Cervical Dysplasia

Cervical Dysplasia

Alternate Names

  • cervical intraepithelial neoplasia (CIN)
  • precancerous changes of the cervix

Definition

Cervical dysplasia is a condition in which a woman has abnormal changes in the top layer of cells of her cervix. The cervix is the opening between the vagina and the uterus. The changes are local and have not spread more deeply into the cervix or to other sites in the body.

What is going on in the body?

The cells of the cervix take months or even years to go through precancerous stages before full-blown cancer occurs. These changes are called cervical dysplasia. Catching and treating the changes early can prevent cancer of the cervix.
The cervix is the opening to the uterus. While it is located within a woman's vagina, its cells act very much like skin cells. When the cells become infected with certain strains of the human papilloma virus, precancerous changes, called dysplasia, may result.
Each stage of dysplasia, or abnormal changes in the cells, is judged by the thickness of the cells that are abnormal. The earliest microscopic change is mild dysplasia or cervical intraepithelial neoplasia, also referred to as CIN 1. If not treated, the precancerous changes may become moderate (CIN 2) and then severe (CIN 3).
The fourth and most severe stage of dysplasia is called carcinoma in situ, or CIS. After that, cancer cells may invade deeper layers of the cervix or spread to nearby sites. At that point it is called invasive cancer of the cervix.

Risks

What are the causes and risks of the condition?

Cervical dysplasia is a precursor to cancer of the cervix, which is the second most common cancer of the female reproductive system. It occurs most often among women aged 40 to 55. Human papilloma virus (HPV) infection causes the abnormal changes that we call cervical dysplasia. Certain health problems, lifestyle choices, and other factors are associated with a woman's risk of HPV infection.
These include:
  • having had another sexually transmitted infection
  • having had an abnormal Pap smear. A Pap smear is an examination, under a microscope, of cells scraped from the cervix.
  • becoming sexually active before age 18
  • having had more than 3 sexual partners
  • not using condoms with new sexual partners
  • having a sexual partner whose previous partner had cancer of the cervix or cervical dysplasia
  • having sex with a male partner who is uncircumcised
  • having a sexual partner who has or has had cancer of the penis
  • smoking
  • having a weakened immune system, for example, as a result of HIV or another immunodeficiency disorder

Prevention

What can be done to prevent the condition?

Many times, cervical dysplasia can be stopped in its early stage by early detection. Cervical dysplasia can be detected by a pelvic examination that includes a Pap smear. Women should start to have Pap smears and pelvic exams when they reach the age of 21 or when they have been sexually active for three years.
A woman can lower her risk for developing cervical dysplasia by taking the following steps:
  • quitting smoking
  • limiting sexual relations to one lifelong, faithful partner
  • using latex condoms with each sexual encounter outside a lifelong, mutually faithful relationship
A woman should ask her sexual partners about their sexual histories, so that those who seem to be high-risk can be avoided. Identification of early warning signs of cervical dysplasia and cervical cancer is also important..
A woman should see her healthcare professional and may need to be treated if she has any of the following signs or symptoms:
  • vaginal discharge that does not seem normal
  • vaginal bleeding between periods
  • bleeding with intercourse
  • painful intercourse, known as dyspareunia

Diagnosed

How is the condition diagnosed?

Diagnosis of cervical dysplasia is done with a pelvic examination that includes a Pap smear. During a pelvic exam, the cervix, vagina, and vulva are checked for signs of changes. To do a Pap smear, the examiner uses a small spatula and a brush to gently scrape cells from the cervix. These cells are sent to a lab for testing. If abnormalities are found, the Pap smear may be repeated in 3-6 months.
Alternately, the healthcare professional may do additional tests, including:
  • colposcopy, a procedure in which a special microscope allows the provider to closely examine the cervix, vagina, and vulva
  • cervical biopsy, a procedure in which small tissue samples are taken from the cervix. This procedure is generally done in a healthcare professional's office.
  • loop electrosurgical excision procedure (LEEP). This is often done in the office with local anesthesia but may be done with the patient asleep in the operating room if the abnormal area is large or there are extra risks of bleeding.
  • cold cone biopsy, a procedure in which a large tissue sample is taken from the cervix. This procedure is normally done in an operating room under general anesthesia. The cone biopsy often removes all of the abnormal tissue.

Long Term Effects

What are the long-term effects of the condition?

With early detection, treatment, and close follow-up care, nearly all cervical dysplasia can be cured. If untreated, the mild to moderate stages of dysplasia often grow more severe. Up to 30% to 50% of carcinoma in situ, or CIS, cases progress to invasive cancer of the cervix.

Other Risks

What are the risks to others?

Cervical dysplasia, per se, is not contagious and does not pose a risk to others
However, human papilloma virus, the underlying cause of cervical dysplasia, is a sexually transmitted infection and can be passed to a partner during sexual activity, including but not limited to sexual intercourse.

Treatments

What are the treatments for the condition?

Early dysplasia can usually be treated with one of the following:
  • cryotherapy, that is, freezing of the abnormal cells with liquid nitrogen
  • laser surgery, with a laser beam directed at the abnormal cells
  • loop electrocautery excision procedure (LEEP), a procedure that uses a heated electrical loop to destroy abnormal cells
For more serious cases of cervical dysplasia, the abnormal tissue may be removed surgically. Options for surgical removal include:
  • cone biopsy, a procedure in which a portion of the center of the cervix is removed. This procedure is also used to diagnose the dysplasia. During the diagnostic cold cone biopsy, the abnormal tissue is often completely removed.
  • hysterectomy, or surgical removal of the uterus and cervix

Side Effects

What are the side effects of the treatments?

During cryotherapy, women often feel cramping and pelvic discomfort. For about a month afterward, they have a great deal of watery vaginal discharge. Laser surgery or LEEP can cause the following:
  • foul-smelling vaginal discharge
  • cervicitis, or inflammation of the cervical tissue
  • bleeding
  • an allergic reaction to the local anesthesia used during the procedure
Possible side effects and complications of hysterectomy are as follows:
  • a pelvic or bladder infection
  • damage to an organ near the uterus such as the bladder or bowel
  • psychological stress
  • bleeding that causes anemia and may require a blood transfusion
  • a reaction to anesthesia

After Treatment

What happens after treatment for the condition?

A woman may be advised to refrain from using tampons, having sexual intercourse, or douching for a period of time following a procedure to treat cervical dysplasia.

Monitor

How is the condition monitored?

Women who have been treated for dysplasia should be closely followed with pelvic exams and Pap smears. During the first year after any treatment, Pap smears should be done every 3 to 6 months.. Any new or worsening symptoms should be reported to the healthcare professional.

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