Pre-cervical cancer: Causes, Detection and Treatment

What is pre-cervical cancer?

Pre-cervical cancer, also known as cervical dysplasia, occurs when cells in the cervix undergo abnormal changes that could potentially develop into cervical cancer, one of the most common types of cancer in women, if left untreated. Although cervical dysplasia is not cancer, early detection and proper management are crucial to prevent its progression.

Wondering how pre-cervical cancer can progress? Read more about cervical cancer, including its causes, risk factors, symptoms, and available treatment options here.

Types of precancerous cervical conditions

There are two types of precancerous conditions affecting the cervix: abnormal squamous cells and abnormal glandular cells. These are classified based on the type of cells involved and the severity of the changes observed under a microscope. 

1. Abnormal squamous cells

   • Abnormal changes in squamous cells of the cervix are classified using the Bethesda Reporting System as Squamous intraepithelial lesions (SIL). These changes are divided into two categories:

     • Low-grade squamous intraepithelial lesion (LSIL): This indicates mild cervical dysplasia, where abnormal changes are limited to the surface layer of the cervix. LSIL corresponds to Cervical Intraepithelial Neoplasia (CIN I), meaning the cell changes are mild and only slightly differ from normal cells.

     • High-grade squamous intraepithelial lesion (HSIL): This signals moderate to severe dysplasia, where abnormal cells penetrate deeper into the cervical lining. HSIL includes CIN II and CIN III, representing more advanced cellular changes. CIN II indicates moderate to severe dysplasia, while CIN III includes severe dysplasia and may involve Carcinoma in Situ (CIS), a condition where abnormal cells are present but haven’t spread beyond the cervix.

   • Early detection of SIL and CIN through routine Pap smears and HPV testing is essential for effective prevention and management of cervical cancer.

2. Abnormal glandular cells

   • Abnormal glandular cells in the cervix are classified as Atypical glandular cells (AGC) and Adenocarcinoma in situ (AIS):

     • Atypical glandular cells (AGC): Abnormal cervical cells linked to a higher risk of developing cervical cancer.

     • Adenocarcinoma in situ (AIS): Pre-cancerous glandular cells that haven’t spread into deeper cervical tissues or nearby areas but require prompt treatment to prevent progression.

Common causes of pre-cervical cancer

The causes of pre-cervical cancer are the same as cervical cancer. It develops in the transformation zone of the cervix, where columnar cells naturally change into squamous cells. While this transformation is a normal biological process, certain factors can disrupt it, causing abnormal cell growth that may lead to a precancerous condition.

Human papillomavirus (HPV) infection:

• High-risk HPV strains, particularly HPV 16 and 18, are the leading causes of pre-cervical cancer. These virus strains are primarily transmitted through sexual contact and can insert their viral DNA into healthy cervical cells, disrupting normal cell functions and triggering uncontrolled cell growth, significantly increasing the risk of cervical cancer.

Want to get your HPV vaccination? Click here to learn more.

Smoking:

• Chemicals in tobacco weaken the immune system and damage cervical cells, making it harder for the body to fight HPV infections.

Multiple sexual partners:

• Having multiple sexual partners increases the likelihood of exposure to HPV and other sexually transmitted infections, raising the risk of developing abnormal cervical cells.

Early sexual activity:

• Becoming sexually active at a young age can increase the risk of HPV infection as the cervix is more vulnerable to cell changes during adolescence.

Symptoms of pre-cervical cancer

Pre-cervical cancer often has no noticeable symptoms in its early stages. This is why regular Pap smears and HPV screenings are crucial for early detection. However, in more advanced stages, some women may experience symptoms related to abnormal changes in cervical cells. Some of the possible symptoms of pre-cervical cancer are: 

1. Abnormal vaginal bleeding:

   • Bleeding between periods

   • Bleeding after sexual intercourse

   • Heavier or longer menstrual periods

2. Unusual vaginal discharge:

   • Watery, thick, or foul-smelling discharge may indicate abnormal changes in cervical cells.

3. Pain during intercourse:

   • Discomfort or pain during sexual activity could be a sign of cervical irritation caused by abnormal cells.

4. Pelvic pain:

   • Persistent or unexplained pelvic pain, especially if unrelated to menstruation, may require medical evaluation.

How to detect pre-cervical cancer?

Detecting pre-cervical cancer early is crucial for effective treatment and prevention. The most common method is through a Pap smear, often followed by a colposcopy if abnormalities are found.

