the tissue is removed. About half of the CIN 1 lesions regress on their own and do not require therapy.
CIN 2: moderate dysplasia
Treatment usually takes place after a short observation period.
CIN 3: severe dysplasia
At this stage, the cervical intraepithelial neoplasia is already well advanced and requires immediate treatment. Almost the entire tissue is affected.
Another way of classification is the Pap classification. There are 5 stages, which, like the CIN classification, depend on the characteristics of the cells and the severity of the infection.
Causes
Cervical intraepithelial neoplasia is caused by infection with human papillomavirus, HPV for short. It mainly affects women between the ages of 24 and 30. With grade 3 cervical intraepithelial neoplasia, the risk of developing cervical cancer is highest.
Symptoms, Ailments & Signs
Cervical intraepithelial neoplasia usually has no symptoms. The precancerous stage can only be diagnosed as part of a regular check-up. Bloody-mucous discharges are only observed at a late stage when cervical cancer has developed. The greatest risk of cervical intraepithelial neoplasia is in women over the age of 30.
Fifteen years later, the age peak for cervical cancer occurs. However, not every cervical intraepithelial neoplasia leads to cervical cancer. In about 80 percent of the cases, the changes in the initial stage recede on their own. Overall, the precancer can be divided into three stages (CIN I-III).
Stage CIN I is characterized by mild changes in the squamous epithelium. The cell plasma around the cell nucleus lightens up. The cell nucleus can be stained more intensely. Furthermore, the cell nuclei change their shape. They no longer appear round. In stage CIN II, serious tissue changes already occur that affect almost all layers of the epithelium. Increased cell divisions sometimes also take place outside of the squamous epithelium.
The individual cells differ in shape and size. In addition, slight nuclear abnormalities are observed. However, there is still differentiation of the cell layers. In the third stage of cervical intraepithelial neoplasia, the different cell sizes are even more pronounced. It is already a carcinoma, but it is still limited to a section of tissue.
Diagnosis & History
There are no symptoms in cervical intraepithelial neoplasia. For this reason, regular gynecological examinations and cancer smears are essential. They should be carried out once a year.
During the examination, the cervix is examined in detail using an examination microscope ( colposcope ). A dilute solution of acetic acid or iodine causes characteristic changes to appear on the diseased areas of the skin.
Sometimes a cervical intraepithelial neoplasia is also palpable. If CIN is suspected, a small tissue sample is taken from the affected area. This procedure can be performed on an outpatient basis.
Complications
With cervical intraepithelial neoplasia, the greatest risk is developing uterine cancer. However, not every cervical intraepithelial neoplasia leads to cancer. Based on the severity of the disease, however, it can be estimated how high the probability of this complication is.
Spontaneous healing of the precancerous condition is possible in grades I and II. Due to various factors, however, there is a risk that a grade I and II neoplasia will also progress and develop into grade III. At this stage there is only a 10% chance of full recovery. While only observation is possible in the case of grade I and sometimes also II, in the case of grade III the altered tissue must be removed by surgery or destroyed by laser coagulation.
Because at this stage there is a high risk of developing cervical carcinoma (uterine cancer). The course of a cervical intraepithelial neoplasia is unpredictable. External factors such as immunosuppression (weakening of the immune system) or smoking as well as internal factors such as genetic predisposition promote the progression of the disease to the point of developing uterine cancer.
However, it has also been found that women who have already successfully cured cervical intraepithelial neoplasia still have a higher risk of later developing cervical cancer. The reason for this is not yet known. But it is suspected that with the surgical methods used, all neoplasms may not always be detected.
When should you go to the doctor?
Sexually mature girls and women should visit a gynecologist at regular intervals. A visit to the doctor is recommended at least once or twice a year so that the state of health can be routinely recorded and documented. The cervical intraepithelial neoplasia is characterized by an initial freedom from symptoms. However, since cervical cancer can develop if left untreated, it is necessary to have preventive examinations carried out. If there are any irregularities in the abdomen or if there are any changes, a doctor should also be consulted.
There is a need for action if there is pain or changes in monthly menstrual bleeding. If you feel vaguely unwell or if you know that your sex partner is suffering from papilloma viruses, you should consult a doctor. It is advisable to check the state of health so that appropriate medical treatment can be initiated if necessary. In the case of changes in the libido or other discrepancies in the abdominal area, it is also advisable to consult a doctor.
