What is CIN 1, CIN 2, CIN 3 - a female diagnosis is not for the faint of heart

Cervical dysplasia - CIN - cervical intraepithelial neoplasia - SIL (squamous intraepithelial lesion) - a precancerous condition. This diagnosis is made to approximately 10 thousand women a year, while 6,000 patients ultimately die from cervical cancer. The reason is a late visit to a gynecologist, when the well-treatable stages of CIN1 and CIN2 turned into difficult-to-treat CIN3.

Consultation with a gynecologist, urologist - 1000 rubles, consultation on the results of ultrasound, tests - 500 rubles. (optional).

What is cervical dysplasia, causes

The content of the article

Cervical cancer does not begin suddenly; it is preceded by 3 precancerous stages of dysplasia, when several layers of cells of the squamous epithelium (lining skin) of the cervix undergo changes. Gradually, normal epithelial cells replace atypical - modified ones. They have a different structure, size and change their location. As a result, the epithelium is transformed from multilayered, easily renewed, into single-layered.

It has been established that the main cause of dysplasia is the human papillomavirus, or rather its oncogenic types - sexually transmitted serotypes 16 and 18. At the same time, dysplasia does not start out of nowhere - it is preceded by cervical erosion, which women often ignore, not wanting to treat. In other words, dysplasia is a complication of erosion. Untreated erosion turns into dysplasia in 90% of cases.

This is due to the fact that the virus freely infects immature germ squamous epithelial cells located in the erosion zone. Such zones are called transformation zones, therefore the most important stage in the treatment of erosion is the treatment (closure) of these zones using various methods. Modern clinics use laser and radio techniques. After treatment with a radioknife or laser, all affected cells are removed, closing the path for dysplasia

Stages and symptoms of cervical dysplasia: CIN 1, CIN 2, CIN 3 - what is it?

Dysplasia is more common in women over 25 years of age, when the immune system is weakened due to changes in sexual partners, which forces the vaginal flora to constantly change, childbirth and other reasons. The peak incidence occurs at 35 years of age. At the same time, the risk of developing cancer still exists after age 65. English scientists from Keele University have proven that HPV, which enters the body at a young age, may not manifest itself for years or decades, becoming more active after menopause.

The disease is asymptomatic for a long time, being discovered by chance during a gynecological examination.

In rare cases, the following symptoms may appear in the precancer stage:

• vaginal discharge (spotting);
• discharge after sexual intercourse;
• intermenstrual bleeding;
• pain in the lower abdomen.

The absence of clear typical signs makes the pathology especially dangerous. Women who neglect preventive examinations by a gynecologist are at great risk.

The stages of dysplasia are abbreviated as CIN. To understand the essence of the process by stages, consider the table.

Dysplasia requires immediate treatment; without it, it easily changes stages, reaching stage CIN 3, which can already be considered cancer. A more accurate name is local cancer, “cancer in place,” i.e. still has metastasized, which leaves hope for a cure. The first stages of precancer SIN 1 and SIN 2 are completely curable with proper therapy.

Diagnostics

Treatment of grade 3 cervical dysplasia is based on the results of diagnostic measures, since the symptoms of atypia can “tell” the doctor little. After collecting anamnesis and clarifying complaints, the doctor performs a gynecological examination, during which he may detect a disturbance in the relief of the epithelium, redness of the tissue, spots, shiny areas, and growths.

