The cervix is the narrow, lower part of the uterus. It is the passageway from the uterus to the vaginal canal. Cervical cancer begins on the surface of the cervix and tends to grow slowly. It is caused by several types of the human papillomavirus (HPV), which are typically spread by sexual contact.
Cervical carcinoma in situ (CIS) is also referred to as stage 0 cervical cancer. It is noninvasive, which means the cancerous cells are confined to the surface of your cervix and have not infiltrated more deeply into your tissues.
According to the National Cancer Institute, in 2012, 12,000 American women will be diagnosed with CIS. Most of these women will be younger than 55. Cervical cancer in situ is rare in women under 20 years old.
Human papillomavirus, or HPV, is the main risk factor for developing cervical CIS. It is often sexually transmitted, but it can also be spread from skin-to-skin contact. There are hundreds of strains of HPV, and they are either low risk or high risk. The high-risk strains cause abnormal cell changes in the cervix that can lead to cancer.
Other risk factors may also play a role in the development of cervical CIS include:
- having multiple sexual partners
- smoking cigarettes
- impaired immune system
- first sexual intercourse at an early age
- diet low in fruits and vegetables
- use of oral contraceptives for an extended period
- infection with chlamydia
Cervical cancer typically does not cause symptoms until its later stages, so cervical CIS may by asymptomatic. Because of this, regular Pap smears are important to catch any abnormal cell changes early.
A Pap smear can collect abnormal cells that are then identified in a lab. An HPV test may be performed on the sample to check for the virus and to ascertain whether high-risk or low-risk strains are present.
A colposcopy is an in-office procedure that allows your doctor to view your cervix with a special magnifying tool. A solution is applied to the surface of your cervix to illuminate any abnormal cells, and your doctor can then take a small piece of tissue called a biopsy. This can be sent to a lab for a more definitive diagnosis.
If the biopsy shows CIS, your doctor might want to remove a larger piece of your cervix. He or she would remove the area with abnormal cells, along with a surrounding margin of healthy tissue.
Treatment for cervical CIS is similar to that for cervical dysplasia. Although it is called carcinoma in situ, it is often treated like a precancer because it is not invasive. A hysterectomy is the most drastic treatment; for women who do not want to preserve their fertility, this may be an option.
Cryosurgery, or freezing of the abnormal cells, is another type of treatment. This can be done in your doctor’s office. Laser surgery or loop electrosurgical excision procedure (LEEP) are surgical options that are done on an outpatient basis. They involve removal of the abnormal tissue with either lasers or an electrically charged wire loop, respectively. Conization is used less often; it is also an outpatient surgical procedure. This involves removing a larger, cone-sized piece of the cervix, to ensure removal of the entire abnormal area.
Talk with your doctor about your treatment options and which one is best for you. He or she might recommend various courses of treatment based on your age, desire to preserve your fertility, your general health, and your risk factors.
Once your cervical CIS is treated, your doctor will want to see you for regular follow-up visits and Pap smears every three to six months. Cervical cancer can come back, but regular Pap smears and checkups will allow your doctor to catch and treat abnormal cells early.
He or she will address any concerns you may have about your cervical health.
Having cervical CIS can be emotionally trying, especially if you are concerned about your fertility. Talk with your doctor about any support groups or finding a counselor if you need extra support.