What are the different types of cervical lesions. How are cervical lesions diagnosed and treated. What are the main risk factors for cervical cancer. How effective is cervical cancer screening in prevention.

Understanding Cervical Lesions and Their Impact on Women’s Health

Cervical lesions are abnormal cell growths on the cervix, the passageway between the vagina and uterus. These lesions can range from precancerous to cancerous, making them a significant concern for women’s health. With advancements in screening methods, cervical cancer rates have decreased, but it remains a prevalent issue. The National Cancer Institute estimates that approximately 14,100 new cases of cervical cancer will be diagnosed in the United States in 2022, accounting for about 0.7 percent of all new cancer diagnoses.

Types of Cervical Lesions: From Precancerous to Cancerous

Cervical lesions can be classified into two main categories: precancerous and cancerous. Understanding the differences between these types is crucial for proper diagnosis and treatment.

Precancerous Cervical Lesions

Precancerous cervical lesions occur when cells in the cervix begin to develop abnormal changes. While most precancerous lesions resolve on their own without causing problems, some may progress to cancer if left untreated. Medical professionals use various terms to describe precancerous cervical lesions, including:

• Cervical dysplasia
• Cervical intraepithelial neoplasia (CIN)
• Squamous intraepithelial lesion (SIL)

When examined under a microscope, precancerous cervical lesions are classified into three categories based on the extent of abnormal cell growth:

1. CIN1 (mild dysplasia): Only a few cells appear abnormal, and this type often resolves without treatment.
2. CIN2 and CIN3 (moderate dysplasia): More cells are abnormal, and treatment options may be discussed with a healthcare provider.
3. High-grade SIL (severe dysplasia): This is the most serious type and requires immediate treatment.

Cancerous Cervical Lesions

Cancerous cervical lesions are classified according to the location of the cancerous cells within the cervix. The main types of cervical cancers include:

• Squamous cell carcinoma: Originates in the cells of the exocervix, often at the junction between the exocervix and endocervix.
• Adenocarcinoma: Begins in the glandular cells of the endocervix.
• Adenosquamous carcinoma: Affects both squamous and glandular cells in the cervix.

Squamous cell carcinoma is the most common type of cervical cancer, accounting for approximately 9 out of 10 cases, according to the American Cancer Society.

The Role of HPV in Cervical Lesion Development

Human papillomavirus (HPV) infection is the primary cause of cervical lesions. The Centers for Disease Control and Prevention (CDC) reports that HPV is responsible for more than 9 out of 10 cervical cancers. While there are numerous types of HPV, about 14 high-risk strains are associated with the majority of HPV-related cancers.

HPV infection is extremely common, with most sexually active individuals contracting the virus at some point in their lives. In most cases, the immune system clears the infection naturally. However, persistent infection with high-risk HPV types can lead to the development of cervical lesions and, potentially, cancer.

Cervical Cancer Prevention: The Impact of HPV Vaccination

The introduction of the HPV vaccine has revolutionized cervical cancer prevention. A 2020 study revealed that when administered before the age of 17, the HPV vaccine reduced the risk of cervical cancer by almost 90 percent. This remarkable efficacy underscores the importance of vaccination in protecting against HPV-related cervical lesions and cancer.

Who should get the HPV vaccine?

The CDC recommends HPV vaccination for all preteens (both boys and girls) at age 11 or 12, though it can be given as early as age 9. Catch-up vaccination is recommended for everyone through age 26 who hasn’t been adequately vaccinated. For adults aged 27-45, the decision to vaccinate should be made in consultation with a healthcare provider, considering individual risk factors and potential benefits.