To make an accurate diagnosis, the following mandatory procedures are prescribed:

• Colposcopy - the cervix is ​​examined under significant magnification of 10 or more times using an optical apparatus (colposcope). A simple colposcopy of the cervix gives a general visual picture of the condition of the epithelium. Extended colposcopy, performed using acetic acid or Lugol's solution (Schiller test), in which the affected tissue reacts to the reagent during treatment, can accurately identify atypical areas on the mucosa.
• Ultrasound examination of the pelvic organs is the most informative examination with a transvaginal sensor; during pregnancy, the examination is performed using an abdominal sensor. Ultrasonography allows you to identify the inflammatory process, genital warts, cysts, abscesses, assess the condition of the uterus and appendages, and blood circulation in the genitals.
• PAP test (Papanicolaou smear, oncocytological smear) is a highly sensitive (up to 90%) test that allows you to detect atypical changes and their severity. Using a special cytobrush, biomaterial is scraped from the area under study, which is transferred to glass (1-3 glasses are used) in the form of a smear-imprint. The biopsy specimen can be dried and fixed or placed in a solution. The prepared preparation is packaged, a direction is attached, and sent for microscopic examination.
• Digene test is a microbiological test that is usually performed with a PAP smear. The combination of these methods gives a more accurate diagnostic result and makes it possible to detect DNA of oncogenic HPV types in almost 100% of cases. The test is reliable and highly sensitive. It is also used to clarify data when the results of a PAP smear are unclear.
• PCR test - carried out to identify causative agents of urogenital infections and papillomavirus, establish its type, and assess the concentration. A smear is taken from the mucous membrane of the neck, in which the DNA of the virus can be detected. The procedure is non-traumatic, does not cause pain, and takes a minimum of time.
• Immunological analysis is a study of cervical mucus for the content of immunoglobulins, which are protected by epithelial cells. With a prolonged course of the dysplastic process, cervical mucus reduces or stops the production of immunoglobulins, which further aggravates the pathology.
• Biopsy - in case of grade 3 dysplasia, a fragment of the affected tissue is necessarily taken for histological examination. The manipulation is carried out during colposcopy; an optical device allows you to more accurately determine the area of ​​tissue from which the biopsy is taken; sometimes fragments are taken from several sectors. The collection is not particularly difficult and usually does not require anesthesia. During careful tissue sampling, the patient feels short-term minor pain, but you can ask the doctor to administer local anesthesia.

With grade 3 cervical neoplasia, all layers of the epithelium are affected, as evidenced by a morphological examination of the tissue, which reveals a large number of atypical cells with an altered structure and structure. Before each test, the doctor explains the preparation rules, otherwise the diagnostic results may be distorted. It is not recommended to have sex, take hot baths, use lubricants, vaginal tampons, suppositories or pills, or douche three days before the procedures. If antibiotics or COCs are taken, the attending physician should know about this. Before the study, you need to perform personal hygiene; sometimes the use of soap or gels is prohibited. Depending on the procedure, the days of the cycle when it is best to perform it are specified. Sometimes it is necessary to take standard clinical tests (blood and urine), a hormonal panel, and undergo other additional diagnostics.

What do the terms CIN and SIL mean?

In medicine, the diagnosis of cervical dysplasia is called differently. To make the diagnosis clear throughout the world, a unified classification of the stages of the process was introduced. Dysplasia was originally designated as CIN, which stood for cervical intraepithelial neoplasia. More accessible is the development of a tumor within the epithelial layer.

When SIN develops into cervical cancer, the process takes a different turn - atypical cells grow inside the tissue, extending beyond the epithelium. The tumor also gives metastases, this CIN is different from cancer. In 2012, WHO introduced a different terminology - CIN was replaced by SIL - squamous intraepithelial lesion. The concept of neoplasia has changed to the more objective term “lesion.” There were only 2 degrees left - a mild degree of damage - LSIL (Low grade SIL) and a severe degree of damage - HSIL (High grade SIL). LSIL is equated to dysplasia 1 (CIN 1), and HSIL to dysplasia 2-3 (CIN 2 and 3). Many specialists still use the first classification, as it more accurately characterizes the scope of the process and allows you to choose the most gentle treatment.

Complications

To understand how dangerous the disease is, you need to know what consequences can occur if treatment is not started in a timely manner.

