CIN 1, 2, 3 HPV Treatment Options and Guidelines for LSIL / HSIL Cervical Dysplasia

CIN 1 2 3 HPV Treatment OptionsDeep down, you know it’s true:

Abnormal pap smear can sound terrifying, especially when the results came back showing high grade cervical cell changes.

So what are the pro and cons of different HPV CIN 1 vs CIN 2 / CIN 3 treatment options?

Any natural remedy that can help as complementary LSIL / HSIL treatment?
 
Just read on, or click on below to go straight to the section of your interest.


CIN 1, 2, 3 HPV Cervical Dysplasia Overview and Statistics

Cervical dysplasia, also called Cervical Intraepithelial Neoplasia (CIN), is a condition in which abnormal cell changes are present on the cervix surface. The abnormal cell growth takes place on the lining of the cervix, with CIN can be classified according to how much epithelial tissue is affected.
 

CIN 1 HPV Mild Dysplasia

CIN 1 refers to mild abnormal cells with about one-third of the thickness of epithelium. In most women with CIN 1, they are also diagnosed with Human Papillomavirus (HPV) in their cervical cells, with HPV is known to infect the lining cells of the genital tract in female.

According to CDC’s National Center for Health Statistics, about 40% of women aged 18-59 have genital HPV infection. HPV is primarily transmitted through sexual contact including anal sex, genital to genital sex or/and oral sex. Since most HPV infections are not accompanied with any symptoms, a large population of people do not even know they have contracted the virus.

However, in some people, the infection persists and eventually leads to the development of CIN 1.

Study in Anticancer Research journal shows 49% of CIN 1 cases regressed to normal after 6 months.
 

CIN 2 Moderate Dysplasia and CIN 3 Severe Dysplasia

CIN 2 refers to moderate dysplasia that affects about one-third to two-thirds of the epithelium, while the severe dyskaryosis CIN 3 is a condition that affects more than two-thirds of the epithelial layer.

According to BMJ, ARHP, AAFP, and International Journal of Gynecological Cancer:

  • Untreated CIN 1 confers a 13% risk for diagnosis of CIN 2 or CIN 3 in two years.
  • One study shows 24% CIN 2 regressed to CIN 1, and 56% CIN 2 regressed to normal.
  • About 16% to 18% of untreated CIN 2 cases progressed into CIN 3+ in two years.
  • Untreated pre-cancerous cells may progress to cancer in 10 to 15 years of time.

Dr. Michael Green gave an excellent elaboration on CIN categorization and progression in video below, alongside the HPV treatment guidelines of CIN 1, 2, 3.



CIN 1, 2, 3 Treatment Guidelines and Options – Pro and Cons

The mild dysplasia sometimes also called Low-grade Squamous Intraepithelial Lesions (LSIL or LGSIL). LSIL is mild cervical cell change that is a common abnormal finding from Pap smear test.

Moderate or severe dysplasia CIN2/CIN3 are often referred to High-grade Squamous Intraepithelial Lesion (HSIL or HGSIL). Normally found when biopsy or a Pap test are done, these are more serious cervical cells changes that are more likely than LSIL to cause precancer and cancer.
 

Treatment For CIN 1 and LSIL

What are the different types of abnormal Pap test results?

CIN1 and LSIL observed are not cancerous and usually go away on their own without treatment.

The decision of CIN 1 / LSIL treatment or observation would be based on the preferences of the patient and the doctor. As these mild cell changes will often return to normal, therefore you may not need any treatment at the moment. According to American Academy of Family Physicians:

For most women, especially younger women, observation provides the best balance between risk and benefit and should be encouraged.

Recommended read: How To Boost Your Body Immunity to Fight CIN 1 and Clear HPV Faster
 
 
If your doctor decides not to treat these minor changes, the doctor may ask you to have frequent follow up cytology screening tests and/or colposcopy at every 6 or 12 months to monitor the abnormalities. This is to ensure that any further abnormal cell changes are detected fast, including when there are cases where it becomes cancerous and even spread to the normal tissues around it.