Risk Factors for Cervical Cancer Beyond HPV Infection

While HPV infection is the primary risk factor for cervical cancer, several other factors can increase a woman’s susceptibility to developing cervical lesions and cancer:

• Family history of cervical cancer
• Smoking
• Weakened immune system
• Long-term use of birth control pills
• Current or previous chlamydia infection
• Pregnancy-related factors (e.g., first full-term pregnancy at 17 or younger, having three or more full-term pregnancies)
• Sexual history factors that may increase HPV exposure risk

The Importance of Cervical Cancer Screening in Early Detection and Prevention

Regular cervical cancer screening is crucial for early detection and prevention of cervical cancer. Two primary screening methods are used:

1. HPV test: This test uses a sample of cervical cells to detect the presence of high-risk HPV types that could lead to precancerous or cancerous changes.
2. Pap test (or Pap smear): This test examines cervical cells for abnormalities that may indicate precancerous or cancerous changes.

Healthcare providers may recommend one or both of these tests depending on a woman’s age and risk factors. The frequency of screening may vary, but generally, women aged 21-29 should have a Pap test every three years, while women aged 30-65 may have the option of an HPV test alone every five years, a Pap test every three years, or a combination of both tests every five years.

How effective is cervical cancer screening?

Cervical cancer screening has proven highly effective in reducing cervical cancer incidence and mortality. Regular screening can detect precancerous lesions before they progress to cancer, allowing for early intervention and treatment. The American Cancer Society reports that cervical cancer death rates have dropped by more than 50% since the 1970s, largely due to the widespread adoption of screening programs.

Diagnosis and Treatment Options for Cervical Lesions

If abnormal results are detected during screening, further diagnostic procedures may be recommended:

• Colposcopy: A procedure that uses a special microscope to examine the cervix more closely
• Biopsy: The removal of a small tissue sample for laboratory analysis

Treatment options for cervical lesions depend on the severity and extent of the abnormality:

1. Watchful waiting: For mild abnormalities that may resolve on their own
2. Cryotherapy: Freezing abnormal cells to destroy them
3. LEEP (Loop Electrosurgical Excision Procedure): Using an electrical current to remove abnormal tissue
4. Conization: Surgical removal of a cone-shaped piece of cervical tissue
5. Laser therapy: Using a laser beam to destroy abnormal cells

For cancerous lesions, treatment may involve surgery, radiation therapy, chemotherapy, or a combination of these approaches, depending on the stage and extent of the cancer.

Empowering Women: Strategies for Cervical Health and Cancer Prevention

Women can take proactive steps to reduce their risk of developing cervical lesions and cancer:

• Get vaccinated against HPV
• Attend regular cervical cancer screenings
• Practice safe sex to reduce HPV exposure
• Quit smoking or avoid starting
• Maintain a healthy diet and lifestyle to support immune function
• Be aware of any unusual symptoms and consult a healthcare provider promptly

By understanding the types, causes, and prevention strategies for cervical lesions, women can take charge of their cervical health and significantly reduce their risk of developing cervical cancer. Regular screenings, HPV vaccination, and lifestyle modifications are powerful tools in the fight against this preventable disease.

Types, Tests, and Cancer Prevention

Cervical cancer starts in the cervix, which is the passageway between the vagina and the uterus. Cervical lesions are patches of abnormal cells growing on the cervix.

Sometimes, cervical lesions are made of precancerous cells. Other times, cervical lesions contain cancerous cells.

Thanks to regular screening methods, cervical cancer is not as common as it used to be. The National Cancer Institute estimates that 14,100 people in the United States will be newly diagnosed with cervical cancer in 2022. This will make up about 0.7 percent of all new cancer diagnoses.

Keep reading to learn about the different types of cervical cancer lesions and how they’re diagnosed and treated.

Precancerous cervical lesions happen when cells in the cervix begin to develop abnormal changes. This means they have the potential to develop into cancerous lesions.

Most precancerous cervical lesions go away on their own, without causing any problems. But in some people, these precancerous lesions develop into cancer. Treating precancerous lesions can prevent cervical cancer.