What threatens dysplasia:

• atypical cells acquire a tumor-like structure, tissue mutation occurs into cancerous tumors;
• the uncharacteristic epithelium begins to move further, affecting more and more healthy cells;
• Cancer cells have a high metabolic rate, they absorb all the nutrients in the body, healthy cells starve;
• severe intoxication against the background of constant poisoning with toxic waste products of cancer cells.

But even modern treatment methods cannot guarantee that certain complications of the disease will not occur. The most dangerous thing is the reappearance of atypical cells, the development of cancer of the cervix or nearby organs. Against the background of the disease, the immune system is greatly weakened; the body may not cope with even the most common cold.

Examination for cervical dysplasia: how to identify CIN 1, CIN 2, CIN 3

Diagnosis of cervical dysplasia throughout the world is carried out according to the standards recommended by the World Health Organization. In Russia, good clinics use the following screening scheme for dysplasia:

• Examination by a gynecologist using a colposcope
  (examination of the cervix under a gynecological microscope with high magnification).
• Cytological smear - Pap test (taken by a gynecologist during an examination). The smear includes epithelial cells, which are then examined in the laboratory under a microscope. Atypical cells are identified: quantity, quality.
• Cervical biopsy
  . This is an additional clarifying examination, carried out in case of poor smear results for cytology and colposcopy.
• Blood for tumor markers
  . If cancer is already present, this will be visible from the results of blood tests for oncology.

The first two examinations for syn1, syn2 and syn3 are included in the mandatory cancer prevention program in gynecology. Colposcopy and cytological smear should be performed at least once every three years, starting from the age of 25. This program is called cancer screening.

Pregnancy with moderate dysplasia

It has been established that cervical neoplasia does not in any way affect the development of the fetus and does not cause placental disorders or abnormalities in the fetus. But a pregnant woman experiences a hormonal surge, under the influence of which atypia can become more active, rapidly progress, and the second degree can quickly turn into the third. In addition, if the cause of the disease is HPV, then the virus can harm the fetus. If a suspicion of dysplasia is detected in a pregnant woman during registration at the antenatal clinic, then during a gynecological examination a general and oncocytological smear is taken, PCR analysis, a Papanicolaou test and abdominal ultrasonography are performed.

In preparation for pregnancy, a woman and her partner undergo standard diagnostics; if a dysplastic process is detected, appropriate therapy is carried out. Only after recovery and restoration of the epithelium is natural conception recommended.

Evaluation of biopsy results for SIN 1, 2 and 3

The diagnosis of dysplasia is made by the presence of atypical cells in a cytology smear and the identified loss of the possibility of normal maturation of stratified squamous epithelial cells due to increased proliferation (accelerated division) of cells.

Dysplasia first degree (LSIL, CIN 1)

In grade 1 dysplasia, HPV invades cells, gradually changing the structure of cells, causing acceleration of their growth. Moreover, this applies not only to erosion; a similar process leads to the formation of genital and flat condylomas. With strong cellular immunity, after removal of condylomas, the process is inhibited. Since the papillomavirus penetrates into the genome of cells, it is impossible to cure it, which is why erosion and papillomas are removed using different methods, trying not to leave affected cells.

Dysplasia second - third degree (HSIL, CIN 2-3)

The development of the dysplastic process directly depends on the patient’s immunity. And even with treatment started in these stages, the infection remains and progresses in 10% of women, which guarantees the development of cancer. At the same time, the speed of development of the process can be different and reach up to 15 years. For this reason, if a woman has been diagnosed with CIN 1 at least once, she will have to monitor the condition of her cervix throughout her life.

Cell changes in stages CIN 2-3 are only neoplastic in nature - i.e. they are completely transformed, and the boundaries of the process are expanded. The number of atypical cells prevails; they multiply rapidly, replacing the normal epithelial layer of the cervical glands and even the canal.

Rehabilitation

After surgical therapy, a woman should adhere to some medical recommendations:

• refusal of sexual activity for 1-1.5 months;
• do not lift heavy objects;
• do not douche;
• do not use tampons;
• do not go to the sauna or bathhouse.

