Precancerous Changes to the Cervix
A range of cervical abnormalities can be detected by screening. In some cases, the changes to the cervix are minimal or of uncertain significance. These cases may be managed with repeated screening, HPV testing, or colposcopy. In other cases, the changes are suggestive of potentially important precancerous or cancerous lesions. These cases are often further evaluated by colposcopy and, depending on the findings, may warrant treatment.
Many cervical abnormalities involve the squamous cells of the cervix and are referred to as cervical intraepithelial neoplasia (CIN). Depending on the extent of the changes, CIN is classified on a scale of 1 to 3. CIN 1 is considered “low-grade;” the condition requires follow-up but may not require treatment. CIN 2 and CIN 3, in contrast, are considered “high-grade” changes that typically require treatment. The goal of treatment is to prevent the development of invasive cervical cancer.
The following is an overview of the diagnosis and treatment of precancerous changes to the cervix. Each person with precancerous changes to the cervix is different, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.
Conservative Surgery for Precancerous Cervical Disease
Surgical procedures that preserve the uterus and may permit future childbearing include cryosurgery (freezing), laser surgery, loop electrosurgical excision procedure (LEEP) or cold-knife conization. Cryosurgery, laser surgery, and LEEP can be performed in the doctor’s office or short procedure facility, often with local anesthesia. A cold-knife conization is a more extensive operation that involves removal of part of the cervix under general anesthesia. Not all patients can be adequately treated with cryosurgery, laser surgery or LEEP. This decision depends on the extent and appearance of the disease upon examination.
Women treated with conservative surgery require lifelong visits to their doctor to ensure that recurrence of cervical disease can be detected in the precancerous state or early while the cancer is still curable.
If the precancerous disease is more extensive or involves adenocarcinoma in situ (AIS), and the woman has completed childbearing, a total hysterectomy may be recommended. During a total hysterectomy, the entire uterus (including the cervix) is removed. In addition, doctors can perform a bilateral salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes. The decision to perform a bilateral salpingo-oophorectomy depends on the woman’s age and whether the ovaries are still functioning.
A total hysterectomy and/or a bilateral salpingo-oophorectomy are the most extensive surgical options used for precancerous disease and require general anesthesia and a hospital stay. Women undergoing a hysterectomy may experience lower abdominal pain and difficulty with urination after the operation. After a hysterectomy, women no longer menstruate and can no longer have children.1,2
Next: Stage I Cervical Cancer
1 Wright Jr TC, Massad S, Dunton CJ et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ.American Journal of Obstetrics and Gynecology. 2007;340-345.