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CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts : Dr Sharda Jain

CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts : Dr Sharda Jain

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CERVICAL
INTRAEPITHELIAL
NEOPLASIA UPDATED
MANAGEMENT
by
DGF / NIGF Experts
Dr Sharda Jain
Cervical Intraepithelial Neoplasia (CIN) refers to the presence
of abnormal, precancerous cells on the cervix.
As a gynecologist, staying updated on the management of
CIN is essential for providing the best care to your patients.
Here are some key points to consider in your discussions:
SCREENING in INDIA
NFHS 5
3%
Screening and Diagnosis:
 Emphasize the importance of regular cervical cancer screening,
including Pap smears and HPV testing, as early detection is key.
 If follow up is issue do VIA / VILI which are 1 rupee , 5 rupee
tests .
 Discuss the latest guidelines for screening intervals and the age at
which screening should begin and end.
VIA / VILI
VIA
40%
VIA
+
VILI
100%
< Half
Camp Setting
No Colposcopy
See & Treat
Single Visit

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CERVICAL INTRAEPITHELIAL NEOPLASIA UPDATED MANAGEMENT by DGF / NIGF Experts : Dr Sharda Jain

  • 2. Cervical Intraepithelial Neoplasia (CIN) refers to the presence of abnormal, precancerous cells on the cervix. As a gynecologist, staying updated on the management of CIN is essential for providing the best care to your patients. Here are some key points to consider in your discussions:
  • 4. Screening and Diagnosis:  Emphasize the importance of regular cervical cancer screening, including Pap smears and HPV testing, as early detection is key.  If follow up is issue do VIA / VILI which are 1 rupee , 5 rupee tests .  Discuss the latest guidelines for screening intervals and the age at which screening should begin and end.
  • 6. < Half Camp Setting No Colposcopy See & Treat Single Visit
  • 7. > Half Clinic Setting of Gynae Trained in Colposcopy Screen & Treat Single Visit
  • 8. Not for See & Treat Clinic PCB PMB Not for Screen & treat
  • 9. Screening : begin at 30 yrs 2 MINIMUM IDEAL 30,35,45 YEARS STOP AT 50 YRS
  • 10. Grading CIN Lesions: Explain the grading system for CIN lesions, which includes CIN1 (mild dysplasia), CIN2 (moderate dysplasia), and CIN3 (severe dysplasia or carcinoma in situ). Highlight that CIN2 and CIN3 are considered high-grade lesions and carry a higher risk of progression to cervical cancer.
  • 11. PROGRESSION TO INVASIVE CANCER CIN 1 1 % CIN 2 5 % CIN 3  30-70%
  • 12. Management Options Discuss the management options for CIN, which can range from watchful waiting to various treatment modalities Treatment decisions should be individualized based on the patient's age, lesion grade, fertility desires, and other clinical factors , whether LMIC
  • 13. Watchful Waiting Explain that watchful waiting may be appropriate for CIN1 lesions, as many of these lesions regress spontaneously. This is followed in western world ‘ Emphasize the need for close follow-up in these cases. 20 years F/U is must.
  • 14. Treatment Modalities: Discuss the various treatment options for CIN, including excisional procedures (e.g., LEEP, cold knife conization), laser therapy, and cryotherapy / Thermal ablation Highlight the pros and cons of each treatment method, considering factors such as fertility preservation and recurrence rates.
  • 15. 20 yrs We do Cryo Cautry / Thermal Ablation in CIN 1 & 2 west INDIA UK Study Is Eye Opener
  • 16. TREATMENT RECOMMENDED IN INDIA BY EXPERTS OF CIN
  • 17. TREATMENT- Simplified CIN -I :- Cryo / Thermal Ablation CIN II :- Cryo / Thermal Ablation CIN III :-THERMAL ABLATION FEW Experts Discourage conservative Rx 
  • 18. HPV Vaccination: Encourage HPV vaccination for eligible patients to prevent new HPV infections and reduce the risk of CIN development.
  • 19. Post-Treatment Monitoring:  Explain the need for follow-up after CIN treatment to monitor for recurrence or persistence of the disease.  Discuss the appropriate follow-up schedule and the importance of regular screenings even after successful treatment.
  • 20. Fertility Considerations:  Address fertility concerns and family planning with patients, especially if they require excisional procedures.  Explain that treatments like LEEP may have minimal impact on fertility, but conization procedures could have a more significant effect.  All of you must know about 5 years follow up in very large study in UK where residual disease is significant using LEEP THERAPY.
  • 21. (UK STUDY) TREATMENT- F/U CIN-I :- 8-10% CIN II :- 15% CIN III :- 50% Disease is seen at end of 5 yrs after Leep Therapy
  • 22. Psychological Support: Recognize the emotional impact that a CIN diagnosis and its management can have on patients. Offer support and counselling resources.
  • 23. Preventing Future CIN: Stress the importance of risk reduction strategies, including safe sexual practices, HPV vaccination, and regular follow-up appointments.
  • 24. Emerging Technologies: Stay informed about emerging diagnostic and treatment technologies, such as the use of biomarkers or molecular testing to enhance CIN management.
  • 25. Multidisciplinary Approach: Collaboration with other healthcare professionals, such as pathologists and oncologists, can be essential for managing complex CIN cases.
  • 26. • Cervical Intraepithelial Neoplasia management is an evolving field, and it's crucial for gynecologists to stay updated on the latest guidelines and research to provide the most up-to-date and evidence-based care to their patients. • Additionally, patient education and emotional support are integral aspects of managing CIN effectively.