In cases where the CIN I is persistent / recurrent and there is a risk of it developing into CIN II or even more severe cancerous cell like CIN III, then treatment (like below) should be administered.
 

Treatment Options for CIN 2 / CIN 3 and HSIL

If left untreated, these abnormal cells may become cancerous and spread to the adjacent healthy tissue. As such, immediate treatment is recommended for non-pregnant patients.

The treatment options of CIN 2 / CIN 3 / HSIL can be done in 2 ways:

  • Excision treatment such as LEEP/LLETZ and Cone Biopsy that removes the abnormal cervical cells and send the tissues as biopsy specimen for further laboratory study to learn the reason of abnormalities, and to confirm nothing more serious present that is missed in colposcopy.
  • Ablative treatment such as Cryotherapy and laser therapy that destroy the abnormal cells in cervix for normal cells to grow back in their place. No tissue is sent for lab analysis.

 
The CIN 2 / CIN 3 treatment involves Loop Electrosurgical Excision Procedure (LEEP) or Large Loop Excision of the Transformation Zone (LLETZ) as the most commonly used treatments.

Patients are given an anesthetic and the colposcopist removes the abnormal cells using a very fine wire loop. The loop is heated with an electric current that cuts into the tissue and seals it at the same time. The piece of tissue the colposcopist removes is then sent to the laboratory for further examination.

The video below by M.D. Alessandro Feo shows an outpatient LEEP surgery for CIN2 pre-cancerous lesions caused by HPV infection. This excision treatment was done under local anesthesia.

(WARNING: The video below contain graphic content that may not be suitable for all viewers)


 
 
Cone biopsy is another treatment administered to remove the abnormal tissue in the cervix. This is carried out under a general anaesthetic and the doctor uses a scalpel to cut a small cone shaped piece of the abnormal tissue from the cervix which will later be taken to the laboratory and examined under a microscope. After the procedure, a small pack of gauze is put in the vagina to prevent bleeding.

Bleeding and discomfort may be experienced as side effects of the treatment. Laser treatment involves destroying the abnormal cells of the cervix using a laser beam. This is done under a local anesthetic and the procedure is associated with discomforts such as spotting and watery discharge.

Cone biopsy would be done instead of a LEEP in certain circumstances, eg. when endocervical curettage shows abnormal cells, when cancer is suspected, etc.

Below is a cervical cone biopsy video by M.D. Ajit Virkud, with the CIN 3 treatment was done using a cold knife. (WARNING: The video contain graphic content not suitable for all viewers)


 
Recommended read: What Does Leg Pain Feel Like as a Cervical Cancer Symptom?
 
 
Cryosurgery, also called Cryotherapy or Cryoablation, is a medical procedure that uses chemical or liquid nitrogen to freeze off abnormal cervical cells. The efficacy of this ablative treatment method in eliminating abnormal cervical tissue can be as much as 90%, says Medscape.

During the Cryotherapy treatment, the doctor puts a speculum into the patient’s vagina and open it to separate the vagina walls. A tool called a cryoprobe will then be put at your cervix to freeze and remove the abnormal cells. Some patients may feel mild cramping during the cryosurgery procedure.

On the other hand, laser therapy uses a focused beam of light like Carbon Dioxide (CO2) laser beam to destroy abnormal cervical tissue while leaving normal tissues intact. According to WebMD, laser surgery normally injects a numbing medicine into the cervix, whilst oral pain medicine and local anesthetic may also be used.
 
 
What are the pro and con of different CIN 1/2/3 and LSIL/HSIL treatment options?