After 3 months, the woman must undergo a repeat colposcopy and take a smear from the cervix for cytology. If everything is normal, she is removed from the medical examination. Rarely, after surgery to remove dysplasia, the following complications can develop:

• relapse;
• infertility;
• transition to the stage of exacerbation of chronic inflammation in the pelvis;
• scars on the neck;
• dysmenorrhea (menstrual dysfunction).

How to treat cervical dysplasia in different stages

How treatment will be carried out depends on the degree of dysplasia.

For pregnant or nulliparous women, expectant management is possible for CIN 2 and 3, provided the coverage area is small. But throughout the entire period of pregnancy, you need to regularly take cytology tests and undergo colposcopic examination.

Treatment of severe dysplasia

Successful treatment of severe cervical neoplasia will allow establishing the exact cause of the disease and an individual approach that takes into account the patient’s age, concomitant diseases, and plans for further motherhood.

The purpose of treatment measures is:

• slowing down the dysplastic process;
• removal of atypical zones;
• elimination of inflammation;
• restoration of epithelial functions;
• restoration of hormonal balance;
• relapse prevention;
• prevention of malignant tissue degeneration.

Treatment of grade 3 dysplasia always begins with conservative measures, consisting of sanitation of the genital organs, the use of antibacterial agents, vitamins, immunostimulants, and dietary nutrition.

When HPV is detected, they act on the pathogen, but since there are no specific medications for papillomavirus yet, interferon preparations are used, which activate the immune defense in the form of the production of antibodies that attack the virus. Unfortunately, in many cases, interferon therapy and other conservative measures do not lead to the expected therapeutic effect. Therefore, for grade 3 cervical dysplasia, minimally invasive surgical methods are often used. The choice of technique depends on the rate of proliferation of atypia, the risk of malignancy of the process, and the presence of contraindications.

The simplest method is chemical cauterization of the mucous membrane, but in severe cases it is ineffective. The most common surgical method for eliminating cervical atypia is conization, which consists of a cone-shaped excision of the affected fragment of the cervix. The operation is performed in a day hospital under local or general anesthesia and takes up to 20-30 minutes, depending on the type of intervention. The procedure is not performed for confirmed cervical cancer, urogenital infections, pregnancy, or exacerbation of chronic diseases.

Moxibustion treatment

Conization is performed in the traditional way (using a scalpel), the loop method (electroconization), and using a laser. Laser vaporization (evaporation) is most in demand. When atypical cells are exposed to a laser beam, the affected area seems to disappear due to the evaporation of water from the tissue. During the manipulation, the doctor adjusts the power of the laser beam, which makes it possible to penetrate to different depths of the epithelium.

The advantages of laser therapy are:

• non-contact - during the operation the affected surface is not touched with instruments;
• control - the ability to control the depth of penetration of the beam;
• non-traumatic - vaporization does not affect healthy tissue due to the use of a colposcope and visualization, which virtually eliminates complications;
• minimal or no blood loss due to vascular coagulation performed during the operation;
• prevention of purulent complications - laser radiation has a detrimental effect on pathogenic microflora;
• rapid healing - laser radiation has not only a therapeutic effect on tissue, but also a stimulating effect, which activates healing and restorative processes, which leads to a short rehabilitation period;
• preservation of reproductive function - after laser vaporization there are no adhesions, scars, or narrowing of the canal. This treatment technique is preferable for patients who plan to have children in the future;
• painlessness - patients who have undergone vaporization do not feel pain or particular discomfort. There may be pain in the lower abdomen and more abundant discharge.

Conization of the cervix

Cervical dysplasia of the 3rd degree can be easily eliminated using radio wave destruction. The surgeon targets the atypical area with radio waves under the control of a colposcope. Under the influence of the wave, low-temperature steam is formed, which also performs the function of coagulation and disinfection. During the manipulation, a biopsy can be taken using a radio wave loop.

