Cervical dysplasia
What is cervical dysplasia?
Cervical dysplasia is when abnormal changes occur in cells of a woman's cervix. Dysplasia refers to changes in cell size or shape that are not normal. Despite being abnormal, these cells are not cancerous, although left untreated, cervical dysplasia can sometimes progress to cervical cancer.
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Cervix
The lower part of the uterus, leading out into the vagina.
Signs and symptoms
Usually there are no symptoms of cervical dysplasia, particularly in its early stages. Often the only way to know if you have it is to have a Pap test. Sometimes symptoms may appear due to inflammation or irritation of the cervix and can include abnormal vaginal bleeding or discharge.
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Cervix
The lower part of the uterus, leading out into the vagina.
Causes
Most of the time cervical dysplasia is caused by human papillomavirus (HPV), a common sexually-transmitted infection (STI). Some types of HPV result in cervical dysplasia and cervical cancer and these types are different to the types that cause genital warts.
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Human papillomavirus
A virus with many subtypes that cause warts, including common warts of the hands and feet, and genital warts. Some strains of HPV cause cervical cancer.
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Sexually-transmitted infection
A viral or bacterial infection contracted through sexual intercourse or genital contact. Such an infection can lead to development of diseases such as chlamydia, gonorrhea, genital herpes and AIDS.
Risk factors
Risk factors for cervical dysplasia include:
- Being sexually active before the age of 18;
- Multiple sexual partners;
- Having a suppressed immune system due to certain medication or HIV/AIDS;
- Having a baby before the age of 16, and;
- Smoking.
Types
Based on a Pap test, cervical dysplasia will be described as low-grade, high-grade, possibly cancerous, or atypical by the cytologist. If a result is greater than low-grade, or if a low-grade change persists beyond a certain timeframe, a biopsy is taken. Biopsy is performed by a gynecologist during a procedure known as colposcopy, and then sent for microscopic examination by a pathologist. If there is cervical dysplasia, it will be described as being mild (CIN I), moderate to marked (CIN II), or severe and carcinoma in situ (CIN III).
Grades of cervical dysplasia.
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Cytologist
Someone who specializes in studying cells.
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Gynecologist
A healthcare professional who specializes in the female reproductive system.
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Pathologist
A doctor specializing in the microscopic study of disease, such as examining a tissue sample taken in a biopsy.
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Colposcopy
Examination of the cervix using a special microscope called a colposcope, to closely identify any abnormalities.
Methods for diagnosis
Pap test
The Papanicolaou test, more commonly known as a Pap test, involves your doctor scraping or brushing off cells from your cervix. The cervix is the lower, narrow part of the uterus located at the upper end of the vagina. The cells collected are smeared onto a glass slide, which is sent to a laboratory where someone who specializes in studying cells (cytologist) checks them for abnormalities. Remember, a Pap test is a screening test, not a diagnostic test, so the results are described as 'possible' abnormalities. A biopsy is required for accurate diagnosis when possible abnormalities are detected on a Pap test.
Human papillomavirus DNA test
Due to the fact some types of HPV cause cervical cancer and others do not, a DNA test to determine the type of HPV you have, if any, can be performed. The test is usually only performed for monitoring purposes after high-grade changes have been confirmed and treated. This is because cervical cancer usually occurs with persistent infection of high-risk types of HPV. In some countries, HPV detection is used for screening in place of a routine Pap test.
Colposcopy
A colposcopy involves a magnifying lens called a colposcope being used to examine your cervix. This test is performed by a specialist gynecologist and is used to identify abnormal-looking regions that can be biopsied for examination by a pathologist. This test is done following certain abnormal Pap test results, to check more accurately for changes in cervical cells.
Biopsy
A biopsy is a tissue or cell sample taken for microscopic examination by a pathologist in the laboratory, to check for levels of dysplasia, cancer and other diseases.
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Cervix
The lower part of the uterus, leading out into the vagina.
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Cytologist
Someone who specializes in studying cells.
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DNA
The genetic material of all living cells and some viruses. The full name is deoxyribonucleic acid.
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Gynecologist
A healthcare professional who specializes in the female reproductive system.
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Pathologist
A doctor specializing in the microscopic study of disease, such as examining a tissue sample taken in a biopsy.
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Uterus
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
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Colposcopy
Examination of the cervix using a special microscope called a colposcope, to closely identify any abnormalities.
Types of treatment
The type of treatment you receive depends on how severe your dysplasia is. Mild dysplasia commonly disappears without treatment, so a follow-up Pap test every 6-12 months may be all that is needed, unless the abnormalities do not go away or get worse.
Biopsy-confirmed moderate to severe dysplasia is treated with the following:
- Large loop excision of the transformation zone (LLETZ) - this uses a small electrical current to remove abnormal tissue from the cervix;
- Cryotherapy - abnormal cells can be removed by being frozen;
- Laser surgery - a targeted carbon dioxide laser can be used to burn away (ablate) abnormal cells;
- Surgery - the surgical removal of abnormal tissue, called a cone biopsy, can be performed, and;
- Hysterectomy - a hysterectomy is the surgical removal of the uterus. It is rarely used for women with cervical dysplasia and may only be considered if potentially dangerous changes persist and the above therapies have failed. As this procedure renders the woman infertile, her stage of life and wishes regarding child-bearing need to be considered prior to this operation.
