Fortunately, the cells of the cervix are not normal one day and malignant the next. It probably takes fifteen or more years before a normal cervix gradually becomes malignant. Not all pre-malignant changes progress to cancer: sometimes spontaneous return to normality may occur. Cells scraped from the cervix (PAP test (cervical smear)) can be analysed under the microscope and pre-malignant changes can be recognised. An estimate of the severity of change is generally reported (mild, moderate or severe dyskaryosis or dysplasia). These are the terms used in cytology, the study of cell structure, as a smear is sent for cytological assessment.

When the cytology indicates pre-malignancy of the cervix (Figure 21.7), a magnified assessment of the cervix (colposcopyFigure 21.8) may indicate where the abnormality is located (Figure 21.9) and a biopsy of the cervix may be obtained. The biopsies are sent for histological examination (high powered magnification of tissue;Figure 21.10). The cytological abnormalities mild, moderate and severe dyskaryosis tend to correspond to CIN I, II and III respectively (cervical intra-epithelial neoplasia (a neoplasm is a tumour). Mild, moderate and severe dysplasia are another set of histology terms for CIN I, II and III respectively). Just to complete the terminology, we sometimes call severe dysplasia (CIN III) - Carcinoma-in-situ). The important feature of pre-malignancy is that the abnormal cells are confined to the surface (epithelium).

Figure 21.7 A Pre-malignant Smear

Figure 21.8 Colposcopy

Figure 21.9

If a CIN III abnormality progresses, the abnormal cells penetrate through the basal layer. Provided they have not become deeper than 5mm, this abnormality (micro-invasive) can still be regarded as pre-malignant.

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