How is cervical intraepithelial neoplasia (CIN) treated?
Treatment will depend on various factors, including the severity of CIN, the patient’s age and her general medical condition, and the preference of the patient and her doctor. Procedures to treat the cervix can affect the ability to have children, so women should discuss various options with their healthcare providers.
In the case of low-grade CIN, treatment usually is not required. In the majority of these cases, the condition resolves itself. Only about 1% of cases of low-grade CIN progress to cervical cancer. A healthcare provider may choose a conservative approach that calls for periodic Pap smears to monitor any changes in abnormal cells.
In the case of moderate and severe CIN, treatment focuses on the removal of abnormal cells that might become cancerous.
Removal (resection) procedures include:
- Loop electrosurgical excision procedure (LEEP)—This technique uses a small, electrically charged wire loop to remove tissue. Unlike ablation procedures, LEEP can remove tissue samples for further analysis. It may be used to treat severe CIN. About 1% to 2% of patients may experience complications following the procedure, such as delayed bleeding or narrowing of the cervix (stenosis).
- Cold knife cone biopsy (conization)—This is a surgical procedure in which a cone-shaped piece of tissue containing the lesion is removed. It used to be the preferred method of treating cervical intraepithelial neoplasia, but now it is reserved for more severe forms of the disease. Conization can provide a sample of tissue for further testing. It has a somewhat higher risk of complications, including cervical stenosis and postoperative bleeding.
- Hysterectomy—Removing the uterus may be an option in cases where CIN persists or does not improve after other procedures are utilized.
Most of the time, cases of CIN can be treated successfully. Ablation and resection are effective in about 90% of all cases, with a 10% chance of recurrence of CIN after treatment. It only rarely progresses to cancer, and when it does progress, it does so very slowly.
The risk of recurrence is highest during the first 2 years after treatment. Ablation and resection procedures can reduce the risk of cervical cancer by 95% in women with high-grade dysplasia in the first 8 years after treatment.
Patients are advised to have follow-up Pap tests every 3 to 6 months for 1 to 2 years after treatment. After that, they may resume having yearly Pap smears.