1. Pap smear

   • A Pap smear is a screening test used to detect abnormal, precancerous, or cancerous cells in the cervix. It’s recommended for women aged 21 to 65, with screening intervals of every 3-5 years, depending on age and medical history. It will be carried out as follows:

     • The procedure is performed at a clinic or doctor’s office.

     • The healthcare providers will insert a speculum into your vagina to gently open it and view the cervix.

     • A soft brush is used to collect cells from the cervix.

     • The cell sample is sent to a lab for testing.

   • If abnormal cells are detected, your doctor may recommend a colposcopy for further examination.

2. Colposcopy

   • A colposcopy is a more detailed procedure that uses a special magnifying tool called a colposcope to closely examine the cervix for abnormal areas. This is usually done if a Pap smear result is abnormal.

     • The procedure is conducted in a clinic and takes about 10-20 minutes.

     • The doctor will insert a speculum into your vagina to expose the cervix.

     • They will examine the cervix using the colposcope, which stays outside the body.

     • A small amount of vinegar or iodine solution may be applied to highlight abnormal cells.

   • Biopsy procedure:

     • If suspicious areas are found, your doctor will take a small tissue sample from the cervix for laboratory testing.

     • The biopsy results will determine the next steps and appropriate treatment options.

   • Regular Pap smears and follow-up procedures like colposcopy are essential for detecting pre-cervical cancer early, helping prevent its progression into cervical cancer.

Early detection can save lives and improve treatment outcomes. You can always request for an appointment with Thomson Medical Centre to arrange for a Pap smear or cervical cancer screening. Learn more about our health screening packages here.

Treatment options for pre-cervical cancer diagnosis

Treatment for pre-cervical cancer depends on several factors: the severity of cervical dysplasia, the patient’s age, future pregnancy plans, and personal treatment preferences. 

If the pre-cervical cancer is classified as low-grade (CIN I), doctors usually take a conservative approach by recommending regular Pap smears and HPV tests to monitor any abnormal cell changes. In most cases, CIN I resolves naturally, with only about 1% of cases progressing to cervical cancer. 

However, if the pre-cervical cancer is high-grade (CIN II or CIN III), your doctor may recommend removing the abnormal cells to prevent them from developing into cervical cancer. Several medical procedures are available for this purpose, depending on the extent of the abnormal cell changes. 

Some of the pre-cervical cancer treatments are: 

1. Loop electrosurgical excision procedure (LEEP)

   • LEEP is a procedure that uses an electrically charged electric loop to remove tissues. The possible complications caused by LEEP are pain, bleeding and narrowing of the cervix (cervical stenosis).

2. Cold knife cone biopsy (conization)

   • Conization is a procedure in which your doctor removes a cone shaped section of your cervical tissue. It is also a diagnostic test for cervical cancer. The possible complications caused by conization are higher than LEEP. It causes pain, bleeding and narrowing of the cervix (cervical stenosis).

3. Hysterectomy

   • Hysterectomy is an operation removing the whole uterus. It is done in those cases in which cervical dysplasia persists or does not improve after other procedures.

To discover the most suitable treatment options tailored to your individual needs, request for an appointment with our experienced gynecologists for a personalised consultation.

FAQ

Can pre-cervical cancer and cervical cancer be cured?

Yes, pre-cervical cancer and cervical cancer can be successfully treated in 90% of cases with early detection and timely removal of abnormal cells. Since cervical dysplasia progresses slowly into cervical cancer, there is usually enough time for doctors to provide appropriate treatment and prevent further development. Regular screening tests like Pap smears and HPV tests are essential for early diagnosis and effective management.

How long does it take for precancerous cells to turn into cancer?

Cervical dysplasia develops slowly and may take several years to turn into cancer, depending on its severity. Mild cervical dysplasia (CIN I) often goes away on its own within 1-2 years without treatment. However, moderate to severe dysplasia (CIN II or CIN III) can take 5 to 10 years or longer to become cervical cancer if not treated. Regular Pap smears and check-ups help detect and treat abnormal cells early, preventing cancer from developing.

Can precancerous cells (cervical dysplasia) go away on its own?

Yes, cervical dysplasia can go away on its own, especially if it is mild (CIN I). In many cases, the body’s immune system can clear the abnormal cells within 1-2 years without treatment. However, moderate to severe dysplasia (CIN II or CIN III) is less likely to resolve naturally and may require medical treatment to prevent it from developing into cervical cancer. Regular Pap smears and follow-up tests are essential to monitor the condition and take appropriate action if needed.

Disclaimer: The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request for an appointment with Thomson Medical today.