Cervical intra-epithelial neoplasia (CIN)

Cervical intra-epithelial neoplasia (CIN) is a term that describes abnormal changes of the cells that line the cervix. CIN is not cancer, but over time it can develop into cancer.

CIN doesn’t cause symptoms. You are unlikely to know you have it unless you have an abnormal cervical screening result. You may then have a test called a colposcopy to look for CIN and check if you need treatment.

There are different types of treatment for CIN. Your doctor will explain any possible side effects and what to expect. You will be asked to have another cervical screening test after about six months to check for abnormal changes again. Most people only need treatment once. Sometimes, CIN comes back and more treatment is needed. This is not common.

Very occasionally, if CIN keeps 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 it is right for you.

What is CIN?

Cervical intra-epithelial neoplasia (CIN) is a term that describes abnormal changes of the cells that line the cervix. CIN is not cancer. But if the abnormal area is not treated, over time it may eventually 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.

Some abnormal changes will go back to normal naturally. But if you do need treatment, this is usually very effective. Treatment removes or destroys the abnormal cells and prevents cancer developing in the future.


What is the cervix?

The cervix is the lower part of the womb (uterus) that joins to the top of the vagina. It is sometimes called the neck of the womb.

The womb is a muscular, pear-shaped organ. The lining of the womb is shed each month when a woman has her period.

The cervix
The cervix

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Causes of CIN

HPV

The main cause of CIN is the human papilloma virus (HPV). There are over 100 types of HPV. Some types (called high-risk HPV) can affect the cervix and cause the abnormal cell changes that may develop into cervical cancer.

HPV is very common and most people are affected by it at some point. Usually the body’s immune system gets rid of the virus 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 clear the infection and the virus stays in the body for longer. If the cervix is affected by high-risk HPV, it means the virus may cause damage that over a long time can develop into CIN.

High-risk HPV can be passed on through any type of sexual contact. It is often shared between partners and using a condom does not always stop it passing from person to person. HPV can affect people who:

  • have had one or more sexual partners
  • have had sex with men or with women
  • are in a long-term relationship with one person.

If you are in a sexual relationship, it is likely that your partner has already been affected by HPV. This is unlikely to cause them any harm. They do not need to be tested or treated for it.

A vaccine can help prevent high-risk HPV infection and reduce the risk of CIN developing. The vaccine is most effective if you have not been exposed to the virus. The NHS offers the vaccine to girls from age 12 or 13. This is because they are less likely to be sexually active or have HPV already.

We have more information about HPV.

Smoking

Your risk of developing CIN is higher if you smoke. This may be because:

  • smoking makes your immune system less effective at clearing HPV
  • the chemicals in tobacco can damage your cells.

We have more information about giving up smoking.


Signs and symptoms of CIN

CIN and HPV do not cause any symptoms. So it is important to have regular cervical screening tests to check for abnormal cell changes. If needed these changes can be treated to prevent cancer.


Diagnosing CIN

A test called a colposcopy is used to diagnose CIN. You may be offered this test if your cervical screening test result is abnormal.

We have more information about cervical screening. The screening test does not show if you have CIN. But it finds the people who are most likely to have changes like CIN. These people are then offered a colposcopy to look at the cervix in more detail.

Colposcopy

This test uses a microscope called a colposcope to look closely at your cervix. You can usually have it done at a hospital outpatient clinic.

A specialist doctor or nurse will do the colposcopy. To get ready for the test you undress from the waist down. You then lie on your back on an examination couch. Some clinics have ones with foot or leg supports you can rest your legs up on. You will be asked to lie with your knees bent and apart. The doctor or nurse puts an instrument called a speculum into your vagina. This holds the vagina open so that they can see your cervix. They put a liquid on your cervix to show any abnormal areas. They then shine a light onto your cervix and look at it through the colposcope. The colposcope is on a stand outside your body, between your legs or feet.

The doctor or nurse may take a small sample of cells from the cervix (a biopsy). These will be sent to a laboratory to be looked at.

A colposcopy takes 15 to 20 minutes. It is not usually painful, but if a biopsy is taken you may feel some discomfort. The biopsy can cause slight bleeding and you may have some vaginal bleeding for up to two weeks. You may be advised not to have penetrative sex, use tampons or go swimming for a few days after a biopsy. This is to reduce the risk of infection and to give your cervix time to heal.