According to American Journal of Obstetrics and Gynecology, WebMD, and eMedicineHealth:
 

TypeTreatmentPro and Con
Excision TreatmentLEEP / LLETZ LEEP is treatment of choice for CIN
Produce biopsy specimen for lab examination
Simple and well tolerated
Less expensive and technically easier
May be done in the office
Spotting and vaginal discharge may occur and persist for up to several weeks
LEEP has been associated with preterm labor in a subsequent pregnancy and may require careful follow-up
Cone BiopsyProduce biopsy specimen for lab examination
Cone biopsy should be done instead of a LEEP in certain circumstances
Need to be done as a day surgery
High cost and high level of technical difficulty
Significant intraoperative and postoperative bleeding
Substantial peri-operative infectious risk
Ablative TreatmentCryosurgeryEasy to perform
Can be done in office setting
Involves less recovery time
No biopsy specimen
Patients may have profuse discharge
May cause cramping, bleeding, or pain
Cryotherapy can make colposcopic assessment afterward more difficult
Laser TherapyWorks well for destroying abnormal cervical tissue
Able to destroy or remove abnormal tissue that is too high in the cervix to be destroyed with cryosurgery
No biopsy specimen
Requires a short day surgery procedure
Patients may have some cervical bleeding up to 7 to 10 days after laser surgery

Christina S. Chu, MD further added via OncoLink:

All procedures have a small risk of causing difficulty conceiving, and LEEP and cone biopsies may have a very small risk of causing difficulty with premature cervical dilation. However, these risks are small, and many women go on to have normal pregnancies.

It has been our practice to use laser or LEEP for low grade lesions, and to use LEEP or cone biopsy for higher grade lesions (like CIN II-III) because of the ability to obtain a tissue specimen.

This video comprehensively covers the CIN treatment, including various pictures and images of CIN 1/2/3, and much more on cervical dysplasia management.

(WARNING: The video below contain graphic content that may not be suitable for all viewers)



Natural HPV Remedies as CIN 1, 2, 3 Complementary Treatment

In addition to conventional CIN treatments, researchers and medical studies have shown several evidence-based natural remedies that can help patients with HPV infections and cervical dysplasia:
 
 
1. Active Hexose Correlated Compound

Preclinical research results by University of Texas show Active Hexose Correlated Compound (AHCC), the natural extract from mushrooms of Basidiomycete class such as shiitake mushroom, is able to eradicate HPV infection from human body.

Among the 10 patients with persistent HPV positive infections, 5 of them achieved negative HPV results after taken a dosage of 3 grams AHCC daily on an empty stomach for about 5 months, whilst 3 of these women have a confirmed HPV eradication after stopped taking AHCC.

Many patients have also shared their success stories and testimonials that AHCC supplement did work to help get rid of HPV and cervical dysplasia, as you can check out what they say here to learn more.
 
 
2. Indole-3-carbinol

Indole-3-carbinol has the potential to prevent formation of precancerous cells on the cervical lining. It has an anti-estrogenic action that is beneficial in the regression of CIN.

When taken orally and gets into the stomach, I3C is converted to DIM (diindolymethane). DIM is helpful in getting rid of HPV infection, as it not only supports functioning of the immune system but also inhibits HPV proliferation in the cells.

Study revealed by Oregon State University show complete CIN-2 / CIN-3 regression was achieved by 44% to 50% of women who took 200 mg or 400 mg of I3C daily for 12 weeks.

This compound is mostly abundant in cruciferous vegetables such as cabbage, cauliflower, broccoli and Brussel sprouts. I3C can also be taken as supplements. >> Learn More
 
 
3. Beta Glucan

Study conducted by Italian researchers on 60 women show Beta Glucan is effective in treating HPV-CIN1 lesions and ASCUS-LSIL lesions, with 15-20% regressions rate improvement after treatment.

Kaunas University of Medicine further researched the effects of Beta Glucan on body immune system, and found this immunostimulating agent can also inhibit tumor growth by acting through the activation of macrophages and NK cell cytotoxicity.

As our body does not produce beta glucans, it needs to be consumed through supplement or food sources. This natural compound can be found in cell walls of cereal grains (such as barley fiber and oats), shiitake mushrooms, baker’s yeast, algae, and seaweed.

