HPV and Cervical Cancer
The CIN Process and Early Diagnosis

How Does the CIN (SIL) Process Progress?

Cervical cellular changes are called CIN (Cervical Intraepithelial Neoplasia) or SIL. This process does not develop suddenly; it is a progressive, step-by-step process over the years.

A person who is CIN 1 on Monday does not become CIN 2 on Tuesday. Cellular changes are a process that unfolds over time. Different grades can be seen together in different regions of the cervix at the same time. For example, while CIN 3 is present in one region, CIN 1 or CIN 2 may be found in another area.

CIN Grades

• CIN 1: Mild cellular change
• CIN 2: Moderate change
• CIN 3: Severe change

At the CIN 3 stage, the cellular changes now reach down to the basement membrane layer but do not pass through this layer. This stage is called carcinoma in situ. This is a stage very close to cervical cancer.

In the next stage, the cancer cells pass through the basement membrane and invasive cervical cancer develops.

Symptoms of Cervical Cancer

Cervical cancer often causes no symptoms in the early stage. When it does cause symptoms, the most common findings are:

• Bloody vaginal discharge
• Bleeding after intercourse
• Irregular bleeding outside the menstrual period
• Postmenopausal bleeding

About 28% of patients present with abnormal smear findings.

If the disease has progressed, spread to the pelvic bones and the urinary tract may be seen. In this case:

• Sciatic pain
• Leg oedema
• Dilation of the kidney channels (hydronephrosis)

Treatment of Cervical Cancer

The treatment of cervical cancer is determined according to the stage of the disease.

• Early stage: Surgical treatment (operation)
• Advanced stage: Radiotherapy and chemotherapy

Thanks to regular HPV DNA testing and smear screening, cellular changes caught at the CIN stage can be treated, and the development of cervical cancer can be largely prevented.