While an HPV infection itself cannot be cured, some of the effects of the infection, such as warts and precancerous lesions, can be treated to prevent them progressing to anything more serious.

Precancerous lesions are abnormal changes in the cells of your skin and mucous membrane (where HPV infection occurs). Screening for these abnormal cells is one of the most effective means to prevent the development of HPV-associated cancers.

On this page we provide an introduction to HPV-associated precancer and discuss treatment procedures for the various types of HPV-associated precancers that can be found in the body.

HPV-ASSOCIATED PRECANCER: AN INTRODUCTION

Only cervical dysplasia is routinely reported in the US, although HPV-related dysplasia can also occur on the anus, penis, vagina, vulva and head and neck. Unfortunately, there are no routine screening programs for these precancerous lesions, which we are working hard to change.

As the UK and US do screen the cervix, there are some public data on how often HPV causes abnormalities. According to the CDC, there will be 300,000 cases of high-grade intraepithelial lesions (HSIL) and 1.25 million low-grade intraepithelial lesions (LSIL) of the cervix every year in the US. In the UK, screening statistics from England report that 1.5% of pap smears conducted revealed mild dyskaryosis or dysplasia, (also known as CIN1 or in the US, LSIL) 0.4% of smears revealed moderate dyskaryosis (CIN2 or in the US, HSIL) and 0.6% of smears revealed severe dyskaryosis (CIN3 or HSIL). It is estimated that 78% of eligible women in the UK received screening for these conditions.

There is a lot of medical terminology surrounding some of the malignancies caused by HPV, and keeping everything straight can be difficult! Essentially, doctors define abnormal changes in cells using a scale of severity:

  • Dysplasia is the general term for all abnormal changes in cells. The dysplasia is classified by the severity of the changes.
  • Dysplasias can be classified by their anatomical site. In this classification, the first letter of the anatomical site is followed by ‘intraepithelial neoplasia’ (IN). For example, anal dysplasia can also be called ‘anal intraepithelial neoplasia’ or AIN. Cervical dysplasia can also be known as ‘cervical intraepithelial neoplasia’ or CIN. These are then classified according to severity. For example, AIN1 (mild), AIN2 (moderate) and AIN3 (severe). Every location that gets HPV-related precancers has a classification like this.
  • Mild dysplasia is also known as low-grade squamous intraepithelial lesions or LSIL. These are mild abnormal changes in cells, which often disappear on their own. Further tests and monitoring are strongly recommended to ensure LSIL does not progress. The medical community is still involved in an ongoing conversation about whether these milder changes should be classified as precancer or not. This may also be identified as the anatomical location+IN1.
  • Moderate to severe dysplasia is also known as high-grade squamous intraepithelial lesions or HSIL. These classifications indicate that cells have undergone more severe changes. Such changes are known as precancer since, if left untreated, they can progress to cancer. This may also be identified as the anatomical location +IN2 or IN3.

TREATMENT

Lesions in the anogenital (anus and genitals i.e. cervix, penis, scrotum, vagina and vulva) and oropharyngeal (back one-third of the tongue, soft palate, side and back walls of the throat and tonsils) regions are commonly treated with any of the procedures listed on this page, sometimes depending on several factors, which may include the type and location of the lesion, its size, the degree and severity, age and pregnancy status, previous treatment history, and patient/provider preferences.

Please remember that this list of available treatments may not be exhaustive or appropriate for your needs. The information contained on this page is not intended to provide medical advice. Any questions regarding your medical health should be directed towards your primary care physician. Be sure to speak with your provider about your options.

ANAL PRECANCER (ALSO KNOWN AS ANAL INTRAEPITHELIAL NEOPLASIA OR AIN)

For details about anal precancer and how to treat it, please see our in-depth Anal Precancer page.

CERVICAL PRECANCER (ALSO KNOWN AS CERVICAL INTRAEPITHELIAL NEOPLASIA OR CIN)

These treatment mechanisms are options in both in the US and in the UK to treat cervical precancer.

  • Cryosurgery: Extremely cold liquid or a cryoprobe is used to freeze and destroy precancerous tissue (this is also used in treating Warts). Liquid nitrogen, liquid nitrous oxide or compressed ion gas are typically used. This is also known as cryoablation and cryotherapy.
  • LEEP (loop electrosurgical excision procedure): This procedure uses an electric current that is passed through a wire loop to remove precancerous tissue. It is also known as loop excision.
  • Surgical conisation: Surgery in which a cone-shaped piece of tissue is removed from the cervix. A scalpel or laser or both are typically used. This can be used to check for signs of cervical cancer as well as act as a treatment for surgical precancer. This is also known as a cone biopsy.
  • Laser ablation: This is also known as laser therapy. It involves the use of a laser to burn away abnormal cells.

