CIN3 Diagnosis: Urgency for Surgery and Travel Considerations

Cervical biopsy report shows CIN3 (Cervical Intraepithelial Neoplasia grade 3)?

Hello Dr.
Tsao, I have had abnormal Pap smears for many years, and I have been undergoing follow-ups annually.
At the end of 2020, after another abnormal result, I underwent a biopsy, and the report indicated CIN3, HSIL.
Here are the detailed findings from the pathology report: "Microscopically, sections show cervical intraepithelial neoplasia 3 (CIN3, HSIL) with moderate nuclear pleomorphism, disorientation, and disarray of epithelial squamous cells involving the entire 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 undergoing surgery here.
I would like to ask you, based on the pathology report, is there an urgent need for surgery? I plan to return to Taiwan by the end of this year; can I wait until I return to Taiwan to have the surgery? How long after a cone biopsy can I fly? I would appreciate your response so that I can 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: 2021/01/07

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, surgery is generally not urgent, but it is necessary to address the issue.
After undergoing a cone biopsy, it is best to observe for about two weeks.
Wishing you good health.

Reply Date: 2021/01/07

More Info

Cervical intraepithelial neoplasia (CIN) is a term used to describe abnormal changes in the cells on the surface of the cervix. CIN3, also known as high-grade squamous intraepithelial lesion (HSIL), is a significant concern because it indicates severe dysplasia and has the potential to progress to cervical cancer if left untreated. Your pathology report confirms the diagnosis of CIN3, characterized by moderate nuclear pleomorphism and disarray of epithelial cells, without evidence of stromal invasion, which is a positive aspect as it suggests that the lesion has not yet invaded deeper tissues.

Given the nature of CIN3, it is generally recommended to proceed with surgical intervention, typically a cervical conization (cone biopsy), to remove the affected tissue and to assess for any potential invasive cancer. The urgency of this procedure can depend on several factors, including the presence of symptoms, the overall health of the patient, and the healthcare system's capacity to provide timely care. In your case, since you have been monitored for several years and have a confirmed diagnosis of CIN3, it is advisable not to delay the surgery.

Regarding your question about whether you can wait until you return to Taiwan for the procedure, it is essential to consider the risks associated with postponing treatment. While it may be tempting to wait, especially given the current healthcare challenges due to COVID-19, the risk of progression to invasive cancer increases with time. Therefore, if you can find a healthcare facility that can perform the procedure safely and effectively where you are currently located, it may be worth considering proceeding with the surgery sooner rather than later.

If you choose to wait until you return to Taiwan, ensure that you have a clear plan for follow-up care and that you communicate your situation to your healthcare provider in Taiwan. They may recommend additional monitoring or interim measures to manage your condition until you can undergo the conization.

As for travel considerations post-surgery, recovery from a cervical conization typically involves some bleeding and discomfort, and you may be advised to avoid strenuous activities for a period of time. Generally, patients are advised to refrain from flying for at least one to two weeks after the procedure, depending on individual recovery and any complications that may arise. It is crucial to follow your surgeon's specific recommendations regarding travel and activity restrictions.

In summary, while it may be possible to wait for surgery until you return to Taiwan, it is essential to weigh the risks of delaying treatment against the benefits of having the procedure done sooner. If you have any concerns about the healthcare facilities available to you currently, it may be beneficial to consult with a healthcare professional who can provide guidance tailored to your specific situation. Prioritize your health and ensure that you have a solid plan in place for managing your CIN3 diagnosis.

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