Tuesday, July 22, 2014

Cervical Cancer - Treatment for CIN and Carcinoma in Situ

Treatment


Treatment of Pre-Invasive Cancer

Treatment of cervical intraepithelial neoplasia (CIN), including pre-invasive cancer, depends on the type and extent of abnormal changes. Some of the treatments for CIN are also used for early-stage cancer.

  • CIN I often goes away on its own. Careful follow up is required to make certain that the Pap smear and colposcopic exam return to normal.
  • CIN II or CIN III may turn into invasive cancer if the suspicious area is not removed. This is often done using an outpatient technique called loop electrosurgical excision procedure (LEEP). [See Surgery section.]
  • If doctors cannot see extensive areas of CIN II or III with colposcopy or if these areas have spread into the mucous membrane in the cervical canal, a more aggressive procedure called conization (cone biopsy) may be required. [See Surgery section.] Since CIN III is considered equivalent to Stage 0 cervical cancer, other procedures may be used if LEEP or conization are inadequate.

Treatment of Invasive Cervical Cancer

In contrast to cervical intraepithelial neoplasia, cervical cancer represents true invasion of cells beyond the epithelium into surrounding tissue. Cervical cancer may be detected in a biopsy performed during colposcopy for an abnormal Pap smear, or it may be visible to the naked eye when the doctor performs a speculum exam.

After making a diagnosis, the doctor will classify the stage of the cancer according to how far the disease has spread into the lining of the cervix, throughout the cervix, or beyond. Doctors use these classifications to determine treatment and prognosis.

Stages of Cervical Cancer

Stage 0. Stage 0 cancer is also called carcinoma in situ. It is equivalent to CIN III pre-invasive cancer. In stage 0, the cancer cells are confined to the first layer of cervical tissue (the epithelium) lining the cervix and have not yet spread further in the cervix.

Stage I. Stage I is invasive cancer, but the tumor is confined to the cervix. This stage is further categorized as IA and IB, which each have further subcategorizations based on the size of the tumor:

  • In stage IA, the cancer cells can be seen only under a microscope. In stage IA1, there is minimal invasion (less than 3 mm and less than 7 mm wide) In stage IA2, there is deeper invasion of 3 - 5 mm) but the microscopic tumor is still less than 7 mm wide.
  • In stage IB, the cancer is either visible without a microscope, or it is still microscopic but is more than 5 mm deep or 7 mm wide. Cancer that can be seen without a microscope is divided into Stage 1B1 and Stage 1B2. In stage 1B1, the cancer is smaller than 4 cm. In stage IB2, the cancer is larger than 4 cm.

Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)