Cervical intraepithelial neoplasia: Difference between revisions

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'''For patient information on Cervical Dysplasia, click [[Cervical dysplasia (patient information)|here]]'''
'''For patient information on Cervical Dysplasia, click [[Cervical dysplasia (patient information)|here]]'''


{{SI}}
{{Cervical intraepithelial neoplasia}}
{{CMG}}
{{CMG}}


==Overview==
==[[Cervical intraepithelial neoplasia overview|Overview]]==
'''Cervical intraepithelial neoplasia''', or '''CIN''', is the abnormal growth of [[precancerous]] [[Cell (biology)|cells]] in the [[cervix]].  Most cases of CIN remain stable, or are eliminated by the host's [[immune system]] without intervention. However a small percentage of cases progress to become [[cervical cancer]], usually cervical squamous cell carcinoma, or SCC.<ref name="Agorastos">{{cite journal |author=Agorastos T, Miliaras D, Lambropoulos A, Chrisafi S, Kotsis A, Manthos A, Bontis J |title=Detection and typing of human papillomavirus DNA in uterine cervices with coexistent grade I and grade III intraepithelial neoplasia: biologic progression or independent lesions? |journal=Eur J Obstet Gynecol Reprod Biol |volume=121 |issue=1 |pages=99-103 |year=2005 |id=PMID 15949888}}</ref>  The major cause of CIN is infection with the sexually transmitted [[human papillomavirus]] (HPV), usually the high-risk HPV types 16 or 18.


==Diagnosis==
==[[Cervical intraepithelial neoplasia classification|Classification]]==
The earliest microscopic change corresponding to CIN is [[dysplasia]] of the [[epithelium|epithelial]] or surface lining of the [[cervix]], which is essentially undetectable by the woman. Cellular changes associated with HPV infection, such as [[koilocyte]]s, are also commonly seen in CIN. It is usually discovered by a screening test, the [[pap smear|Papanicolaou or "pap" smear]]. The purpose of this test is to diagnose the disease early, while it has not yet progressed to invasive carcinoma, and thus is easy to cure. Though epithelial dysplasia may regress spontaneously, persistent lesions must be removed, either with surgery, chemical burning, heat burning, burning with laser, or freezing ([[cryotherapy]]).
 
==[[Cervical intraepithelial neoplasia historical perspective|Historical Perspective]]==
 
==[[Cervical intraepithelial neoplasia pathophysiology|Pathophysiology]]==
 
==[[Cervical intraepithelial neoplasia epidemiology and demographics|Epidemiology & Demographics]]==
 
==[[Cervical intraepithelial neoplasia epidemiology and demographics|Risk Factors]]==
 
==[[Cervical intraepithelial neoplasia screening|Screening]]==


==Grades==
==[[Cervical intraepithelial neoplasia causes|Causes]]==
CIN has three distinct grades:
* '''CIN1''' (Grade I), the least risky type, represents only mild [[dysplasia]], or abnormal cell growth<ref name="Agorastos"/> and is considered a '''low grade squamous intraepithelial lesion''' (LGSIL). <ref name="Park">{{cite journal |author=Park J, Sun D, Genest D, Trivijitsilp P, Suh I, Crum C |title=Coexistence of low and high grade squamous intraepithelial lesions of the cervix: morphologic progression or multiple papillomaviruses? |journal=Gynecol Oncol |volume=70 |issue=3 |pages=386-91 |year=1998 |id=PMID 9790792}} </ref>. It is confined to the basal 1/3 of the epithelium.
* '''CIN2''' (Grade II), as well as CIN III, are considered '''high grade squamous intraepithelial lesions''' (HSIL). <ref name="Park"/> CIN2 represents moderate dysplasia, and is confined to the basal 2/3 of the epithelium
* '''CIN3''' (Grade III): In this lesion, severe dysplasia spans greater than 2/3 of the the entire epithelium, and may involve the full thickness. This lesion may also be referred to as cervical [[carcinoma in situ]].
<br/>
<gallery>
Image:Cervical intraepithelial neoplasia (1) normal squamous epithelium.jpg|Normal cervical epithelium (H&E stain).
Image:Cervical intraepithelial neoplasia (2) koilocytosis.jpg|Grade I CIN.
Image:Cervical intraepithelial neoplasia (3) CIN2.jpg|Grade II CIN.
Image:Cervical intraepithelial neoplasia (5) CIN3.jpg|Grade III CIN.
</gallery>