Colposcopy procedure
Colposcopy procedure

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Colposcopy cross section
Colposcopy cross section

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Your colposcopy results

A colposcopy shows the abnormal areas of the cervix and how abnormal these cells are.

Sometimes the doctor or nurse can see during the test that the cells are very abnormal. They may offer you treatment to remove these cells straight away. Before any treatment, you should be given time and information to make a decision. If you have questions, want more time or are not sure, the treatment can always be done on another day.

Your doctor or nurse will only offer treatment if they are sure the cells are very abnormal and there is a risk of cancer developing. Sometimes they can see the abnormal cells but it is not clear how serious the changes are. A small sample (biopsy) of the cells will be collected and looked at under a more powerful microscope to check if you need treatment. Biopsy results may take two or three weeks. Ask your doctor or nurse when you will get the results.


Grading of CIN

CIN is graded by how deep the cell changes go into the surface of the cervix:

  • CIN 1 – one-third of the thickness of the surface layer is affected.
  • CIN 2 – two-thirds of the thickness of the surface layer is affected.
  • CIN 3 – the full thickness of the surface layer is affected.

CIN 3 is also known as carcinoma-in-situ. Although this sounds like cancer, CIN 3 is not cervical cancer. Cancer develops when the deeper layers of the cervix are affected by abnormal cells.

CIN 1

Cells showing CIN 1 will often return to normal without any treatment at all. You will have further screening 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 and 3

CIN 2 and 3 have a higher risk of developing into cervical cancer. You will usually be offered treatment to prevent this happening.


Treating CIN

Abnormal cells found during a colposcopy usually affect a small area where the outer cervix meets the cervical canal. Most treatments aim to remove or destroy only this small area of abnormal cells. This means nearby healthy areas of cervix are not likely to be damaged.

Area of cervix treated
Area of cervix treated

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Treatments that remove the abnormal area include:

  • large loop excision of the transformation zone (LLETZ)
  • cone biopsy.

Treatments that destroy the cells in the abnormal area include:

  • laser therapy
  • cold coagulation
  • cryotherapy.

Sometimes, a type of surgery called a hysterectomy is used to remove the whole cervix and womb. This is not a common treatment for abnormal cells. Your doctor will explain if they think it is right for you.

We have more information about having a hysterectomy in our cervical cancer information.


Types of treatment

You usually only need one treatment to remove the abnormal cells completely. Your doctor will explain what type of treatment they suggest for you. This may depend on:

  • the treatments your local hospital can provide
  • the type of abnormal cells
  • the area of cervix affected.

Your doctor will explain possible side effects and what to expect during and after your treatment. Some people find this type of treatment upsetting or embarrassing. Your healthcare team will try to help. Let them know how you are feeling and tell them if you have any questions or worries. If you want to bring someone with you for support during the treatment, this can usually be arranged.

Getting ready for any of these treatments is similar to having a colposcopy. You lie on your back on a couch or chair with leg supports. The nurse or doctor gently puts an instrument called a speculum into your vagina. They use this to open the vagina just enough to see your cervix. The treatment can then be done through the open speculum.

Large loop excision of the transformation zone (LLETZ)

LLETZ is the most common treatment for removing abnormal cells from the cervix. It is sometimes called LEEP (loop electrosurgical excision procedure). It takes about five to ten minutes and is usually done under local anaesthetic as an outpatient. If a larger area of the cervix is treated, you may need a general anaesthetic and may stay in hospital for the day or overnight.

Some local anaesthetic is used to numb your cervix. Then the doctor or nurse removes the abnormal area using a thin loop-shaped tool. The loop is heated with an electric current, which cuts and seals the tissue at the same time. This should not be painful but you may feel some pressure inside your cervix.

The removed area of tissue will be sent to a laboratory to be checked and to confirm the type of abnormal cell changes.

Cone biopsy

A cone biopsy is a small operation to cut a small, cone-shaped piece of tissue from the cervix. This is usually done under general anaesthetic. You may need to stay overnight in hospital.

Afterwards, you may have a small pack of gauze (like a tampon) in the vagina to prevent bleeding. You may also have a tube to drain urine from the bladder while the gauze pack is in place. The gauze pack and tube are usually removed within 24 hours. Then you can go home.

