OG33.5 | Benign and Premalignant Cervical Lesions — Summary & Reflection

KEY TAKEAWAYS

Benign cervical lesions (ectropion, nabothian cysts, polyps, cervicitis) are common and require clinical distinction from premalignant CIN. CIN is graded by depth of dysplastic epithelial involvement: CIN 1 (lower third = LSIL, ~60% regress spontaneously — manage with surveillance), CIN 2 (lower two-thirds = HSIL, ~40% regress — treat adults), CIN 3 (full thickness including CIS = HSIL, ~31% progress to invasive cancer over 30 years without treatment — always treat). Colposcopy grades lesions as Grade 1 (minor — thin acetowhite, fine vessels) or Grade 2 (major — dense acetowhite, coarse vessels, sharp borders) per IFCPC 2011; directed biopsy provides histological confirmation. Treatment of CIN 2/3 uses ablative methods (cryotherapy: freeze-thaw-freeze — 3 min freeze, 5 min thaw, 3 min freeze — or thermal ablation) when four eligibility criteria are met (satisfactory colposcopy, lesion in TZ, <75% ectocervix, no glandular/invasion suspicion), or excisional methods (LEEP/LLETZ: provides histological specimen; cold-knife cone biopsy: preferred for endocervical lesions, microinvasion suspicion, or glandular disease). Post-treatment surveillance with cytology at 6-monthly intervals is mandatory.

REFLECT

The woman in the opening clinical scenario has CIN 2 with satisfactory colposcopy and a lesion eligible for ablative treatment. She can be reassured: she does not have cancer, and her cervix does not need to be removed. LEEP under local anaesthesia will almost certainly cure her lesion with a single outpatient procedure. But reflect on the broader picture: she is 28 years old and the lesion was detected because she happened to attend for a Pap smear. Millions of women in India never receive a smear. Consider what this scenario illustrates about the purpose of cervical screening: not to diagnose cancer, but to intercept the 10–15-year premalignant phase at a stage when a brief outpatient procedure — not chemotherapy, not radiotherapy, not major surgery — is curative. How should this message inform how you counsel women about the importance of screening?