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Cervix
The lower part of the uterus, leading out into the vagina.
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Uterus
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
Potential complications
Without treatment, cervical dysplasia may progress to cervical cancer.
Prognosis
With treatment, cervical dysplasia can be removed, although it is possible for it to return later. If left untreated for a number of years, severe cervical dysplasia may turn into cervical cancer. This is why it is important to have regular screening through Pap tests.
Prevention
Speak to your doctor about the HPV vaccine. The chances of getting cervical dysplasia are greatly reduced in girls who have the vaccine before they become sexually active. The vaccine alone will not completely eliminate your chances of getting cervical dysplasia, because it is not 100% effective and sometimes there are other causes of cervical dysplasia than the strains of HPV covered by the vaccine. It is important to continue routine screening with Pap tests even if you have had the vaccine. Limiting your number of sexual partners, practicing safe sex and quitting smoking can all reduce your risk of developing cervical cancer.
References
- Sydney Gynaecological Oncology Group - Function. Accessed 1 August 2014 from link here
- WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention - NCBI Bookshelf. Accessed 1 August 2014 from link here
- WHO Guidelines for Treatment of Cervical Intraepithelial Neop... [2014] - PubMed - NCBI. Accessed 1 August 2014 from link here
- RISK FOR CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 3 OR WORSE IN RELATION TO SMOKING AMONG WOMEN WITH PERSISTENT HUMAN PAPILLOMAVIRUS INFECTION. Accessed 1 August 2014 from link here
10 Most frequently asked questions (FAQs)
What are the symptoms of cervical dysplasia? There are usually no symptoms of cervical dysplasia, particularly in its early stages. Often the only way to know if you have it is to have a Papanicolaou test (Pap smear). Sometimes symptoms may appear due to inflammation or irritation of the cervix and can include abnormal vaginal bleeding or discharge. What causes cervical dysplasia? Most of the time cervical dysplasia is caused by human papillomavirus (HPV), a common sexually transmitted infection (STI). Some types of HPV result in cervical dysplasia and cervical cancer and these types are different to the types that cause genital warts. Who gets cervical dysplasia? Cervical dysplasia is most common in women aged 25 to 35 years. Other risk factors that increase the chance of developing cervical dysplasia include: being sexually active before the age of 18; having multiple sexual partners; having a suppressed immune system due to certain medications or HIV/AIDS; having a baby before the age of 16, and; smoking. How is cervical dysplasia diagnosed? Cervical dysplasia can be diagnosed by: 1) Pap smear - this involves the doctor scraping or brushing off cells from your cervix, which are then analyzed for possible abnormalities. 2) Human papillomavirus DNA test - a test used to determine the type of HPV you may have. 3) If a Pap smear shows certain results, colposcopy is done to check more accurately for changes in cervical cells. A magnifying lens called a colposcope is used to examine your cervix. 4) Biopsy - a tissue or cell sample will be taken for examination in the laboratory, to check for levels of dysplasia, cancer and other diseases. How is cervical dysplasia treated? The type of treatment you receive depends on how severe your dysplasia is. Mild dysplasia commonly disappears without treatment, so a follow-up Pap smear every six to 12 months may be all that is needed, unless the abnormalities do not go away or get worse. Biopsy-confirmed moderate to severe dysplasia is treated with the following: 1) Large loop excision of the transformation zone (LLETZ) - uses a small electrical current to remove abnormal tissue from the cervix. 2) Cryotherapy - abnormal cells can be frozen ,then removed. 3) Laser surgery - a targeted carbon dioxide laser can be used to burn away (ablate) abnormal cells. 4) Cone biopsy - the surgical removal of abnormal tissue. 5) Hysterectomy - surgical removal of the uterus. This is rarely used for women with cervical dysplasia and may only be considered if potentially dangerous changes persist and the above therapies have failed. As this procedure renders the woman infertile, her stage of life and her wishes regarding child-bearing need to be considered. Can cervical dysplasia be prevented? Speak to your doctor about the HPV vaccine. The chances of getting cervical dysplasia are greatly reduced in girls who have the vaccine before they become sexually active. The vaccine alone will not completely eliminate your chances of getting cervical dysplasia, because it is not 100% effective and sometimes there are other causes of cervical dysplasia than the strains of HPV covered by the vaccine. It is important to continue routine screening with Pap smears even if you have had the vaccine. Limiting your number of sexual partners, practicing safe sex and quitting smoking can all reduce your risk of developing cervical cancer. Is cervical dysplasia serious? Cervical dysplasia ranges from mild to severe. Mild dysplasia can go away on its own, but moderate or severe dysplasia is serious because it can develop into cervical cancer.
Related topics
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