==Progression==
==[[Cervical intraepithelial neoplasia differential diagnosis|Differentiating Cervical intraepithelial neoplasia from other Diseases]]==


Cases of CIN are thought by some to progress through these stages toward cancer in a linear fashion.<ref name="Agorastos"/><ref>{{cite journal |author=Hillemanns P, Wang X, Staehle S, Michels W, Dannecker C |title=Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy |journal=Gynecol Oncol |volume=100 |issue=2 |pages=271-5 |year=2006 |id=PMID 16169064}}</ref><ref>{{cite journal |author=Rapp L, Chen J |title=The papillomavirus E6 proteins |journal=Biochim Biophys Acta |volume=1378 |issue=1 |pages=F1-19 |year=1998 |id=PMID 9739758}}</ref>
==[[Cervical intraepithelial neoplasia natural history|Natural History, Complications & Prognosis]]==


However, evidence suggests that cancer can occur without first detectably progressing through these stages and that a high grade intraepithelial neoplasia can occur without first existing as a lower grade.<ref name="Agorastos"/><ref>{{cite journal |author=Monnier-Benoit S, Dalstein V, Riethmuller D, Lalaoui N, Mougin C, Prétet J |title=Dynamics of HPV16 DNA load reflect the natural history of cervical HPV-associated lesions | journal=J Clin Virol |volume=35 |issue=3 |pages=270-7 |year=2006 |id=PMID 16214397}}</ref>
==Diagnosis==
[[Cervical intraepithelial neoplasia history and symptoms|History & Symptoms]] | [[Cervical intraepithelial neoplasia physical examination|Physical Examination]] | [[Cervical intraepithelial neoplasia staging|Staging]] | [[Cervical intraepithelial neoplasia laboratory tests|Lab Tests]] | [[Cervical intraepithelial neoplasia electrocardiogram|Electrocardiogram]] | [[Cervical intraepithelial neoplasia chest x ray|Chest X Ray]] | [[Cervical intraepithelial neoplasia CT|CT]] | [[Cervical intraepithelial neoplasia MRI|MRI]] | [[Cervical intraepithelial neoplasia echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cervical intraepithelial neoplasia other imaging findings|Other Imaging Findings]] | [[Cervical intraepithelial neoplasia other diagnostic studies|Other Diagnostic Studies]]
 
==Treatment==
[[Cervical intraepithelial neoplasia medical therapy|Medical Therapy]] | [[Cervical intraepithelial neoplasia surgery|Surgery]] | [[Cervical intraepithelial neoplasia primary prevention|Primary Prevention]] | [[Cervical intraepithelial neoplasia secondary prevention|Secondary Prevention]]


==Related chapters==
==Related chapters==
* [[Cervical cancer]]
* [[Cervical cancer]]
* [[Human papillomavirus]]
* [[Human papillomavirus]]
==References==
{{Reflist|2}}


[[Category:Disease]]
[[Category:Disease]]
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[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Oncology]]
[[Category:Oncology]]
{{SIB}}


[[bg:Цервикална интраепителна неоплазия]]
[[bg:Цервикална интраепителна неоплазия]]

Revision as of 22:05, 21 January 2012

For patient information on Cervical Cancer, click here

For patient information on Cervical Dysplasia, click here

Template:Cervical intraepithelial neoplasia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Classification

Historical Perspective

Pathophysiology

Epidemiology & Demographics

Risk Factors

Screening

Causes

Differentiating Cervical intraepithelial neoplasia from other Diseases

Natural History, Complications & Prognosis

Diagnosis

History & Symptoms | Physical Examination | Staging | Lab Tests | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention

Related chapters

bg:Цервикална интраепителна неоплазия sv:Cervikal intraepitelial neoplasi


Template:WS

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