Types of precancerous changes
Cervical abnormalities (CIN)
Cervical intraepithelial neoplasia (CIN) refers to abnormal cells on the cervix, usually associated with human papillomavirus (HPV) infection. Low-grade changes often resolve without treatment, while high-grade abnormalities (CIN2 or CIN3) may require treatment to prevent progression to cervical cancer.
Vulval abnormalities (VIN)
Vulval precancerous changes may cause persistent itching, irritation or changes in the appearance of the skin. Some are associated with HPV, while others occur independently of HPV, sometimes in association with skin conditions such as lichen sclerosus.
Vaginal abnormalities (VAIN)
Vaginal intraepithelial neoplasia (VAIN) refers to abnormal cells in the lining of the vagina, often associated with HPV. These changes are uncommon and may be identified during assessment of an abnormal screening result or follow-up after previous cervical treatment.
Atypical endometrial hyperplasia
Atypical endometrial hyperplasia, also known as endometrial intraepithelial neoplasia (EIN), is a precancerous condition affecting the lining of the uterus. It often presents with abnormal uterine bleeding, including postmenopausal bleeding, and may coexist with endometrial cancer.
Tests and diagnosis
Assessment depends on the location of the abnormality and may involve:
- Colposcopy and biopsy of the cervix or vagina
- Examination and biopsy of suspicious vulval lesions
- Pelvic ultrasound, endometrial biopsy or hysteroscopy for abnormalities of the uterine lining
A biopsy allows examination of the tissue to determine the type and severity of the changes and guide management.
Treatment
Treatment is individualised according to the diagnosis, extent of the abnormality and patient preferences.
Cervical changes: High-grade abnormalities are commonly treated with excisional procedures, such as a large loop excision of the transformation zone (LLETZ) or cone biopsy, to remove the abnormal tissue. The most appropriate procedure depends on the type and extent of the abnormality. Monitoring may be appropriate in selected circumstances.
Vulval and vaginal changes: Treatment may include surgical excision, laser treatment or topical medications. Some abnormalities can be monitored, depending on their type and severity.
Atypical endometrial hyperplasia: Hysterectomy is generally recommended because of the risk of progression and the possibility of an existing endometrial cancer. Hormonal treatment, often using a levonorgestrel-releasing intrauterine device (Mirena), may be considered in selected patients, including those wishing to preserve fertility, with careful ongoing surveillance.
Follow-up
Follow-up is important because some precancerous changes can persist or recur after treatment. The type and frequency of review depend on the original diagnosis and treatment received.
Common questions
Does having precancerous changes mean I will develop cancer?
No. Many abnormalities will never progress to cancer. The risk depends on the type and severity of the changes, and appropriate treatment or monitoring can substantially reduce this risk.
Why have I been referred to a gynaecological oncologist?
Gynaecological oncologists have specialist expertise in managing precancerous conditions, particularly when abnormalities are high-grade, recurrent, extensive or require more complex treatment.
Will treatment affect my fertility?
Many treatments do not prevent future pregnancy, although some procedures can have implications for fertility or pregnancy outcomes. Fertility-preserving options may be appropriate in selected circumstances and will be discussed before treatment.
Do I need a referral?
Yes. A referral from your GP or specialist is needed for a Medicare rebate. Please address this to Dr Shaun McGrath at Arc Specialist Care.
Further information and support
Seeing us in Brisbane
Ask your GP or specialist for a referral to Dr Shaun McGrath at Arc Specialist Care, then call us to book.
This information is general in nature and does not replace individual medical advice. Investigation and treatment recommendations depend on your specific circumstances.