In video below, a patient shared the experience on how she cured her HPV and cervical dysplasia in 6 months with Beta Glucan supplement and AHCC.

 
4. Lycopene and Carotenoids

Research shows women with low concentrations of serum carotenoids such as alpha carotene, beta carotene and lycopene have a higher risk of developing cervical dysplasia. Lycopene is effective in accelerating the clearance period of the HPV infection from the body, revealed University of Arizona.

Lycopene is the bright red pigment natural found in tomatoes. Carotenoids and lycopene are also found in carrots, spinach, sweet potatoes and pumpkins.
 
5. Turmeric

Turmeric contains a powerful compound called Curcumin that has priceless medicinal properties. Research revealed by the Chittaranjan National Cancer Institute indicates curcumin is an antimicrobial agent that helps clearing HPV from the body.

Regional Cancer Centre in Thiruvananthapuram also published research that shows Curcumin has antioxidant properties that are helpful in preventing cell damage or development of cancerous cervical cancer cells associated with HPV-16 and HPV-18. >> Learn more about benefits of Turmeric
 
6. Selenium

Selenium is important for optimal functioning of the immune system. This in turn aids in the prevention and management of CIN as it easily resolves itself with a low risk of transgressing. Research also shows 200 mcg of Selenium daily helped patients to achieve CIN1 regression.

Selenium is naturally found in Brazil nuts, sardines, turkey and barley hence ensure to include some of these foods in your diet. You can also take it as a supplement.
 
7. Vitamins A, C, E

Antioxidants such as vitamins A, C, E and beta-carotene are known to be excellent in boosting the body’s immune system. When the body has a strong immune system it is able to fight off and eliminate viruses such as HPV. Research on Women who have a high dietary intake of antioxidant foods have a lower risk of developing cervical dysplasia.

LSIL HSIL Cervical Dysplasia Treatment LGSIL HGSILVitamin A is a powerful antioxidant that works to promote healthy epithelial cells in the body, this lowers the risk of developing cervical dysplasia as the cervical cells are protected from abnormal cell changes. Vitamin E plays a role in the replication of cells and hence regulates excess cell proliferation that may be the cause of occurrence of CIN.

Make it a habit to take fruits that are rich in antioxidants such as plums, strawberries, red grapes and citrus fruits such as oranges.

>> Check out the Recommended Vitamins Regimen For Cervical Dysplasia and HPV
 
8. Folic Acid

Folate, also called Folic acid, is a B-vitamin that is found naturally in most green leafy vegetables such as spinach. Study on 724 women published by ResearchGate indicated high folate levels in the blood contribute significantly to the prevention of cervical cancer caused by high risk HPV.

Folate is vital in the formation and repair of DNA, with the American Journal of Clinical Nutrition also revealed research findings that show folic acid helps to reverse the abnormal cell changes that within the cervical cells and even inhibits the HPV virus from attacking the DNA. Folic acid can be supplemented with vitamin B12 to make it more beneficial in fighting CIN 1. >> Learn More
 
 

HPV CIN-1 / CIN-2 / CIN-3 Treatment Options Review Summary

CIN1 is not cancerous and usually go away on their own, so doctor may recommend the “wait and see” approach without treatment required. You may be asked to have follow up visit for screening tests at every 6 or 12 months to monitor the abnormalities – in case the mild cell changes progress into moderate CIN 2+ or the more severe CIN 3+.

CIN 2 and CIN 3 treatment options include Ablative procedures such as cryotherapy that destroys abnormal cervical cells, and Excision procedures like LEEP/LLETZ as the most common treatments for cervical dysplasia.

In addition to the conventional CIN / LSIL / HSIL treatments by medical professionals, natural remedies listed above (found in food sources or over the counter dietary supplements like below) can offer complementary immune enhancing benefit to get HPV out of your body system faster.


 
 

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