Disease Description (Causes and Symptoms)

Definition summary: Carcinoma in situ of the cervix is a condition in which cancer cells are present only within the epithelial layer of the cervix, without invasion yet (spread into the tissue beyond the basement membrane), and is classified as stage 0 cancer. It is the final stage in the process of progression from a precancerous lesion to invasive cancer.
Causes and pathophysiology: Persistent infection with high-risk human papillomavirus (HPV), particularly HPV 16 and 18, is the main cause. Immunosuppression, smoking, early sexual activity, multiple childbirths, long-term use of oral contraceptives, and low-income living conditions increase the risk.
Main symptoms: Most patients have no symptoms in the early stages. As the condition progresses, abnormal vaginal bleeding (including postcoital bleeding), increased foul-smelling vaginal discharge, pelvic pain, lower back pain, and difficulty urinating or defecating may occur.

Treatment Methods

Goal: To remove the lesion and prevent progression to invasive cancer. The treatment is selected based on the patient's age, desire for pregnancy, and extent of the lesion.
Non-invasive/cervix-preserving treatment
- Cryotherapy
- Laser treatment
- Thermocoagulation
- Conization or LEEP (Loop electrosurgical excision procedure): for diagnostic and therapeutic purposes
Irreversible treatment
- Hysterectomy (particularly when the lesion is extensive or the patient does not wish to preserve the uterus)
Follow-up care after treatment
- Regular follow-up examinations, including cervical cytology (Pap) and/or HPV testing, are performed. In general, follow-up at intervals such as 6 and 12 months after treatment is often recommended (according to national or institutional guidelines).
Drug treatment: Anticancer drugs have no primary role in treating carcinoma in situ itself.
Lifestyle management and precautions
- Smoking cessation is recommended (to reduce the risk of progression).
- Until complete healing after treatment, avoid sexual intercourse and tampon use, or follow the doctor's instructions.
- If pregnancy is desired, consultation is needed regarding the suitability of conservative treatment.
Risk of complications
- After procedures such as conization, bleeding, infection, cervical stenosis, and an increased risk of cervical insufficiency and preterm birth during pregnancy may occur.

Items/documents to bring
- List of medications currently being taken (including prescriptions and supplements)
- Previous gynecological medical records (previous Pap test, HPV test, and biopsy results)
- Menstrual cycle and the date of the most recent menstrual period
- Pregnancy status or method of contraception
Symptom records
- Abnormal bleeding (timing, frequency, and amount), discharge (color and odor), and the onset and pattern of changes in pain
- Sexual history (recent sexual contact, whether condoms were used, etc.)
Preparing for examinations
- Do not use intravaginal medications or vaginal cleansing products for 24–48 hours before the examination, and refrain from sexual intercourse (confirm the healthcare institution's instructions).
Examples of questions to ask during an outpatient visit (brief)
- "What information can be obtained from this examination or procedure?"
- "What is the recovery period after the procedure, and when can I return to my daily activities?"

"What does the diagnosis mean, and what is the expected future course (prognosis)?"
"What treatment options do you recommend, and what are the advantages, disadvantages, and risks of complications of each?"
"What follow-up examination schedule and tests will be needed after treatment?"
"What treatment is recommended if I want to become pregnant?"

"To what extent could conization (or LEEP) affect pregnancy and delivery, including the risk of preterm birth?"
"If the HPV test is positive, does my partner need testing or treatment? Would HPV vaccination still be effective if I receive it now?"