A doctor might use a variety of medical terms when talking about precancerous cervical lesions, including:

• cervical dysplasia
• cervical intraepithelial neoplasia (CIN)
• squamous intraepithelial lesion (SIL)

When examined under a microscope, precancerous cervical lesions are classified into one of three categories. These categories depend on how much of the cervix appears abnormal:

• CIN1 (mild dysplasia): Only a few of the cells appear abnormal. This type will often go away on its own without treatment.
• CIN2 and CIN3 (moderate dysplasia): More of the cells are abnormal. Because this type sometimes goes away on its own, you may choose to get regular screenings instead of treatment after talking with your doctor.
• High grade SIL (severe dysplasia): This is the most serious type. It needs to be treated right away.

Cancerous cervical lesions are classified according to the location of the cancerous cells. These can include cells of the:

• Exocervix: This is the outer part of your cervix that faces down into your vagina. It’s the part that a doctor looks at as a part of a pelvic exam. The cells of the exocervix are called squamous cells.
• Endocervix: This is the inner part of your cervix that faces up toward the uterus. The cells here are called glandular cells.

As such, the main types of cervical cancers are:

• Squamous cell carcinoma: Squamous cell carcinoma begins in the cells of the exocervix, often at the meeting point between the exocervix and endocervix.
• Adenocarcinoma: Adenocarcinoma begins in the glandular cells of the endocervix.
• Adenosquamous carcinoma: Adenosquamous carcinoma affects both squamous and glandular cells in the cervix.

Overall, squamous cell carcinoma is the most common type of cervical cancer. According to the American Cancer Society, it accounts for 9 out of 10 cervical cancers.

The main cause of cervical lesions is an infection with human papillomavirus (HPV). According to the Centers for Disease Control and Prevention (CDC), HPV causes more than 9 out of 10 cervical cancers.

Not all types of HPV can cause cervical cancer. There are about 14 types of HPV that are considered high risk and are responsible for the majority of cancers that are caused by HPV.

HPV infection is very common. Most people contract HPV at some point after becoming sexually active. While the immune system typically clears the infection, sometimes high risk types of HPV can remain and lead to cancer.

The good news is that cervical cancer is now a very preventable cancer because of the HPV vaccine. A 2020 study found that, when given before age 17, the HPV vaccine reduced the risk of cervical cancer by almost 90 percent.

Cervical cancer risk factors

In addition to HPV infection, other risk factors for cervical cancer are:

• having a family history of cervical cancer
• smoking
• having a weakened immune system
• taking birth control pills for a long time
• currently or previously having chlamydia, a sexually transmitted infection (STI)
• factors related to pregnancy, such as being 17 years or younger at the time of your first full-term pregnancy or having three or more full-term pregnancies
• factors related to sexual history, which can raise the risk of contracting HPV, such as:
  • having had many sexual partners
  • becoming sexually active at a younger age
  • having a sexual partner who has a known HPV infection or who has had many sexual partners

Cervical cancer screening is vital in preventing cervical cancer. This can include an HPV test, a Pap test, or both.

The HPV test uses a sample of cervical cells to test for HPV. While it doesn’t specifically detect cervical lesions, it can alert your doctor to the presence of a high risk type of HPV that could lead to precancerous or cancerous changes in the future.

A Pap test also uses a sample of cells collected from the cervix. The cells are examined under a microscope to check for abnormal changes.

The current American Cancer Society cervical cancer screening guidelines are that all people with a cervix between the ages of 25 and 65 get a primary HPV test every 5 years.

If HPV primary testing isn’t available, HPV-Pap co-testing every 5 years, or a Pap test every 3 years, may also be used.

What if my screening result is abnormal?

If the results of your HPV or Pap test come back abnormal, your doctor may do a colposcopy or cervical biopsy. These are two procedures that let them examine the cells of your cervix more closely to check for precancer or cancer.

During a colposcopy, a doctor uses a speculum to open the vagina so they can see the cervix. They then insert a device called a colposcope that has a light and a magnifying glass to help them get a better view of the cervix.

