High-Grade Squamous Intraepithelial Lesion, or HSIL, which includes CIN II and CIN III, is an abnormal condition of the cells of the cervix and is considered to be precancerous. HSIL may be characterized by a long lead time before development into cancer. When detected early and treated, the abnormal cells can often be completely eliminated before development into cervical cancer. Approximately 1% of all Pap tests result in a diagnosis of HSIL. Although HSIL is a precancerous result that may develop into cervical cancer and will require additional follow up, it is important to understand that a diagnosis of HSIL does not necessarily mean that you currently have cervical cancer.

Pap Test Background Information

All women 18 and over (and younger women who are sexually active) should have a pelvic examination at least once a year. An important part of the pelvic exam is the Pap test. It is performed so a medical laboratory can examine cells from a woman's cervix. The Pap test is important because it can help prevent cervical cancer by detecting cell changes at an early stage. Most of these early abnormalities are completely curable.
Dr. George Papanicolaou developed the Pap test in the 1940's.

• Since the Pap test was introduced, the number of annual deaths from cancer of the cervix in the United States has declined by over 70%.
• Most women who die from cervical cancer today have not had Pap tests on a regular basis to detect early signs of the disease.
• The American Cancer Society estimates that approximately 13,000 new cases of cervical cancer will be diagnosed this year.
• The 5-year survival rate for cervical cancer is > 90%.
• Risk factors for cervical cancer include but are not limited to: infection with Human Papillomavirus (HPV), sexual activity at a young age, history of multiple sexual partners, smoking, and conditions which compromise the immune system such as HIV infection.
  

Follow-up Options for HSIL

Colposcopy: Your clinician may perform an additional test called a colposcopy. In this procedure, an instrument with a magnifying lens is inserted through the vagina and used to view the cervix directly. Your clinician will be able to see the surface of the cervix clearly during the procedure and will look for any abnormal areas.

Biopsy: If abnormal areas are seen during the colposcopy, your clinician may biopsy (remove a small tissue sample) and send it to a laboratory for study under a microscope. Often, multiple areas of the cervix are biopsied during the procedure.

Endocervical Curettage (ECC): In this procedure, your clinician will scrape cells from the wall of your cervical canal. The cells are then sent to a laboratory and studied for abnormal changes. ECC is often performed with a biopsy.

Cryotherapy: In order to destroy abnormal cells, your clinician may elect to use a very low temperature probe to freeze abnormal cells. The cells that grow back during the healing process are usually normal and healthy.

Laser Therapy: In this procedure, a highly concentrated beam of light energy called a laser is focused on the affected area of the cervix, and the abnormal cells are vaporized. In time, the vaporized tissue grows back with cells that are usually normal and healthy.
LEEP (Loop Electrosurgical Excision Procedure): Your clinician may use an electric loop to remove abnormal tissue from your cervix. The tissue sample is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.

Cone Biopsy: Your clinician may remove a cone-shaped wedge of tissue from the opening of the cervix. The tissue is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.

Important Questions to Ask Your Doctor

• For my condition, what follow-up options do I have?
• What do you suggest and why?
• What are the potential risks or side effects to this option?
• When do you recommend a repeat Pap test?

Sources for Additional Information

AmeriPath: 800-330-6565
American Cancer Society: www.cancer.org or 800-227-2345
National Cancer Institute: www.nci.nih.gov or 800-4-CANCER
WebMD: www.webmd.com

This report is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon medical history and current condition. Only your physician and you can determine your best option. Provided to you as a service by AmeriPath, Inc.