The treatment you need for CIN, if any, depends on the type of CIN you’re diagnosed with. Below we’ve compiled a thorough overview of the types of treatment, and what you can expect afterwards, below.
How is CIN 1 treated?
CIN 1 does not usually need treatment. Provided a high grade abnormality has been excluded by colposcopy, most cases of CIN 1 are left to resolve spontaneously. A follow-up with colposcopy or a smear is recommended in six months’ time to make sure that further changes have not occurred.
How is CIN 2 and 3 treated?
CIN 2 and 3 should be treated by removing the abnormal area of skin whilst damaging the normal tissue as little as possible. Some treatments destroy the abnormal cells rather than removing them but then one never knows exactly what the abnormality was or whether it has been completely treated.
What are the ways of removing CIN?
CIN can be removed using electro surgery (LEEP / LLETZ procedure), laser excision, or a cone biopsy. Very occasionally it may be part of more extensive surgery such as a hysterectomy. When CIN is excised it is sent to the laboratory for analysis to check exactly what has been removed and whether it has been removed completely.
What are the ways of destroying CIN?
CIN may be destroyed by cold coagulation, cryotherapy or laser vaporisation. These procedures do not provide a sample for analysis so the grading of the abnormal tissue that has been destroyed is not available. Nor is it possible to know whether the treatment is complete.
Which treatments are best?
Excision is safer than destroying CIN because the tissue is available for analysis in the laboratory. LEEP / LLETZ treatment is the most common but sometimes results in more tissue being removed than necessary. An experienced and skillful doctor can make all the difference with this procedure.
How are treatments done?
Most of the time, CIN can be treated in the outpatient setting using local anaesthetic. The treatment only takes 5 to 10 minutes and is not painful although it may be uncomfortable. Occasionally treatment is performed under general anaesthetic.
Types Of Treatment
What is LEEP treatment?
LEEP is an acronym for Loop Electrosurgical Excision Procedure. LEEP is the preferred name in the USA, but in the UK the same treatment is called LLETZ. LEEP is used to remove the small piece of skin that is abnormal using a fine wire loop with an electrical current to cut out the abnormal skin. LEEP is sometimes called a cone biopsy because the shape of the tissue removed is cone shaped.
What is LLETZ treatment?
LLETZ is an acronym for Large Loop Excision of the Transformation Zone. LLETZ and LEEP are different words for exactly the same treatment. The transformation zone is the part of the cervix where the abnormal skin is found. LLETZ treatment uses a fine wire loop with an electrical current to remove the abnormal skin. LLETZ is also sometimes called a cone biopsy because the shape of tissue removed resembles a cone.
What is laser treatment to the cervix?
A laser can be used to remove the abnormal cells in the same way as a LEEP or LLETZ treatment. This is sometimes called a laser cone biopsy. A laser cone biopsy takes a little longer than a LEEP or LLETZ, but it is more precise and allows the area treated to be more carefully tailored to the area of abnormal skin, probably reducing the amount of unnecessary tissue removed.
Laser is also used to vaporize or destroy the abnormal cells. Laser vaporization is similar to other destructive treatments. This is sometimes called laser ablation. With laser ablation, no tissue is available for analysis in the laboratory.
What is a cone biopsy?
The term cone biopsy can be used in two ways. Firstly it can be used as a generic term to include all types or excisional treatment because they produce a piece of tissue that is generally shaped like a cone, as you can see in the diagram. So one might talk about a laser cone biopsy. This could be a very small precise treatment.
The other use for the term is to refer specifically to treatment done with a scalpel to cut out the cone of tissue. This is done under general anaesthetic and is performed very rarely these days. In the past, the term usually referred to a large biopsy, followed by stitches to the cervix.
What is NETZ?
NETZ is an acronym for needle excision of the transformation zone. NETZ uses a diathermy current like a LLETZ or LEEP but instead of a loop, a straight wire is used. This allows the abnormal tissue to be removed by a carefully tailored cone biopsy, rather like a laser cone biopsy. NETZ can be performed under local anaesthetic like a LEEP / LLETZ or general anaesthetic.