After the procedure, there are no scabs left, as after cryodestruction, against which scars could later form and infection could occur. Radio wave destruction is ideal for women planning pregnancy, since it practically does not injure the cervical mucosa and preserves the structure of the epithelium.

The procedure is carried out approximately 5-7 days of the cycle after the inflammation has been eliminated, duration – up to 20 minutes. The epithelium will be completely restored in a month and a half. In the first two weeks, sex, hot baths and other thermal procedures are not recommended, you should not do heavy physical work, lift weights, douche, or use tampons. You should definitely consult your doctor if you experience severe pain, heavy discharge (especially with an unpleasant odor), heavy bleeding, or febrile temperature. The first postoperative oncocytological smear is taken after a three-month period. Further, examinations are carried out every three months throughout the year. If the test results are negative, the patient is under clinical observation and undergoes preventive diagnostics as part of it.

Treatment should be accompanied by dietary nutrition, which must be followed after treatment procedures. The consumption of foods rich in ascorbic acid, folic acid, tocopherol, retinol, and microelements is required. It is recommended to consume more orange-colored vegetables and fruits, liver, seafood and dairy products, nuts, and vegetable oils. Alcohol, baked goods, fast foods, marinades, smoked foods, and fried foods should be excluded.

Where to get tested and treated for CIN 1, CIN 2, CIN 3 in St. Petersburg, prices

Treatment of all stages of precancer requires high-quality diagnosis and treatment using professional modern equipment. The Diana Clinic in St. Petersburg invites all women residents and guests of the city to undergo examination and treatment of dysplasia at any stage. The clinic’s gynecologists use new devices - a colposcope and a Fotek radio knife - this is the best equipment recommended by the Ministry of Health.

In our medical center you can take tests, undergo colposcopy, remove condylomas without pain and complications, cure erosion and dysplasia (laser, radio knife). We perform any gynecological low-traumatic operations, for example, conization of the cervix, excision with electric loops.

An appointment with a gynecologist costs only 1,000 rubles, an appointment based on test results costs 500 rubles. Appointment with an oncologist - 1000 rubles. Today this is practically the lowest and most reasonable price in St. Petersburg.

Predictions and prevention

Modern therapeutic and diagnostic capabilities of medicine allow us to make favorable prognoses regarding cervical neoplasia at the second stage of the process.

The main danger that awaits a woman with this diagnosis who does not seek help from a specialist is:

• the transition of the process to the next stage, which may take years;
• acquisition of malignant characteristics by atypical cells;
• constant occurrence of urogenital infections, which in themselves negatively affect reproductive function;
• cervical deformity;
• the proliferation of genital warts and their acquisition of gigantic sizes, if the cause of the disease is HPV.

Timely contacting a gynecologist, undergoing preventive examinations, following all medical recommendations during therapeutic procedures is the surest and best prevention to avoid pathological changes in the cervix and their complications, as well as the best way to preserve reproductive health. Without adequate therapy, the dysplastic process worsens and becomes complicated in more than 25% of cases. In advanced situations, lack of treatment for cervical atypia can lead to infertility.

During routine examinations, when a woman does not have any symptoms, the PAP test gives a positive result in approximately 5–7% of cases. Cervical neoplasia in the early stages can indeed regress, but women with a high immune status, the absence of severe concomitant diseases, and who are selective in their choice of sexual partners can hope for self-healing. But even in such cases, it is not a fact that the disease will not progress. When choosing a wait-and-see approach, the main thing is to regularly see a doctor and undergo appropriate tests on time. The AltraVita laboratory is equipped with innovative equipment; laboratory technicians use only modern, ultra-sensitive tests for diagnosis, which give no reason to doubt the research results. When you contact our clinic, test results will be ready in the shortest possible time and interpreted by experienced diagnosticians. If health problems are detected, you can consult a gynecologist and undergo appropriate treatment measures.