Colposcopy and cervical intraepithelial neoplasia

Cervical cancer is both preventable and curable. It has a long natural history with a prolonged pre-cancerous phase that is easily detectable and treatable. Exfoliative cervical cytology remains the mainstay for screening of pre-cancerous lesions (cervical intraepithelial neoplasia, CIN). Assessment of women presenting with abnormal cervical cytology and the selection of those requiring treatment relies mainly on colposcopic impressions of the cervical transformation zone and histological appraisal of directed punch biopsies. There is variation in the assessment of cytology, colposcopy and histology findings, and therefore the ‘final’ diagnosis involve of all three disciplines. The need to maximise clinical resources, achieve quicker and more effective management of patients, limit postoperative complications and preserve reproductive function has led to the popularity of local excisional methods for cervical premalignancy. Although the cure rates for all local ablative and excisional methods are more than 90% after one treatment, the excisional methods provide a more reliable histopathological diagnosis and the patient may be treated at the initial visit. Cure rates for CIN correlate principally with the extent of the CIN. More than 95% of cervical cancer cases are associated with oncogenic types of human papillomavirus. Important advances have been made in developing recombinant vaccines to prevent and treat this infection. Clinical trials of preventive and therapeutic vaccines have been reported and the vaccine is now available for use.