What is CIN?
CIN is caused by the persistent infection of high-risk HPV subtypes. It is not a cancer but a 'preinvasive' disease, in which a group of malignant cells (called a lesion) has formed but has not yet invaded surrounding tissues and other parts of the body. In the name 'Cervical Intraepithelial Neoplasia', 'neoplasia' indicates an abnormal growth, and 'intraepithelial' indicates the position of the growth in between layers of cell tissue.CIN is usually categorized into grades which signify the proportion of abnormal to normal cells and correlates to the risk of progression to invasive cancer. Grade 1 signifies a low risk of cancer: most low grade CINs resolve themselves within a relatively short space of time. However, grades 2 and 3 imply a greater proportion of abnormal cells and a higher probability of eventual cancer.
Diagnosing CIN
If a smear test confirms the presence of abnormal cervical cells you may be referred to a clinic for a further examination, called a colposcopy, in order to decide whether you need treatment. The examination is very simple, and similar to a smear. The vaginal walls are held open with a speculum, but instead of taking a sample of the cells, the doctor examines the cells from a distance using a non-penetrative microscope. If you wish, you can choose to follow this examination on a screen, called a colposcope. For more information on the smear test and colposcopy, please see our related factsheet 'The Smear Test'.CIN treatments
CIN can, over a period of years, develop into cancer, but treatment of early lesions is simple and effective. There are two forms of treatment, known as 'ablative' and 'excisional'. Ablative therapy aims to destroy the pre-cancerous cells, while excisional therapy aims to remove them. Where CIN is identified as high-grade, there is a possibility that ablative treatments will not be adequate to eliminate all the abnormal cells. In this case, an excisional treatment will be advised. Both methods take about fifteen minutes.Cryotherapy
Cryotherapy is an ablative technique which aims to destroy the neoplastic cells through thermal shock. It is effective in up to 95% of cases. The cells are frozen to a temperature of -20°C and then slowly thawed. Often this cycle is repeated to ensure that all the abnormal tissue is destroyed.As for a colposcopy, the vaginal walls are held open with a speculum in order to give a clear view of the cervix. An instrument called a cryoprobe is inserted into the vagina and the tip makes contact with the lesion of abnormal cells. The probe is made of highly conductive metal which transfers the drop in temperature to the target cells. This drop is brought about by releasing a refrigerant gas (nitrous oxide or carbon dioxide) from a compressed gas cylinder into the probe. Local anaesthetics are not usually administered for this procedure, although you may feel some discomfort when the speculum is inserted and some women experience mild cramps or a pain similar to a bee-sting when the refrigerant gas is applied.
Following this treatment up to six weeks are needed for healing. During the first month, women might experience a watery discharge, and they should avoid using tampons or having sex. It is thought that cryotherapy might increase the transmissibility of HIV, and so the use of condoms is advised. A follow-up appointment should be made for 9-12 months after the treatment to assess the regression or persistence of the cancerous lesion.
Loop electrosurgical excision procedure (LEEP) or LLETZ (large loop excision of the transformation zone)
LEEP is an excisional technique that has the advantage of preserving the extracted tissue for further examination. A small electric current is applied to a thin wire around the periphery of the affected tissue, causing the cells to separate and be cut away. This process is painless, but a local anaesthetic ensures that there is no discomfort. However, the injections of anaesthetic into the cervix can cause some transitory pain.The vaginal walls are held apart with an insulated speculum. A very thin wire loop electrode is attached to a generator and inserted into the cervix. The loop is adjusted to cover the area of the lesion, which it then cuts away and removes.
This process can cause bleeding, and so gauze is applied to the vagina to facilitate heeling and should not be removed for several hours. Following the treatment, it is normal to experience a brown or black discharge for up to two weeks. However, if moderate to severe bleeding occurs the patient should contact the clinic immediately for further help. It is not advised to use tampons or have sex for one month following treatment. Another appointment should be made for 9-12 months' time, in order to monitor healing and to check that no new lesion has formed.
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