Introduction Different approaches to screening and treatment of cervical precancer Anatomical considerations

Anatomical considerations Gross anatomy of female genital organs, External genitalia Internal genital organs Gross anatomy of the cervix Cervical epithelium Squamous epithelium Columnar epithelium Squamocolumnar junction (SCJ)

Physiological changes of the cervical epithelium

Ectropion Squamous metaplasia Transformation zone of the cervix Changes induced by pregnancy Atrophic changes Congenital transformation zone (CTZ)

Neoplastic changes of the cervical epithelium

Genesis of cervical cancer – Role of HPV HPV structure and types Genesis of precancerous lesions and cervical cancer Cervical intraepithelial neoplasia (CIN) Adenocarcinoma in situ (AIS) Cervical cancers

HPV tests – Variation between tests Instruments, consumables, and setup required

for collection of samples for HPV testing (provider-collected) for self-collection of samples for HPV testing

Procedure to collect samples for HPV testing

Sample collected by a health provider Counselling of a woman undergoing HPV testing History taking Preparation for sample collection for HPV testing Steps for inspection of the external genitalia Steps for insertion of the speculum and exposure of the cervix Steps for collection of cervical samples Steps for self-collection of samples Storage of the samples after collection, and transportation to the laboratory

Interpretation of HPV test results Management of women with a positive HPV test result

Management of women with a positive HPV test result The different strategies Triage with cytology Triage with VIA Triage with colposcopy

Treatment of cervical intraepithelial neoplasia – principles Steps to determine eligibility for ablative treatment

Criteria used to determine eligibility for ablative treatment Steps to determine eligibility for ablative treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment

Role of Lugol’s iodine in identifying the transformation zone for treatment Steps for applying Lugol’s iodine to the cervix Pre-treatment assessment

Treatment by cryotherapy

Principles Cryosurgical unit Ancillary instruments and consumables Steps Side-effects and complications Post-treatment advice and follow-up Video

Treatment by thermal ablation

Principles The benchtop model The battery-operated model Complications Video

Using an HPV test as the test of cure in women treated for cervical abnormalities or cervical intraepithelial neoplasia (CIN) Infection prevention

Standard procedures for protection from infection Essential steps for infection prevention in a cervical cancer screening clinic Preparation of 0.5% chlorine solution

Case studies

VIA triage outcome (applicable in screen-and-treat setting only) – negative cases VIA triage outcome – positive cases VIA triage outcome – suspicious of cancer cases

Foreword Acknowledgement Authors Suggested citation Copyright

Home / Training / Manuals / Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide / Learning

Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

Filter by language: English / Français / Español

Neoplastic changes of the cervical epithelium – Cervical intraepithelial neoplasia (CIN)

Click on the pictures to magnify and display the legends

Cervical intraepithelial neoplasia (CIN) is a precancerous condition because the abnormalities are restricted to the thickness of the squamous epithelium. The neoplastic cells do not breach the basement membrane to invade deeper into the stroma or beyond. Depending on the severity of the abnormality and the extent of involvement of the thickness of the squamous epithelium, CIN lesions are graded as CIN1, CIN2, and CIN3.
The neoplastic cells present in CIN have a higher nuclear–cytoplasmic ratio compared with normal cells, an irregular nuclear membrane, dense chromatin in the nucleus, and mitotic figures. These features increase in prominence with higher grade of neoplasia. In addition, the normal systematic arrangement of the different layers of the epithelium is lost (this is called a loss of polarity) as the cells become cancerous.

CIN1 is the earliest form of CIN, in which the neoplastic cells are limited to the lower third of the thickness of the cervical epithelium. Most of these lesions are caused by a transient HPV infection and disappear with the clearance of the HPV infection. The abnormal cells have the classic features of HPV infection. These cells (also known as koilocytes) have an empty and irregular zone (a halo) around the nucleus, and the nucleus is often larger in size, with irregular borders.

In CIN2 and CIN3, the cervical epithelial abnormalities extend to the middle third and the upper third of the thickness of the cervical epithelium, respectively, and the cellular abnormalities become progressively more severe. The rapidly dividing abnormal cells cannot accumulate glycogen, and the cytoplasm remains intact.

CIN1 lesions rarely progress to invasive cancer, but about 30–50% of CIN3 lesions will progress to invasive cancer if left untreated. The potential of CIN2 to progress further is somewhere between that of CIN1 and that of CIN3. CIN1 lesions are also known as low-grade squamous intraepithelial lesions (LSIL), because of the low potential for progression. CIN2 and CIN3 lesions are grouped together as high-grade squamous intraepithelial lesions (HSIL).

The next section provides more information about glandular precancers: adenocarcinoma in situ.

IARC, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France - Tel: +33 (0)4 72 73 84 85 - Fax: +33 (0)4 72 73 85 75
© IARC 2024 - All Rights Reserved.