The cone-shaped piece of tissue will be sent to a laboratory to be checked and to confirm the type of abnormal cell changes.

Laser therapy

This treatment uses a laser beam to burn away the abnormal cells. It is also called laser ablation. It is usually done under general anaesthetic. You may need to stay overnight in hospital.

Cold coagulation

Despite the name, this treatment uses heat to destroy the abnormal cells. Some local anaesthetic is used to numb your cervix. Then a small heated probe is placed onto any abnormal areas to burn them away.

Cryotherapy

You may be given a local anaesthetic but often this is not needed. A small probe is used to freeze the abnormal cells. During the treatment, you will hear a hissing noise from the gas used to cool the probe. You may have a slight stinging feeling or period-like pain while the probe is touching the cervix.


After treatment

If you have a general anaesthetic, you will stay in hospital for the day or overnight after your treatment. If you have a local anaesthetic, you will be able to go home the same day.

You may feel fine after your treatment. But some people feel slightly unwell for a few hours after the local anaesthetic. It is a good idea to have the day off, in case you need to go home and rest. You may want to arrange someone to help you get home.

You may have some period-like pains for a few hours after the treatment. Some bleeding or discharge after treatment is normal. This usually stops within four weeks but may last up to six weeks. The bleeding should not be heavier than a moderate period and should get steadily lighter.

You should contact your GP or the clinic where you had your treatment if:

  • the bleeding gets heavier – for example, completely soaking a pad within two hours
  • the discharge smells unpleasant
  • you have a fever or temperature
  • you have severe pain
  • you are worried for another reason.

It will take a few weeks for the cervix to heal. Your doctor or nurse will probably advise you not to have sex for at least four weeks after your treatment. This allows the cervix to heal properly. You may also be advised not to use tampons or swim for four weeks and to shower rather than have a bath.

Your treatment should not affect your ability to enjoy sex once your cervix has healed.

Fertility and pregnancy after treatment

Your treatment should not affect your ability to get pregnant. But, very rarely, the cervix can become tightly closed after treatment. This is known as stenosis. It may make it harder for sperm to enter the womb and so can affect your chances of becoming pregnant naturally. Your cervix is not completely closed if you still bleed during your periods.

Removing some of the cervix may make it slightly weaker. This depends on how much needs to be removed. Towards the end of your pregnancy, you may be more likely to give birth early if your cervix is weakened. Some women may be referred to a local specialist maternity service for closer monitoring during pregnancy. Your doctor can tell you more about this.


Follow-up for CIN

Treatments for CIN are usually very successful. To check, you will be asked to have another cervical screening test about six months after your treatment. Your sample will be carefully checked for signs of abnormal cells and high-risk HPV.

If your sample shows no high-risk HPV and normal cells, or only slightly abnormal changes, you will be asked to come for cervical screening again in three years. Your risk of developing more serious abnormal changes in this time is very low.

If your sample shows high-risk HPV or more abnormal changes, you will be asked to come for a more detailed check up with a colposcopy again. For a few people, the colposcopy shows that an abnormal area of cells has come back and more treatment is needed.

Treating CIN that comes back

Sometimes abnormal cells come back and more treatment is needed. This is not very common but it can happen. The same types of treatments 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 it is right for you.

We have more about having a hysterectomy in our cervical cancer information.

After a hysterectomy, you may still need tests to check for abnormal cells. This is similar to having a cervical screening test but the sample of cells is taken from the top of the vagina. It is sometimes called a vaginal vault smear.


Your feelings

Finding out you are affected by CIN can be stressful and difficult to cope with. The tests and treatments used for CIN are very personal. Many people find it a bit embarrassing. For some, the thought of having procedures is too frightening and stressful and they decide they cannot cope with it.

You are likely to need several appointments to treat CIN and then check how effective treatment has been. People often feel anxious waiting for the next appointment, treatment or more test results. 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.

Some people 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 difficult to cope, it may help to talk it through with someone. You may want to talk to a friend or family member. Your GP or practice nurse can answer any questions you have and explain ways they can support you. Sometimes it is easier to talk online to people in a similar situation. Our online community offers this kind of support. Or you can call one of our cancer support specialists for more information and support. Some other organisations also provide information and support about having tests and treatment for CIN.

Back to Cervical screening and CIN

About cervical screening

Cervical screening can help stop cancer developing in the cervix by finding abnormal cells early.