Cervical cancer: How are precancerous cells treated?

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Screening tests for cervical cancer can detect abnormal cells on the cervix. These cells are often not dangerous and usually go back to normal again without treatment. But it is also possible that they are precancerous. So major tissue changes (dyplasias) are typically removed surgically.

In Germany, cervical dysplasias are classified in three grades, depending on the outcome of the examination of the tissue sample (biopsy):

  • Low-grade dysplasia (CIN 1)
  • Moderate dysplasia (CIN 2)
  • High-grade dysplasia (CIN 3)

CIN stands for "cervical intraepithelial neoplasia."

Low-grade or moderate dysplasia is usually no cause for concern. Many women have this kind of dysplasia at some point in their lives without knowing it. The body fights off human papillomaviruses that cause cells to change. That is why the dysplasias usually go away – especially in women between the ages of 20 and 30.

At higher grades the cells have already undergone major changes – they quite often develop into cervical cancer. So doctors recommend removing them before that can happen. The procedure for removing this tissue is called conization.

What is the difference between tissue changes (dysplasias) and cancer?

Dyoplasias have cells that have changed only in their very top layer – but they do not yet contain any cancer cells. If cancer cells have developed but haven't yet spread, it is called a “carcinoma in situ” ("in situ" is Latin and means “in its original place”). Cervical cancer is said to be "invasive" if the cancer cells have spread from the uppermost mucous membrane layer to the tissue beneath it.

When is a dysplasia removed?

Whether and when to have surgery to remove abnormal tissue is a personal decision. You are not putting yourself at risk if you don't get a low-grade or moderate grade dysplasia removed immediately. You can wait at first, and have check-ups to see what happens to the abnormal cells. This can avoid potentially unnecessary treatment.

But things are different in women who have high-grade dysplasia. Without treatment, an estimated half of these women will go on to develop cervical cancer. For this reason, doctors recommend removing the precancerous tissue using a procedure known as conization. This is usually enough to get rid of all of the abnormal tissue and prevent cervical cancer.

Good to know:

there's no need to panic if abnormal cells are found. There's enough time to calmly gather information and talk to your doctor about what you would like to do next.

What happens during conization?

In conization, a roughly cherry-sized, cone-shaped wedge of tissue is removed from the opening of the cervix and the cervix itself using a laser or a scalpel. This usually removes all of the abnormal tissue. The operation is done through the vagina, under local or general anesthesia. It is usually an outpatient procedure (no need to stay overnight in a hospital).

The illustration on the left shows the internal sex organs and a tumor on the opening of the cervix; the illustration on the right shows the cervix after tissue has been removed.

Women may have mild pain and bleeding immediately afterwards. A reddish discharge and bleeding in the first few days after surgery are possible too. So it's important to take care and rest a lot at first, and to avoid sex in the first few weeks after surgery.

What are the potential serious side effects of conization?

Conization usually doesn't cause any severe side effects. Surgeons should remove as much tissue as necessary, but as little tissue as possible, particularly in women who would still like to have children. Removing tissue weakens the cervix, increasing the risk of preterm birth in women who get pregnant after the procedure. This risk is especially high if a lot of tissue is removed: Conization can cause preterm birth in about 3 out of 100 pregnancies (before 37 weeks of pregnancy). Removing less tissue greatly reduces the risk of preterm birth.

If high-grade dysplasia is discovered during pregnancy, doctors normally recommend waiting and operating after the baby is born, to avoid weakening the opening of the cervix.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Invitation and decision aid for cervical cancer screening; Executive report; Commission P15-02. 2017.

Krebsinformationsdienst (KID), Deutsches Krebsforschungszentrum (DKFZ). Gebärmutterhalskrebs (Zervixkarzinom). 2023.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on March 25, 2025

Next planned update: 2028

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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