It’s possible that a biopsy may be taken during the colposcopy. In a biopsy, a small sample of cervical cells is removed. The sample is then examined in a lab for signs of precancerous or cancerous cells.

Symptoms of cervical lesions

Precancerous cervical lesions often don’t cause symptoms. Because of this, many people don’t know they have them.

The same can be said about early cancerous lesions. Overall, most people with cervical cancer don’t have symptoms until the cancer has become more advanced. Some of the most common symptoms can include:

• abnormal vaginal bleeding, including:
  • after sex
  • between periods
  • menstrual periods that are much heavier or longer than usual
• after menopause
• vaginal discharge that may contain blood or may smell foul
• pain after sex
• pelvic pain

The fact that precancerous and early cervical cancer lesions don’t typically lead to symptoms makes regular cervical cancer screenings very important for early detection.

For some people, precancerous cervical lesions will go away without treatment. However, if you do have precancerous cervical lesions, getting treatment can go a long way in preventing them from becoming cancerous in the future.

Treatment involves removing the precancerous lesions. This can be accomplished in a few ways.

Ablation-based treatments work by destroying precancerous lesions. This can be done using cold (cryotherapy) or heat (laser surgery).

Excisional treatments remove the precancerous lesions. This can be done with a scalpel that removes a cone-shaped section of tissue (cold knife conization) or by using a thin wire loop containing an electrical current (LEEP).

It takes a long time to develop cervical cancer. According to the World Health Organization (WHO), it can take 15 to 20 years for cervical cancer to develop.

However, the WHO also notes this time frame is different for people with weakened immune systems. This can include people who are:

• living with HIV
• taking immunosuppressive drugs
• organ or bone marrow transplant recipients
• undergoing cancer treatments, like chemotherapy

In people with a weakened immune system, the WHO states cervical cancer can develop in a shorter span of time — about 5 to 10 years.

Precancerous cervical lesions are abnormal changes in cells of the cervix that are not yet cancerous. Some precancerous lesions go away on their own. Others will need to be treated to prevent cancer from developing.

Cervical lesions are mainly caused by HPV infection. Screening tests can detect HPV as well as abnormal changes to cervical cells. An HPV vaccine is available that can greatly reduce the risk of HPV infection and cervical cancer.

It’s not common for precancerous or early cancerous cervical lesions to cause symptoms. This makes regular cervical cancer screenings all the more vital for detecting and treating these lesions early.

Symptoms | Cervical cancer | Cancer Research UK

Early cervical cancers and pre cancerous cell changes don’t usually have symptoms.

Not everyone diagnosed with cervical cancer will have symptoms, that’s why it’s important to attend regular cervical screening. 

The most common symptoms of cervical cancer include:

• unusual vaginal bleeding
• pain or discomfort during sex
• vaginal discharge
• pain in the area between the hip bones (pelvis)

There are many other conditions that cause these symptoms. Most of them are much more common than cervical cancer.

You should see your doctor if you have any unusual vaginal bleeding, or any of the other symptoms mentioned here.
Although your symptoms are unlikely to be cancer, it is important to get them checked by a doctor.

Bleeding

The most common symptom of cervical cancer is bleeding from the vagina at times other than when you’re having a period. You may have bleeding:

• between periods
• during or after sex
• at any time after your menopause

Bleeding after sex

Bleeding after sex isn’t necessarily a sign of cervical cancer. It’s often caused by something called a cervical erosion or ectropion.

A cervical erosion means that the cells that are normally inside the cervical canal (glandular cells) can be seen on the outside surface of the cervix. It is common:

• in young girls
• during pregnancy
• in women on the contraceptive pill

This is due to changes in hormone levels. Sex can make it start bleeding.

