Cervical intraepithelial neoplasia (CIN)
Cervical intraepithelial neoplasia (CIN) is a term that describes abnormal changes of the cells that line the cervix. CIN is not cancer. But if the abnormal cells are not treated, over time they may develop into cancer of the cervix (cervical cancer).
CIN does not cause any symptoms. You are not likely to find out you have it unless you have cervical screening. Screening uses tests to find abnormal changes and to check whether they should be treated.
For some people with CIN, the abnormal changes go back to normal naturally. But if you do need treatment, it is usually very effective. Treatment removes or destroys the abnormal cells and prevents cancer developing in the future.
The main cause of CIN is an infection called the human papilloma virus (HPV). There are over 100 types of this virus. Some types of HPV can affect the cervix. The types that cause abnormal cell changes in the cervix are called high-risk HPV
Usually, the body’s immune system gets rid of the infection naturally. There are no symptoms and often the virus does not cause damage. Most people will never know they had it.
In some people, the immune system does not get rid of the infection and the virus stays in the body for longer. We do not know exactly why this is. If the cervix is affected by HPV for a long time, the virus can cause damage that may eventually develop into CIN.
HPV is very common, and most people are infected with it at some point. It can affect all sexual orientations and anyone who has ever been sexually active. This includes people in a long-term relationship with one partner. HPV may still affect you even if you have not been sexually active for some years.
The virus can live on the skin around the whole genital area. It passes easily from person to person during any type of sexual contact, including skin-to-skin genital contact or sharing sex toys. Using a condom or other barrier contraception may reduce your risk of HPV infection, but it does not offer complete protection.
Your risk of developing CIN is higher if you smoke. This may be because:
- smoking makes your immune system less effective at getting rid of HPV
- the chemicals in tobacco can damage your cells.
If you want to stop smoking:
The colposcopy shows abnormal areas of the cervix and how abnormal the cells are. It can be used to diagnose CIN and to decide if you need treatment.
CIN 1 means one-third of the thickness of the cervical surface layer is affected by abnormal cells. This will often return to normal without any treatment at all. You will have further cervical smear tests or colposcopies to check the cells have improved. If these tests show the CIN 1 is not improving, you may be offered treatment.
CIN 2 means two-thirds of the thickness of the cervical surface layer is affected by abnormal cells. There is a higher risk the abnormal cells will develop into cervical cancer. You may be offered treatment to stop this happening, or another colposcopy.
CIN 3 means the full thickness of the cervical surface layer is affected by abnormal cells. CIN 3 is also called carcinoma-in-situ. This sounds like cancer, but CIN 3 is not cervical cancer. Cancer develops when the deeper layers of the cervix are affected by abnormal cells. You will be offered treatment to stop this happening.
There are different types of treatment that can be used to remove CIN. Your doctor will explain what treatment they suggest for you. They will only offer treatment if they are sure the cells are very abnormal and there is a risk of cancer developing. You usually only need one treatment to remove the abnormal cells completely.
You may have one of the following:
Treatment during your colposcopy test
Treatment at a later appointment
Sometimes the colposcopy shows abnormal cells, but it is not clear how serious the changes are. The doctor or nurse will collect a small sample (biopsy) of the cells to check under a microscope. They will contact you with the results. They will give you another appointment if you need treatment.
Treatments for CIN are usually very successful. To check, you will be asked to have another cervical smear test about 6 months after your treatment. Your sample will be carefully checked for signs of abnormal cells and for high-risk HPV. What happens next depends on the results:
- If the sample shows no HPV
You will be asked to have cervical screening again in 3 years. Your risk of developing more serious abnormal changes in this time is very low.
- If the sample shows HPV
You will be asked to have another more detailed check-up, with a colposcopy.
Sometimes the colposcopy shows that an abnormal area of cells has come back and more treatment is needed. This does not happen often. The same types of treatment can often be used again to remove or destroy the abnormal area of cells.
Very occasionally, if the abnormal cells keep coming back after treatment, your doctor might suggest having surgery to remove the cervix completely. This usually means having an operation called a hysterectomy. Your doctor will explain if they think this is right for you.
After a hysterectomy, you may still need tests to check for abnormal cells. This is similar to having a cervical smear test, but the sample of cells is taken from the top of the vagina. It is sometimes called a vaginal vault smear.
Finding out you are affected by CIN can be stressful and hard to cope with. The tests and treatments used for CIN are very personal. You may find it a bit embarrassing. For some, the thought of having procedures is frightening and stressful.
It may help to remember that the aim is to stop cancer before it develops. Treating a small area of abnormal cells is usually a simple and effective way to do this.
You are likely to need several appointments to treat CIN and then check how effective treatment has been. You may feel anxious waiting for the next appointment, treatment or more test results.
You may feel ashamed or embarrassed about CIN. It is natural to have mixed emotions, including feeling uncertain or alone. You may have questions or worry what others will think.
If you are finding it hard to cope, it may help to talk about it with someone:
- You could talk to a family member or friend.
- Your GP or practice nurse can answer any questions you have and explain how they can support you.
- You might find it is easier to talk online to people in a similar situation. Our Online Community offers this kind of support.
- You can call one of our cancer support specialists on 0808 808 00 00 (7 days a week, 8am-8pm).
Below is a sample of the sources used in our cervical cancer, cervical screening and CIN information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
GOV.UK. Cervical screening: programme overview. Updated 18 November 2019. Available from www.gov.uk/guidance/cervical-screening-programme-overview (accessed March 2020).
GOV.UK. Colposcopic diagnosis, treatment and follow up. Updated 5 February 2020. Available from www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/3-colposcopic-diagnosis-treatment-and-follow-up (accessed April 2020).
Marth C, Landoni F, Mahner S, et al. Cervical cancer: ESMO clinical practice guidelines. Annals of Oncology, 2017; 28, suppl 4, iv72–iv83. Available from www.esmo.org/guidelines/gynaecological-cancers/cervical-cancer (accessed October 2020).
Reed N, Balega J, Barwick T, et al. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: recommendations for practice. 2020. Available from www.bgcs.org.uk/wp-content/uploads/2020/05/FINAL-Cx-Ca-Version-for-submission.pdf (accessed October 2020).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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