Carcinoma In Situ (Cervix)

Introduction

• Description: Carcinoma in situ of the cervix is characterized by morphologic alteration of the cervical epithelium in which the full thickness of the epithelium is replaced with dysplastic cells (cervical intraepithelial neoplasia [CIN] 3). This change is generally associated either spatially or temporally with invasive carcinoma. Patients with low-grade CIN (CIN 1) are unlikely to develop cervical malignancy, whereas those with high-grade lesions (CIN 2–3) are at high risk of progression to malignancy.

• Prevalence: Less than 2% of Pap tests.

• Predominant Age: Early 30s (approximate peak age, 32 years).

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Linked to certain serotypes of human papillomavirus (HPV; 99.7% of cancers contain high-risk HPV serotypes).

• Risk Factors: Infection by HPV, herpes virus, or cytomegalovirus; early sexual activity; multiple sexual partners; cigarette smoking (1.5 times risk); oral contraceptive use (two to four times risk); early childbearing; intrauterine diethylstilbestrol exposure; immunosuppression.

Signs and Symptoms

• Asymptomatic

• Abnormal cervical cytology

• Abnormal colposcopy

Diagnostic Approach