Cervical erosion is nothing to do with cancer. It’s harmless and often goes away by itself or by changing contraception. Sometimes it might need treatment. Your doctor does this by freezing the area under local anaesthetic (cryotherapy).

As cervical cancer can also cause bleeding after sex, it is always sensible to get any unusual bleeding checked by your doctor.

Discomfort or pain during sex

Some women have discomfort or pain during sex. This is called dyspareunia. 

There are many other conditions that can cause this symptom. But you should see your doctor straight away if you have this. 

Other symptoms

Some women also have:

• a vaginal discharge that smells unpleasant
• pain in the area between the hip bones (pelvis)

Cervical screening

Pre cancerous cell changes do not have any symptoms. The cervical screening programme aims to pick these changes up and prevent cancer from developing in the first place.  

• Cancer and its Management (7^th edition)
  J Tobias and D Hochhauser
  Wiley-Blackwell, 2015

• Suspected cancer: recognition and referral​
  The National Institute for Health and Care Excellence (NICE), June 2015.

• Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
  C. Marth and others 
  Annals of Oncology, 2017. Volume 28, Supplement 4

Last reviewed: 

28 Jan 2020

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Diseases of the cervix. Diagnosis and treatment of diseases of the cervix – Gynecology – clinic of gynecology

Diseases of the cervix is not just a small gynecological problem, but a real risk of developing oncology.

In most cases, diseases of the cervix are almost asymptomatic and are detected during a woman’s visit to the doctor for a routine examination. That is why all women, at least twice a year, are recommended to undergo preventive examinations by a gynecologist.

Occasionally, changes in the cervix may appear as bleeding from the genital tract unrelated to the menstrual cycle, often occurring after sexual intercourse or exercise. This serves as a mandatory reason for an unscheduled visit to the doctor.

The cause of diseases of the cervix can be hormonal disorders, severe traumatic childbirth, abortion, past infectious and inflammatory diseases, general weakening of the immune system.

Diagnosis of diseases of the cervix

The main means of timely diagnosis of diseases of the cervix is ​​a regular examination by a gynecologist. To do this, in addition to visual examination of the cervix in the mirrors, more accurate examination methods are used, such as colposcopy (examination of the cervix using a special microscope) and a cytological examination of a scraping from the cervix (PAP test).

The cervix is the part of the uterus that is visible through the vagina. Inside it is the cervical canal, which leads to the uterine cavity. There are 2 parts of the cervix: internal – endocervix (facing towards the cervical canal) and external – exocervix (located from the side of the vagina). The surface of the endocervix is ​​normally covered with a columnar epithelium, and the exocervix is ​​covered with a flat epithelium. Only in girls, up to a certain age, the cells of the cylindrical epithelium extend beyond the inner part of the cervix and cover the outer part of the cervix. This version of the norm is called “congenital erosion”.

The area located at the junction of the outer and inner parts of the cervix is ​​called the transformation zone. This is an extremely important area, which is a source of reserve cells. This type of cells that can turn into both squamous and cylindrical epithelium cells. It is here that various processes most often occur that can cause various diseases of the cervix.

Diseases of the cervix

The main pathologies of the cervix include:

• erosion of the cervix is ​​a change in which an area of ​​cylindrical epithelium cells of various sizes is determined in the outer part of the cervix (exocervix). Most often, cervical erosion looks like a “wound” or damaged area;
• leukoplakia of the cervix – this whitish spot on the cervix can be compared with a kind of callus. This disease is most often viral in nature. Leukoplakia can progress with the development of precancerous conditions.
• endometriosis – proliferation of cells of the inner layer of the uterine wall outside it;
• polyps – the occurrence of neoplasms of various structures on the mucous membrane of the cervical canal.
• ectropion is an eversion of the cervical canal towards the vagina. Most often occurs after childbirth.
• retention cyst of the cervix (nabotovy cysts) – the appearance of closed and dilated glands in the cervix, filled with secrets accumulated in them;
• papillomas and condylomas of the cervix – viral manifestations on the cervix;
• cervical dysplasia is a precancerous disease characterized by the presence of atypical cells with a high risk of malignancy.
• cervical carcinoma – cancer of the cervix.

