What is HPV (Human Papilloma Virus)?
HPV is the most common sexually transmitted viral infection. The HPV virus is the cause of CIN changes, which can, but not necessarily, turn into cervical cancer.
What is CIN?
In cervical intraepithelial neoplasia, the term “neo” means something new while the term “plasia” means growth. Cervical intraepithelial neoplasia refers to abnormal growth of cervical cells and is also called cervical dysplasia.
CIN is not cancer!
It is classified into 3 grades: CIN 1 (low-grade dysplasia), CIN 2 (intermediate-grade dysplasia), and CIN 3 (high-grade dysplasia).
This disease belongs to the group of sexually transmitted diseases or STDs (Sexually Transmitted Diseases). It is caused by certain subtypes of the genital virus called Human papillomavirus or HPV. The appearance of the disease is favored by additional exogenous factors such as cigarette smoking, and lack of folic acid in the diet. Mostly girls aged 25-35 are affected, but the rest of the population is not spared.
The outside of the cervix and vagina are lined with several layers of cells called squamous cells or squamous epithelium. Normally, at the bottom of these layers are young, oval cells. As the cells mature, they ascend into the upper layers of the mucosa and become squamous. Such layers of cells are separated from the deeper structures by a so-called basement membrane, which is extremely important in determining the extent of the change.
How is it diagnosed?
HPV and CIN changes are detected with a Pap test. However, the Pap test is only a screening method, so the final diagnosis is made with colposcopy (a method of observing the cervix) and biopsy (painless taking of very small samples from the cervix). If the presence of HPV is proven with these methods, it is desirable to type the virus, that is, to show which subtype of the virus it is in order to predict the eventual development of the disease.
Symptoms of HPV
Most people who are infected with HPV do not know they have the virus. The HPV virus shows no symptoms in 90% of cases. However, certain subtypes of the HPV virus can cause genital warts in men or women. Other types can also cause different types of cancer
HPV and CIN
CIN changes are closely related to the HPV virus, that is, the HPV virus is the cause of CIN changes. There are more than 130 subtypes of this virus, divided into groups according to their aggressiveness. Carriers of the group of high-risk viruses are HPV 16 and HPV 18. Of course, there are other high-risk subtypes.
Should and why to treat?
Although CIN is not cancer, it can develop into it. Mild-grade dysplasia, or CIN 1, can sometimes resolve spontaneously without treatment. In all Western European countries, the practice is preventive treatment of HPV changes on the cervix. There is no method to predict which CIN1 changes will resolve and which will progress to CIN2 or eventually cancer. Of course, the subtype of HPV, the body’s immune system, smoking and other external factors affect the outcome. Due to the fact that the virus is found in the cells themselves, by removing them, the virus itself is also removed, that is, it does not remain in the body.
How is CIN treated?
There are several ways of treatment. Which method should be chosen depends on the stage of the change, the age of the woman, the presence of other gynecological problems, etc. The experience of the doctor and the availability of adequate equipment are of great importance.
The most commonly used methods are:
Laser treatment. Superior and the most used way of treating CIN changes. All diseased cells are removed with a thin laser beam. Advantages: short-term and painless intervention, the shortest recovery time, because it does not remove the cervix, it is recommended for women who have not yet given birth. Percentage of successful treatment over 95%. Disadvantages: expensive equipment
Cryotherapy or freezing. With a probe, the cervix is frozen at a temperature below zero. Damaged cells are shed through copious secretion over the next 30-45 days. Advantages: easy method. Disadvantages: more treatments, abundant secretion
Loop excision. With a thin wire loop under the influence of electricity, a part of the cervix is removed. Advantages: The method is both diagnostic and therapeutic. Disadvantages: Limited usability
Conization. As the name suggests, conization is the removal of a part of the cervix in the form of a cone. The operation is performed under general anesthesia. Advantages: it is also used to treat carcinoma in situ. Disadvantages: a higher percentage of complications, the possibility of complications during pregnancy due to shortening of the cervix
Hysterectomy. Surgical removal of the entire uterus. The method is used in the advanced stages of the disease.
Are controls necessary after treatment?