OROPHARYNGEAL PRECANCER

Oropharyngeal precancer is quite difficult to detect, and so most people are unaware of their precancer until it has progressed to cancer. Treatment is usually dependent on the location of the precancerous cells. These treatment mechanisms are options available both in the US and in the UK.

  • Surgical excision: Removal of the affected area can be carried out either with a laser or a scalpel. This treatment is used for precancer that is found on the lining of the oral cavity called epithelial dysplasia.
  • There is ongoing research into the use of compounds to lower the risk of these cancers developing, particularly in high-risk groups. At this time, these studies have not found a long-term benefit in preventing cancer.

PENILE PRECANCER (ALSO KNOWN AS PENILE INTRAEPITHELIAL NEOPLASIA, OR PIN)

These treatment methods are options in both in the US and in the UK to treat penile precancer.

  • Laser ablation: This is also known as laser therapy. It involves the use of a laser to burn away abnormal cells. This treatment is effective for treating PIN but has also been associated with a high recurrence rate in some studies.
  • Mohs micrographic surgery: This is a process in which the surgeon will remove a layer of skin from the affected area, and check the sample under a microscope. This process will be repeated until it is determined that no further layers need to be removed. This technique aims to preserve as much healthy tissue as possible.
  • Electrodessication and curettage: Using a thin instrument called a curette, the surgeon scrapes the affected cells away and then applies an electric current using a needle to try and destroy any affected cells.
  • Cryosurgery: Extremely cold liquid or a cryoprobe is used to freeze and destroy precancerous tissue (this is also used in treating Warts). Liquid nitrogen, liquid nitrous oxide or compressed ion gas are typically used. This is also known as cryoablation and cryotherapy.
  • Topical therapies and creams: Topical use of the chemotherapy drug 5-FU and off-label application of imiquimod cream have also been employed as therapy. This cream works by boosting the body’s immune response to the specific area of abnormal tissue.

VAGINAL PRECANCER (ALSO KNOWN AS VAGINAL INTRAEPITHELIAL NEOPLASIA OR VAIN)

These treatment mechanisms are options to treat vaginal precancer. Some are available in both the US and UK and some are available only in one country.

    • Topical chemotherapy: The chemotherapy drug fluorouracil (5-FU) may be applied directly to the vaginal lining. This type of treatment can be repeated weekly for about ten weeks, or given nightly for about one to two weeks. This can cause harsh vaginal or vulvar irritation. This method is used both in the US and the UK.
    • Creams: Some precancers can be treated in a similar manner to genital warts. For example, one treatment for vaginal precancer is the off-label use of imiquimod cream. This method is used both in the US and the UK.
    • Laser ablation: This is also known as laser therapy. It involves the use of a laser to burn away abnormal cells. This may be more effective than topical chemotherapy application. This method is used both in the US and the UK.
    • Diathermy treatment: This method seems to be more commonly used in the UK than the US. A thin wire with an electrical current running through it is used to destroy the precancerous cells. Local anaesthetic is used.
    • Radiation therapy: Radiation therapy is most commonly reserved for vaginal cancer in both the US and the UK, but there is evidence that it has been used to treat recurrent VAIN in the UK. This may be carried out through brachytherapy, in which a small applicator in a shape similar to a tampon and containing the radiation treatment is placed in the vagina. This may be placed there for several hours or a few days.

VULVAR/VULVAL PRECANCER (ALSO KNOWN AS VULVAR INTRAEPITHELIAL NEOPLASIA OR VIN)

These treatment mechanisms are options in both in the US and in the UK to treat vulvar/vulval precancer.

    • Surgical interventions for VIN are considered the principal treatment mechanism. The exact type of surgery depends on how advanced the precancer is. The goal of surgery is to remove the precancerous area while preserving function. Removing the entire vulva (known as a vulvectomy) is rare in all but the most extensive cases of VIN.
    • Topical therapies and creams: Topical use of the chemotherapy drug 5-FU and off-label application of imiquimod cream are also employed as therapy. This cream works by boosting the body’s immune response to the specific area of abnormal tissue.
    • Photodynamic therapy (PDT): Light-sensitive medication is applied either topically to the vulva or injected into the bloodstream and is taken up by precancerous cells. Shining a cold laser light on the cells a few hours later will activate the medication, which then begins to destroy the abnormal cells. This method is used both in the US and the UK.
    • Laser ablation: This is also known as laser therapy. It involves the use of a laser to burn away abnormal cells. This method is used both in the US and the UK.