Reference Manual - IARC Screening Group

Pathophysiology of Cervical CancerWarts by themselves are usually low-grade lesions. Extensive warts, asseen in this case, however, may mask higher grade lesions in the deepertissue. Studies indicate that such lesions often regress spontaneously andthat treatment is not always successful in the long run. If treatment isdesired, a variety of techniques can be provided, including cryotherapy orLEEP. It is important to note that warts are transmitted by sexual contact.In order to avoid transmission to a partner, patients should be advised touse condoms during sexual intercourse.SquamousIntraepithelialLesionsThe face (exocervix) of thenormal cervix is largelycovered with squamousepithelium (Figure 3-5).The endocervix, whichconsists of glandularcolumnar epithelium, linesthe cervical canal and isvisible at the cervical os.Low-grade squamous intraepitheliallesions (LGSIL),or CIN I, are ones in whichup to a third of theepithelium is occupied bydysplastic cells (Figure3-6). Such lesions are alsooften visible during VIA.Figure 3-5. Normal CervixFigure 3-6. Microanatomy of DysplasiaHigh-grade squamous intraepithelial lesions (HGSIL), or CIN II and CINIII/CIS, are ones in which more than one third of the depth of the cervicalepithelium is occupied by dysplastic cells, as shown in Figure 3-6.Therefore, when acetic acid is applied to the cervix, it is more thoroughlyabsorbed than in low-grade lesions, thereby resulting in more clearlyvisible acetowhite lesions.3-8 Cervical Cancer Prevention Guidelines for Low-Resource Settings