If there is an unusual discharge or if you have unprotected sex, regular check-ups are recommended. To avoid complications and for early detection of existing diseases, regular cooperation with a doctor is necessary. Women in particular who wish to become pregnant are well advised to undergo regular check-ups by a doctor.
Treatment & Therapy
The treatment mainly depends on the severity, the age of the patient and the localization of the cervical intraepithelial neoplasia. Spontaneous healing is not uncommon. In the case of isolated altered cells, local anti-inflammatory therapy is sometimes sufficient. If the cervical intraepithelial neoplasia is already advanced, removal of the tissue is unavoidable. Laser ablation in particular is a common method. The superficial layers of the tissue are vaporized by a laser beam. However, it is not uncommon for recurrences to occur with this treatment.
Cryotherapy is recommended for smaller lesions. In this case, the affected skin area is treated and destroyed with cooling probes at a temperature of approx. minus 90 degrees. Conization with a scalpel or an electric loop is rarely used. Treatment is usually on an outpatient basis.
If cervical intraepithelial neoplasia is diagnosed during pregnancy, treatment can begin only after childbirth. Regardless of which treatment is used, regular follow-up examinations are essential.
Prevention
A cervical intraepithelial neoplasia can only be prevented to a limited extent. Frequently changing sexual partners increases the risk of cervical intraepithelial neoplasia. First and foremost, it is important to avoid infection with HPV viruses.
It is advisable to use condoms during sexual intercourse. However, these cannot offer 100 percent protection, since HPV can also be transmitted through intimate contact (petting) or touching the genitals. A vaccine against HPV has existed for several years. However, this is extremely controversial due to its sometimes serious side effects.
In addition, the vaccines are not directed against all strains of the virus, but primarily against the main triggers, the high-risk virus strains HPV 16 and HPV 18. In order to minimize the risk of cervical intraepithelial neoplasia, one should adopt a healthy lifestyle without alcohol and nicotine, as well as an annual, thorough examination by the gynecologist, be respected.
Aftercare
The cervical intraepithelial neoplasia can occur in different degrees of severity. After that comes the aftercare. Following a spontaneously healed low-grade cervical intraepithelial neoplasia, a healthy lifestyle with a diet rich in vitamins and low in sugar, abstinence from smoking and alcohol as well as sufficient sport and exercise in the fresh air is highly recommended in order to prevent renewed cell dysplasia.
Safe sex and not frequently changing sexual partners prevent infection with human papillon viruses, which are a main trigger for cell changes. A gynecological check-up with smear should be carried out every six months at the beginning and at least once a year later.
In the case of high-grade dysplasia that has been surgically removed, rest for at least a week immediately after the operation is very important. No heavy objects may be lifted and rest is conducive. An outpatient check-up is indicated after about a week. Once the wound has healed successfully, you should also pay attention to a healthy lifestyle.
Six-monthly check-ups by the gynaecologist are absolutely necessary, who will take a smear to check whether a new cervical intraepithelial neoplasia has occurred. Stress and emotional strains weaken the immune system and also promote the disease.
You can do that yourself
Most women with cervical intraepithelial neoplasia can go about their daily lives without any problems. The disease is usually asymptomatic. In a few cases, there is a disturbance in the libido. Therefore, the disease can sometimes put a strain on the partnership. For some of those affected, it is advisable in such a case to consult a couples therapist.
Pain occasionally occurs only in the case of advanced cervical intraepithelial neoplasia. Discomfort or bleeding during intercourse can sometimes occur. It is therefore advisable to refrain from sex with penetration, at least for the time that the disease is being treated. Afterwards, the affected women should definitely use condoms, otherwise a new infection or other complications can occur. This is particularly important if you frequently change partners. Sexual intercourse should definitely be stopped if pain or bleeding occurs.
In order to prevent the development of cancer, it is absolutely necessary to reduce risk factors. Affected smokers should stop their nicotine consumption immediately. In addition, excessive alcohol consumption should be avoided. Any excess weight must also be reduced urgently. A healthy diet and a stable immune system are particularly important.
