It's normal to feel a little scared and worried when you see the word 'SIL' or 'Squamous Intraepithelial Lesion' on the report after a Pap test. Things like "What is this? Do I have cancer?" may immediately come to mind. But don't panic. Take a deep breath and calm down. SIL is not cancer. But it's something we need to be aware of. So, today we're going to talk very simply about what SIL is, why it develops, and what to do about it.
Simply put, what is this SIL?
SIL, or Squamous Intraepithelial Lesion , is a condition in which the cells on the surface of our body's skin, especially the cells in the thin membranes that cover certain organs, grow in a slightly different, slightly irregular way than normal. The word "intraepithelial" itself means that this change is only in the surface layer of the skin/membrane, and does not go deeper.
Think of our skin as a brick wall that's been laid out neatly. In SIL, it's as if the top row of bricks in this brick wall has been pulled apart and has a different shape. The wall is still strong, but there's a slight difference in the top layer.
These types of cell changes can occur in many different parts of our body. The most common ones are:
- Cervix
- Vagina
- External vaginal area (Vulva)
- Anus
- Penis
- Back of your throat
The important thing is that SIL is not cancer . But we call it a precancer . That means that if we don't treat and pay attention to these cell changes for a long time, there is a chance that they will turn into cancer in the future. That's why it's so important to detect it early.
There are two main types of SILs:
Doctors look at these altered cells under a microscope and divide SIL into two main types, depending on how different the cells are from normal cells.
| SIL type | Simple explanation |
|---|---|
| Low-grade SIL (LSIL) (Mild dysplasia) | This is a small change in the cells. It's like weeds sprouting up in a garden. Most of these can be controlled by our own immune system. That means they are more likely to get better on their own without any treatment. The risk of them turning into cancer is very low. |
| High-grade SIL (HSIL) (Moderate/Severe dysplasia) | There's a significant, clear change in the cells here. In the same example from the garden, these are a little bit bigger, like weeds that have taken root and sprouted. They're less likely to get better on their own . So to stop them from turning into cancer in the future, you usually have to do some kind of treatment . |
What is the main reason for the development of SIL?
The main and most common cause of SIL is the Human Papillomavirus , or HPV , a sexually transmitted infection (STI). HPV is responsible for about 90% of SIL cases.
When the HPV virus enters our body, it affects certain cells, causing them to divide faster and in a different way than normal. This is the cause of SIL.
But here's the thing: There are more than 100 types of HPV.
- Some types (e.g. HPV 6, 11) are low-risk types. These are more likely to cause things like genital warts and LSIL conditions.
- Some other types (e.g. HPV 16, 18) are considered ``high-risk`` types. These high-risk types are more likely to cause HSIL and cancer.
Most of the time, our body's immune system can fight off HPV infection and clear it from the body within a few months or a year or two. But sometimes, especially high-risk types, they can persist in the body and slowly cause cell changes over many years, leading to SIL.
What are the symptoms of this condition?
One of the biggest challenges here is that there are almost no specific symptoms for SIL . Many people find out they have the condition through a Pap smear or gynecological exam done for another reason.
However, sometimes the following symptoms may appear. If you notice these, you should definitely see your doctor.
Regarding the genital area:
- Unusual vaginal discharge or bleeding (especially outside of menstruation or after sexual intercourse)
- The appearance of lumps or genital warts
- A burning sensation or itching
- A pain
- Redness of the area
If SIL occurs in the back of the throat:
- Ear pain
- Hoarseness of voice
- Pain when swallowing something
- Long-lasting sore throat
- Swollen glands in the neck
This is why it is so important for a woman to have a Pap smear test at regular intervals , even if she has no symptoms.
Who is at higher risk of developing SIL?
Although anyone infected with HPV can develop SIL, some people are at a slightly higher risk.
- People with weak immune systems: People with HIV, organ transplant recipients, or those whose immune systems are weakened by other medical conditions have a harder time fighting the HPV virus.
- Smokers: The chemicals in cigarettes damage our cells and weaken our immune system, making it harder for smokers to control an HPV infection.
- Unsafe sexual behavior: Having multiple sexual partners and not using protective methods such as condoms increase the risk of HPV infection.
How does a doctor diagnose SIL?
There are several tests to diagnose SIL.