What is cold coagulation?
Cold coagulation is so called to contrast it with cautery which is very hot. Cold coagulation involves moderate heat used to destroy the abnormal cells using a hot probe placed on the skin of the cervix. Cold coagulation has a good success rate overall. The main disadvantage is that no sample is available for analysis, and very occasionally a small cancer may be missed by treating with cold coagulation.
What is cryotherapy?
Cryotherapy uses a metal probe that is frozen to treat the abnormal skin. The treatment is very easy and quick and is done without anaesthetic. However, cryotherapy may not treat the tissue to sufficient depth and so the success rate is not as good as other techniques. Cryotherapy has been used a lot in the USA but it is not frequently used in the UK.
After Treatment for CIN
What should I expect after treatment?
Some bleeding is common after treatment. It is usually not apparent immediately but the bleeding may start and stop and occasionally goes on for 3 to 4 weeks. It is usually heaviest at about 7 to 10 days after treatment and may be bright red at this stage. If there is very little bleeding you may notice a watery discharge. Some cramping period like pain may be noticeable for the first few days also. Many women feel tired after a treatment and this sometimes last a day or two.
Are there any things I should avoid after treatment?
It is best to avoid intercourse whilst the cervix is healing and this takes about 4 weeks. Otherwise, it is fine to resume all your normal activities. It is probably best to avoid very strenuous exercise for the first few days or if you are having troublesome bleeding.
Is one treatment all that is necessary?
Mostly, a single treatment is all that is necessary to remove the abnormal skin completely. In a small number of cases, the abnormality will recur or persist after treatment. To a certain extent this depends upon the skill of the person doing the treatment.
Do I need follow up after treatment?
For most women, a single treatment is all that is required. However, for a small number, abnormal cells will develop again. For this reason, careful follow up is usually recommended.
What is the risk of recurrence after treatment?
Overall, the risk of needing a second treatment is about 1 in 10 women treated. In the very best centres, the risk of recurrence is about 1 woman in 40.
What affects the chance of recurrence?
We know that if the abnormal skin is removed completely with clear edges on histology, then the chance of recurrence is much less than if the abnormal skin goes right to the edge of the tissue removed. This is determined by sending the sample to the laboratory for analysis.
Is there anything that I can do to reduce the chance of recurrence?
Interestingly, vaccination with HPV vaccine seems to reduce the risk of recurrence by increasing the immune response to the virus associated with the abnormalities.
Will a LEEP / LLETZ treatment affect sex?
A LEEP / LLETZ treatment will not affect your ability to enjoy sex once the cervix is completely healed which takes about 4 weeks.
Does a LEEP / LLETZ treatment affect fertility?
Some very large studies have suggested that a LEEP or LLETZ treatment may affect fertility very slightly. The effect is so small it is not likely to be of any significance. Why this occurs is not completely understood but it may be the loss of a small part of the canal of the cervix affects sperm motility.
Does a LEEP / LLETZ treatment affect future pregnancies?
After LEEP / LLETZ treatment there is a very small increase in the risk of your baby being born prematurely. This seems to be related to a problem called cervical incompetence when the cervix is not strong enough to hold the pregnancy in, and slowly dilates, leading to premature labour. The risk of this problem is related to how big a treatment was needed and also whether more than one treatment is necessary. In a pregnancy following a LEEP / LLETZ treatment, the cervix can be examined by ultrasound scan in the weeks between about 12 and 20 weeks. If any signs of the cervix shortening or dilating are noted, a stitch may be placed to stop this happening. This is a very successful approach which will help most pregnancies to continue for a normal time.
What treatment is done if the abnormal cells come back?
In most cases when abnormal cells recur it is possible just to treat the cervix again. In this situation it is best to do an excisional treatment to be sure that the treatment is complete.