What is a Cervical Lesion?

A cervical lesion is an area of abnormal tissue found on the cervix, which is the lower end of a woman’s uterus. Such lesions may be found during routine Pap smears and can indicate the presence of infection with human papillomavirus (HPV) and/or precancerous changes in the cells of the cervix. In general, a cervical lesion is classified as either low grade or high grade, which corresponds to the degree of abnormality seen in the cervical tissue. For many women diagnosed with these lesions, regular follow-up testing is recommended to monitor the degree of abnormality of the cervical tissue. In certain cases, treatment may be recommended to remove the abnormal tissue.

Often, a cervical lesion is found only when a woman goes in for a regular Pap smear, which is an exam that involves scraping cells off the surface of the cervix and inspecting them under a microscope to look for changes that could be a sign of cancer. When the Pap smear shows changes in cervical cells that don’t rise to the level of cancer but are still considered abnormal, it often means there is a cervical lesion present. Based on how these abnormal cells look under a microscope, the lesion may be classified as a low-grade intraepithelial squamous lesion (LSIL) or a high-grade intraepithelial squamous lesion (HSIL).

A diagnosis of LSIL typically means there are mild changes in the cells of the cervix. These changes are often caused by infection with HPV. In many cases, especially in younger women, the body’s own immune system is able to fight off this infection, at which point the lesion that previously existed may also clear up. For certain women, however, the HPV infection and/or low-grade cervical lesion may persist. In these cases, there is a risk that the cells of the cervix may continue to change and eventually become cancerous, although this risk is generally considered low.

HSILs, on the other hand, have a greater risk of turning into cancer. A diagnosis of HSIL generally means the changes in the cells of the cervix are more severe and are considered precancerous. There are different levels of HSILs that correspond to increasing risk of the cells becoming cancerous, ranging from a moderate risk to very likely.

For both LSILs and HSILs, follow-up testing is often recommended to get a closer look at the abnormal cervical cells. One common follow-up test is known as a colposcopy. During a colposcopy, a health care provider looks at the cervix under magnification, and if the cervical lesion can be seen, a biopsy of it may be taken for further testing. If the biopsy results confirm or show the cervical cell changes are only mild, more frequent Pap smears to continue to monitor the cells is often the only recommended course of action. A health care provider may recommend more active treatment, however, if the results confirm or show more severe changes.

Cervical lesion treatment usually involves removal of the abnormal tissue. The goal of this type of treatment is to help prevent the abnormal cells from becoming cancerous and invading nearby normal tissue. Options for removal of a cervical lesion often include cold-knife or electrosurgical excision, cryotherapy, and laser therapy. Frequent Pap smears may be recommended for a certain amount of time after treatment to monitor for any additional cervical changes.