What is Cervical Neoplasia?
A diagnosis of cervical intraepithelial neoplasia, or cervical neoplasia, refers to changes in the cervix that may or may not be precursors to cervical cancer. In fact, a cervical neoplasia diagnosis can refer to a wide range of changes to the cervix. These changes can range from self-resolving mild to moderate cervical dysplasia all the way to the early stages of cervical cancer.
Defining Cervical Intraepithelial Neoplasia
The cervical in cervical intraepithelial neoplasia has an obvious meaning, it refers to the uterine cervix, but to understand what a cervical intraepithelial neoplasia is, it helps to understand the other terms as well. Intraepithelial means "within the epithelium." The muscular structure of the cervix is covered with layers of several types of epithelial cells, and it is these cells that are affected by cervical intrapithelial neoplasia. Neoplasia literally means "new growth," but is usually used to refer to abnormal or uncontrolled cell growth. Thus cervical intraepithelial neoplasia is abnormal cell growth within the layers of epithelial cells that cover the cervix.
Grading Cervical Neoplasias
Cervical neoplasias are diagnosed by biopsy and graded according to their severity. Severity is graded as follows:
Cervical Intraepithelial Neoplasia 1 (CIN I) - mild dysplasia
CIN II - mild to moderate dysplasia
CIN III - severe dysplasia to cancer
People who are diagnosed with CIN I, or mild dysplasia (LSIL if diagnosed by Pap smear), are generally not treated since this type of cervical damage often heals itself without intervention. Instead, they are followed up more closely by their doctor, with more frequent Pap smears, HPV testing, or possibly colposcopy
In contract, individuals with CIN II and CIN III (which correspond to HSIL, ASC-H, AGC, or carcinoma in situ Pap smear diagnoses) are almost always referred for treatment. Treatment for moderate to severe cervical neoplasias involves removal of the lesions, through cryotherapy, LEEP, or conization.
Even after treatment to remove the lesion, individuals with high grade cervical neoplasias remain at increased risk of developing cervical cancer in the future. They are generally advised to continue visiting their doctors for more frequent follow-up.
Cervical Neoplasia or Squamous Intraepithelial Lesion?
When diagnosed by Pap smear, cervical dysplasias are generally known as squamous intracellular lesions (SIL) instead of cervical interepithelial neoplasias. The cervical neoplasia diagnsosis is reserved for diagnosis by biopsy or coploscopy. This is because Pap smears provide the examiner with loose cells but biopsies allow them to see any cervical damage in context. This gives doctors the ability to perform a more accurate diagnosis by determing how deep into the cervix any lesions grow.
"My Doctor Says I Have Cervical Neoplasia, Does That Mean I Have Cancer?"
Being diagnosed with a cervical neoplasia does not mean you have cancer. It doesn't even mean that you are going to get cancer. What it does mean is that you are probably at an increased risk of developing cancer at some point in the future - particularly if you are diagnosed with CIN II or CIN III.
Your absolute cancer risk is still low, after a CIN II or III diagnosis, but your doctor will probably recommend regular follow-up, just to make sure that that she can catch it early if cancer does develop. Early diagnosis and treatment is a critical step in limiting mortality from cervical cancer.
J.W. Sellors and R. Sankaranarayanan "Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner's Manual - Chapter 1: An introduction to the anatomy of the uterine cervix" International Agency for Research on Cancer 2003/4. Accessed Online 6/2/10
Kalliala I et al (2009) "Mortality in a long-term follow-up after treatment of CIN" International Journal of Cancer 126(1):224-231
Melnikow J. et al. (2009) "Cervical Intraepithelial Neoplasia Outcomes After Treatment: Long-term Follow-up From the British Columbia Cohort Study" J Natl Cancer Inst 101: 721 - 728