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Precursors of cervical cancer: Do you know the mysterious changes of CIN?
Cervical Intraepithelial Neoplasia (CIN) is an abnormal proliferation of cells on the surface of the cervix. This change may eventually lead to cervical cancer. CIN actually represents potentially precancerous changes in the cells of the cervix, specifically in the transition zone between cylindrical and squamous epithelium—the squamous-column junction of the cervix. The condition is divided into three main levels, which assess how abnormal the cells are.
Signs and symptoms
CIN usually does not have obvious signs and symptoms. Of course, if cervical cancer develops, you may experience some common symptoms, such as:
Abnormal or postmenopausal bleeding
Abnormal secretions
Changes in bladder or bowel function
Pelvic pain
Cause
The main cause of CIN is due to persistent HPV (human papillomavirus) infection, especially high-risk types such as types 16 or 18. Infection with high-risk HPV can affect tumor suppressor genes, such as p53 gene and RB gene, leading to abnormal cell proliferation and accumulation of mutations.
Certain groups of women are at higher risk of developing CIN, including:
Infection with high-risk HPV types (such as types 16, 18, 31 or 33)
Low immune system (e.g. HIV infection)
Bad eating habits
Multiple sexual partners
Not using condoms
Smoking
Pathophysiology
The early microscopic change of CIN is abnormal proliferation of cervical epithelium, which is almost undetectable by women. These changes mainly occur at the junction of scale and column, which is an unstable area prone to abnormal changes. In addition, cellular changes caused by HPV infection, such as koilocytic changes, are also common in CIN. Although HPV infection is required for the development of CIN, most infected individuals will not develop high-grade lesions or cancer.
Diagnostic methods
HPV tests, such as the Digene HPV test, are highly accurate and are an effective detection tool for confirming CIN. The screening process usually involves a Pap test followed by a colposcopy, which performs tissue biopsies to identify existing lesions.
Diagnosis of CIN or cervical cancer requires a tissue biopsy for histological analysis.
Grading and classification
CIN is divided into three grades based on the degree of abnormality of the cells. In 1988, the National Cancer Institute developed the "Bethesda System" to uniformly describe abnormal epithelial cells to guide clinical management. Different grades of cellular changes were reclassified as low- or high-grade fecal epithelial lesions (LSIL or HSIL) to provide clearer clinical guidance.
Screening and prevention
Screening is mainly done through Pap tests and HPV tests. Health guidance agencies recommend regular screening to detect the disease early. The HPV vaccine is the main strategy to prevent CIN and cervical cancer. Although the vaccine cannot prevent all types of HPV infection, regular screening is still needed.
Treatment Plan
Immediate treatment is generally not recommended for CIN 1 (mild abnormality) because most of the symptoms will disappear on their own within a year. In contrast, patients with CIN 2 and above require surgical resection or other ablation procedures to remove abnormal cells.
Treatment methods include cryo-necrosis, electrocautery, laser ablation, etc., but may increase the risk of future pregnancy.
Treatment Outcomes and Epidemiology
In reality, most CIN will reverse itself, and 70% of CIN 1 cases will disappear within a year. It is estimated that 250,000 to 1 million women in the United States are diagnosed with CIN each year, with the condition most affecting women between the ages of 25 and 35.
It is extremely important to popularize knowledge about CIN, because regular screening and early detection are important measures to prevent cervical cancer. But after you understand the relationship between CIN and cervical cancer, do you also realize the importance of paying attention to health screening?
