Your doctor will make an informed decision whether it’s best to monitor you over time or perform one of several procedures that destroys or removes the abnormal cells or lesions. These procedures are known as cervical excisions or ablations.
Primary Treatment
Following the American Cancer Society’s (ACS) recommendations for cervical cancer screening means your doctor can detect cell changes in their earliest stage (otherwise known as CIN-1 or low-grade CIN). The primary treatment for this first stage is monitoring with a repeated co-test—two tests together, a Pap smear, or Pap test, and HPV (human papillomavirus) testing—in a year’s time.
However, the ACS also recommends treatment when there are distinct differences between results from Pap tests and biopsies (removal of tissue for close examination) through colposcopy (examining the cervis, uterus, and vagina).
For example, if one test shows a potential problem but another reads negative, your doctor will do a biopsy, which serves as both a diagnostic tool to better determine what’s causing the cell changes and as a therapeutic tool to remove the cells.
Surgeries and Specialist-Driven Procedures
The following are treatment options available for CIN-2 and higher. You and your doctor will discuss the pros and cons specific to your health status. If you have any concerns about the procedures, it’s best to be honest with your doctor because they can help reduce any fears and answer any questions specific to your case.
In most cases, though, treatment of CIN-2 and CIN-3 will come down to excision or ablation (the surgical removal of tissue). This type of treatment is estimated to be effective in one round in about 70%–90% of cases. The remaining patients may need additional procedures in the future.
LEEP Procedure
During the LEEP procedure, a thin wire loop is used to remove abnormal tissue. The wire is inserted after a speculum is placed, which is the same tool used in a routine Pap test. The speculum is used to open the walls of your vagina so the doctor can examine your cervix. Numbing medicine will be applied to prevent discomfort.
The small wire instrument will remove the questionable cells. Your blood vessels in the area will be cauterized with electrocautery by applying topical silver nitrate or other thickening paste like ferric subsulfate to prevent bleeding.
The entire procedure can be done in around 10 minutes. Patients are typically followed for 12 months post-procedure.
Side effects from the local anesthesia may include:
Tingling in your tongueRinging in your earsRapid heart rate
If any of these effects occur, they usually will last just a few minutes.
One study that looked at past data from 303 patients found that the vast majority (86%) experienced two negative post-LEEP assessments (meaning the procedure has lasting results). Another 10.4% of patients experienced three negative post-LEEP assessments and the remaining 3.2% were treated again with a second LEEP to remove CIN-2 or 3.
Cold Knife or Laser Conization
The cold knife conization or laser conization procedure is a biopsy done under general anesthetic that removes a cone-shaped piece of tissue in the area demonstrating abnormal cell growth or lesions. The instrument used is either a scalpel or a laser knife.
This procedure may not be appropriate in the following cases:
There’s not enough cervix to sample from due to previous biopsy procedures. You’re pregnant (talk to your doctor to weigh personal risk factors and likelihood of cervical cancer). Other health conditions make you an unsuitable candidate for surgical procedures.
The most significant complication from conization procedures is hemorrhage or excessive bleeding. Postoperative bleeding is estimated in 5%–15% of cases.
Posttreatment
After your treatment, you will need follow-up appointments not only to see how you’ve healed, but also to check for any signs of returning abnormal cells.
While Monsel’s was once a popular solution for physicians, the FDA discouraged its use in 2018 after a BioDiagnostics facility inspection found unsanitary conditions and manufacturing practices, which could result in contamination and decreased quality of the Monsel’s Solution.
In cases with no cancerous cells, post-procedure treatment CIN-2 or CIN-3 should follow protocol (check-ins at 12 months and 24 months).
The ACS suggests that people previously treated for these cervical abnormalities or lesions in cases CIN-2 or CIN-3 should continue cervical cancer surveillance for at least 25 years, with continued surveillance at three-year intervals as long as the patient is in reasonably good health.
A Word From Verywell
It may sound complex, but treatment for CIN is a rather straightforward process of either monitoring the situation or destroying or removing the cells with a simple procedure. If you’re not sure which treatment option is right for you, be open with your doctor.
For example, if your treatment plan is to return for testing at frequent intervals and you know this isn’t something you can confidently commit to, have a conversation with your doctor. Just know that CIN is highly treatable and therapeutic technologies are only improving as evidenced by LEEP.
