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Precancerous conditions of the cervix

Precancerous conditions have the potential to develop into cancer. With a precancerous condition, abnormal changes have taken place in the cells of the cervix. Over time, some of these precancerous changes can turn into cancer if left untreated. It may take many years (typically about 10 years or more) for precancerous conditions to progress into an invasive cervical cancer, but sometimes this can happen in less time.

 

The most common precancerous conditions of the cervix are:

  • cervical dysplasia
  • cervical intraepithelial neoplasia (CIN)
  • squamous intraepithelial lesion (SIL)
  • atypical glandular cells

 

All these conditions include precancerous changes to the cells that are found in the surface layer of the cervix. Precancerous changes in the cervix are quite common. They occur most often in women in their 20s and 30s.

 

There are a few different ways to describe precancerous conditions in the cervix depending on how abnormal the cells look under the microscope and how severe the cell changes are.

 

Precancerous changes in the cervix – cervical dysplasia, CIN and SIL

Cervical dysplasia

Cervical intraepithelial neoplasia (CIN)

Squamous intraepithelial lesion (SIL)

Description

mild

CIN I

low grade

early changes to the cells

 

considered a mild abnormality

moderate/severe

marked changes to the size and shape of the cells

 

cells considered abnormal

 

associated with a higher risk of becoming cancer or may indicate that there is an underlying cancer

 

CIN III also includes carcinoma in situ

 

Precancerous changes in the cervix – atypical glandular cells

Glandular cell abnormalities (Bethesda system)

Also includes

Description

atypical glandular cells (AGC)

endocervical dysplasia

 

atypical hyperplasia

 

endocervical glandular atypia

 

cervical intraepithelial glandular neoplasia (CIGN) grade 1 or 2

Cells do not appear normal.

 

Changes are associated with a higher risk of becoming cancer or may indicate that there is an underlying cancer.

adenocarcinoma in situ (AIS)

endocervical AIS

 

CIGN grade 3

Cancer cells are found in the glandular tissue of the cervix (endocervix) but have not spread into the deeper tissues of the cervix or surrounding tissue (non-invasive or pre-invasive).

adenocarcinoma

cancer

Risk factors

The following risk factors may increase a woman's chance of developing a precancerous condition of the cervix.

  • persistent human papillomavirus (HPV) infections
  • having many sexual partners
  • becoming sexually active at a young age
  • smoking
  • weakened immune system
  • multiple pregnancies (multiparity)
  • long-term oral contraceptive use
  • lower socio-economic status

Signs and symptoms

Precancerous changes in the cervix often do not cause any signs or symptoms.

Diagnosis

An abnormal Pap test result is often the first sign that some cells in the cervix are abnormal. This is why it is important to have regular Pap tests and pelvic examinations.

 

If the doctor suspects a precancerous condition of the cervix, further tests will be done to make a diagnosis. Tests may include:

  • another Pap test after a few months (usually 3 to 6 months), if there are mild changes
  • HPV test, which may be done on a sample of cervical cells taken during a Pap test
  • colposcopy and biopsy
  • endocervical curettage during colposcopy

Treatment

Often, milder changes (such as CIN I or low-grade SIL) return to normal without any treatment. The doctor will discuss if repeating the Pap test later on and waiting to see if mild changes will resolve on their own is an option. More severe abnormalities (such as CIN III or high-grade SIL) are more likely to develop into invasive cervical cancer, especially if they are not treated. It is hard to predict which of these will become invasive and which will not.

 

Treatment options for precancerous changes in the cervix may include:

References

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