CIN3 Diagnosis: Urgency of Cone Biopsy and Travel Considerations

Cervical biopsy report: CIN3 (Cervical Intraepithelial Neoplasia grade 3)

Hello, I have had abnormal Pap smears for many years, with annual follow-ups.
At the end of 2020, after another abnormal result, I underwent a biopsy, which reported CIN3, HSIL.
The detailed pathology report states: "Microscopically, sections show cervical intraepithelial neoplasia 3 (CIN3, HSIL) with moderate nuclear pleomorphism, disorientation, and disarray of epithelial squamous cells involving the whole layer of squamous epithelium.
There is no definite stromal invasion identified in the sectioned specimen.
Endocervical tissue can also be seen.
The high-grade squamous intraepithelial lesion is confirmed by P16 and P40 immunohistochemical stains." I understand that CIN3 requires a cone biopsy, but I am currently abroad, and the hospitals here are overwhelmed due to COVID-19, making me feel uneasy about having the surgery here.
I would like to ask the physician if there is an urgent need for surgery based on the pathology report.
I plan to return to Taiwan by the end of this year; can I wait until I return to Taiwan for the surgery? How long after the cone biopsy can I fly? I appreciate your response, as it will help me assess whether I need to have the surgery here or if I can wait until I return to Taiwan.
Thank you!

Molly, 30~39 year old female. Ask Date: 2021/01/06

Dr. Cai Yonglong reply Obstetrics and Gynecology

CIN3 or HSIL are considered significant dysplasia, which can progress to CIS or Stage Ia1.
It is essential to perform cervical conization and endocervical curettage (ECC) as soon as possible to determine if there is any extension.
Therefore, please do not delay and address this promptly.
Good luck to you.

Reply Date: 2021/01/06

More Info

Cervical intraepithelial neoplasia (CIN) is a term used to describe abnormal changes in the cells on the surface of the cervix. CIN is classified into three grades: CIN1, CIN2, and CIN3, with CIN3 being the most severe form, often referred to as high-grade squamous intraepithelial lesion (HSIL). The distinction between CIN3 and carcinoma in situ (CIS) is nuanced, as both conditions indicate significant cellular abnormalities, but CIS is considered a non-invasive cancer.

In your case, the diagnosis of CIN3 indicates a high risk of progression to invasive cervical cancer if left untreated. The pathology report you provided confirms the presence of moderate nuclear pleomorphism and disarray of epithelial cells, which are characteristic of CIN3. Importantly, the report states that there is no evidence of stromal invasion, which is reassuring as it indicates that the abnormal cells have not penetrated deeper tissues.

Regarding the urgency of a cone biopsy, it is generally recommended to proceed with treatment for CIN3 due to the potential risk of progression to invasive cancer. While the immediate urgency may vary based on individual circumstances, it is advisable to address this diagnosis sooner rather than later. Delaying treatment could increase the risk of developing invasive disease, particularly if there are any changes in your health status or if the healthcare situation worsens due to ongoing COVID-19 challenges.

If you are currently abroad and concerned about the quality of care available, it is understandable to want to wait until you return to Taiwan for the procedure. However, it is essential to weigh the risks of delaying treatment against the potential benefits of having the procedure performed in a familiar and trusted healthcare environment. If you choose to wait, ensure that you have a plan for follow-up care and monitoring in the interim.

As for travel considerations post-cone biopsy, recovery time can vary from person to person. Generally, it is recommended to avoid long flights and strenuous activities for at least two weeks following the procedure to allow for proper healing. However, individual recovery may differ, and it is crucial to follow your healthcare provider's specific recommendations regarding travel and activity restrictions.

In summary, while there may not be an immediate life-threatening urgency, the diagnosis of CIN3 warrants timely intervention to prevent potential progression to invasive cancer. If you decide to wait until your return to Taiwan, ensure that you have a clear follow-up plan and consider the timing of your travel in relation to your recovery from the cone biopsy. Always consult with your healthcare provider for personalized advice and to discuss any concerns you may have regarding your health and treatment options.

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