Treatment of diseases of the cervix

Among the various options for the treatment of diseases of the cervix, modern medicine prefers the radio wave method. The time has passed when “cauterization” left scars and was a contraindication for nulliparous patients. Now it is possible to cure the disease and eliminate the threat of developing cervical cancer with the help of an effective and painless radio wave procedure on the Surgitron apparatus.

This technique is the gold standard for the treatment of cervical diseases, suitable for nulliparous patients, performed on an outpatient basis by experienced gynecological surgeons.

Diseases of the cervix: symptoms, signs

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Diseases of the cervix lead to a variety of consequences. Some cause discomfort, others cause pain, but there are those that lead to the saddest outcome – cancer and infertility. Today we will analyze which diseases of the cervix are the most common, the causes of diseases and symptoms. In addition, we will identify pathologies that indicate cancer.

Diseases leading to cervical cancer

• Mucosal inflammation

Name: exocervicitis, endocervicitis.

In the first case, an infectious disease affects the vaginal part of the organ, in the second – the membrane of the cervical canal. And since both parts of the organ are directly connected, both diseases are most often found. The disease is common and affects more than 70% of all women. In addition, it is often accompanied by urethritis, cystitis, vulvitis and vaginitis. With the course of the disease without diagnosis and treatment, it leads to erosion.

Symptoms: purulent or mucous discharge; itching; discomfort caused by irritation of the vulva and swelling; less pain.

Diagnosis: exocervicitis can be detected during a gynecological examination, and endocervicitis with a colposcopy.

There are 4 subspecies of cervicitis (depending on the etiology of the disease):

Treatment: after differentiation, anti-inflammatory, antifungal and antibacterial drugs of local action are selected.

• Erosion

Erroneously, the diagnosis of “erosion” is made with ectopia or pseudo-erosion, which is a deviation from the norm, and not the same disease. Therefore, doctors designate the disease as a true erosion of the cervix.

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True erosion of the cervix can directly lead to cancer. But erosion itself is not the cause of cancer, but HPV, for which the damaged epithelium of the uterus is the place of dislocation. It should also be added that the human papillomavirus is sexually transmitted even with protected contact. And the most dangerous types of HPV are 16 and 18.

What causes erosion

• Colpitis or cervicitis can cause erosion if left untreated. So, abundant secretions increase the permeability of the cervical epithelium;
• Tears and injuries. Mechanical damage (childbirth, traumatic examination with a mirror, sexual contact) can cause the disease;
• Burn caused by appropriate treatment;
• Female hormone deficiency or post menopause;
• Uterine prolapse;
• Lack of useful trace elements and minerals, reduced immunity.

Diagnosis: detected by colposcopy.

Treatment: after receiving cytological studies (to exclude other diseases), drugs are prescribed to eliminate the cause of inflammation.

Diseases that turn into cancer

1. The first in this list can be considered leukoplakia. The mucous membrane of the cervix thickens, the processes of keratinization are disturbed, accompanied by the formation of white outgrowths. This disease has a risk of transforming into oncology. There are several types of disease:

Causes:

• The appearance of simple leukoplakia can be caused by hormonal disorders, organ injuries, infections;
• With atypia (precancerous disease) occurs when layering outgrowths.

Treatment: leukoplakia of a simple form, after detection, is not treated. However, a cancer test is done once a year. If atypical cells are found, the area is cauterized by the radio wave method.

2. Condyloma. Warty growths caused by HPV. The risk of transformation into cancer is accompanied by a large spread among the population. However, only high-risk HPV types can lead to cancer.

There are two types of warts: flat, pointed.

Treatment: removal of outgrowths with a laser.

3. Dysplasia. There are three types of disease: