Preinvasive cervical carcinoma is referred to as carcinoma in situ, or cervical intraepithelial neoplasia III.
The squamocolumnar junction of the cervix is an area of active squamous cell proliferation. At puberty, due to hormonal changes and possibly due to changes in vaginal acidity, the squamous margin begins to encroach on the single layer of mucus-secreting cells, creating an area of metaplasia (cellular changes) known as the "transformation zone." Over time, varying degrees of atypical cellular changes may occur consistent with squamous cell dysplasia or cancer. Currently, the malignant potential of a specific lesion cannot be predicted, so all types of dysplasia must be observed and treated if they persist or become more severe.
Risk factors for cervical cancer include:
- Frst sexual experience at an early age
- Having multiple sex partners, or having male sex partners who themselves have had multiple partners
- A current or prior human Papillomavirus (HPV) infection, condylomata or both
- HIV infection
- A history of other sexually transmitted diseases (STDs), including herpes simplex virus
- Having had abnormal Pap smears in the past
- Cigarette smoking
- A history of cervical dysplasia or cervical, endometrial, vaginal or vulvar cancer
There are no specific symptoms or signs of cervical intraepithelial neoplasia.
Diagnosis is made by Pap smear during pelvic examination, colposcopy (viewing the cervix with 10-20x magnification), and punch biopsy (obtaining small amounts of tissue for analysis under the microscope) and endocervical curettage (gentle scraping of the cervical opening).
In women who have completed childbearing, total hysterectomy (removal of the entire uterus) is the treatment of choice. In other women, acceptable options include cervical conization (surgical removal of the entire "transformation zone" and endocervical canal), or in experienced hands, destruction of the lesion with cryotherapy or laser treatment.
Close follow-up with Pap smears every four months for one year and every six months for one year are necessary after cryotherapy or laser treatment.
What treatment do you recommend for cervical carcinoma in situ?
What type of follow-up do I need?
How often do I need a Pap smear?
Is there a chance of recurrence?
What is the prognosis?
Preventive measures include:
1. Regular Pap smears
2. Limiting the number of sexual partners
3. Using a latex condom for intercourse
4. Stopping smoking