1. Pap Smear: This is the most important and commonly used test. In this test, a small sample of cells is taken from the cervix and examined under a microscope to see if there are any abnormalities. An anal Pap smear can also be used to detect SIL in the anus.
2. Colposcopy: If your Pap smear report shows SIL, your doctor will likely order this test. This involves using a special magnifying lens called a colposcope to look at the cervix and vagina. If there is anything unusual, it can be clearly seen.
3. Biopsy: If the doctor sees any suspicious area during the colposcopy, a very small piece of tissue is removed and sent to the lab for testing. This is called a biopsy. This is what determines whether it is SIL, LSIL, HSIL, or something more serious.
What does 'Negative for squamous intraepithelial lesion' mean?
If your Pap smear report says ``NILM - Negative for Intraepithelial Lesion or Malignancy'', that's great news. It means that no abnormalities or signs of pre-cancer were found in your cervical cells. But even if this result is good, it's still important to continue having Pap smears at the intervals recommended by your doctor.
What are the treatments for SIL?
The treatment method depends on whether you have LSIL or HSIL, where it is located, and your age and health.
- For LSIL: Most LSIL cases, especially in young women, resolve on their own without any treatment. So your doctor will often follow a "watchful waiting" approach. That means getting a Pap smear every 6 months to a year to see if the cell changes get worse or get better.
- For HSIL: HSIL usually requires treatment because it has a higher risk of developing into cancer than LSIL. There are several treatment options:
| Treatment method | How to do it |
|---|---|
| Topical treatments | In some cases, a cream is applied to the area where the abnormal cells are located. These kill the abnormal cells or stimulate the body's immune system. |
| Cryotherapy | A very cold substance, such as liquid nitrogen, is used to freeze and destroy tissue containing abnormal cells. |
| Laser treatment | A powerful laser beam is directed to burn and remove the abnormal tissue. |
| Excisional surgery | This is the most commonly used method. For HSIL of the cervix, methods such as LEEP (Loop Electrosurgical Excision Procedure) or Cone Biopsy are used to remove only the area with abnormal cells in a cone shape. |
What is the chance of developing cancer if you have HSIL?
This is a big fear for many people. Just because the report says HSIL doesn't mean you have cancer. It just means there are some cells that could turn into cancer.
According to research, if left untreated, HSIL cases only have a small 2% chance of turning into cancer. But no one can say how long it will take for that to happen. It could be 10 years, it could be 10 months.
That's why we don't take any risks, and as soon as we are confirmed to have HSIL, we remove those abnormal cells with the appropriate treatment recommended by the doctor. By doing so, we can almost completely stop the risk of developing cancer.
Can SIL be prevented?
The best and most effective way to prevent SIL is to avoid infection with the HPV virus, which is its primary cause.
1. Get the HPV Vaccine: This is the most important thing. The HPV vaccine protects against 90% of the main types of HPV that cause cancer and SIL. Getting this vaccine at the right age (usually for girls and boys between the ages of 9-14) can greatly reduce future risks. If you are over that age, ask your doctor if this vaccine is appropriate for your age.
2. Safe sex: Using condoms correctly every time you have sex can protect you from sexually transmitted diseases, including HPV.
3. Limiting sexual partners: The risk of HPV infection increases with the number of partners.
4. Get Pap smears done on time: Even if you don't have any symptoms, get a Pap smear at the intervals your doctor recommends, depending on your age and risk. If there is any change, it can be caught at the LSIL level before it progresses to a more serious condition like HSIL.
It's normal to be scared when you get a diagnosis of SIL. But it's not the end of the world. It's your body's warning, saying, "Here's a little something, let's pay attention to this." Talk openly with your doctor and listen to the meaning of the report. Be clear about what to do next. If detected early and treated properly, this is a completely curable condition.
Take-Home Message
- SIL (Squamous Intraepithelial Lesion) is not cancer. It is a pre-cancerous condition that can develop into cancer.
- The main cause of this is the sexually transmitted HPV virus.
- There are two types of SIL: LSIL (mild change, often resolves on its own ) and HSIL (high-grade change, requires treatment).
- SIL often has no symptoms, so it is extremely important to have a Pap test on time.
- Even if HSIL is present, early detection and proper treatment (e.g., LEEP) can almost completely prevent the development of cancer.
- Getting the HPV vaccine and practicing safe sex are the best ways to prevent SIL.
- If you have any concerns or doubts about your report, ask your doctor for clarification.
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