Cervical dysplasia is the formation of abnormal or pre-cancerous cells in and around the cervix. The vagina opens into the lower part of the uterus, the cervix. Cervical dysplasia is detected by a pap test (smear test) and diagnosed with a biopsy. Abnormal changes in cells can be mild, moderate or severe. The presence of cervical dysplasia does not necessarily mean that a person has cervical cancer. However, if cells are not treated, they can cause cancer. This article contains information about what cervical dysplasia is, its symptoms, causes and treatment methods.
What is Cervical Dysplasia?
Cervical dysplasia is defined as a precancerous condition in which abnormal cells grow in the cervix. The cervix is the narrow part at the lower end of the uterus that connects the vagina and the uterine cavity. The cervix is divided into two parts: endocervix and exocervix. While the first contains the opening in the uterus, the second protrudes into the vagina. Both the inner and outer parts are lined with different types of cells and can merge in the area where it was formed. Most cases of cervical dysplasia happen here. Cervical dysplasia is sometimes called squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) and is classified in different stages. This classification is as follows:
• CIN1, mild cervical dysplasia or low grade intraepithelial lesion (LSIL): Only a small portion of the tissue is abnormal.
• CIN2 or CIN3, moderate or severe cervical dysplasia or high grade intraepithelial lesion (HSIL): More of the tissue is abnormal.
Cervical Dysplasia Symptoms
Cervical dysplasia like HPV infections and even early stage cervical cancer tend to be asymptomatic. For this reason, it is important that pelvic examinations and Pap smear tests are performed on schedule. If the smear test and pelvic check results are abnormal, the doctor may refer further examination or a specialist. Depending on the personal background, the following tests and controls may be required.
• A repeated Pap smear: It can be performed one to three years after the first test, depending on the characteristics of the condition.
• HPV test: This test identifies infections that are high risk HPV strains and can be performed on the same sample collected for your Pap smear.
• Colposcopy and biopsy: Colposcopy uses a magnifying device to examine the cervix closely. If the doctor detects anything suspicious, they’ll likely do a biopsy (i.e. take a tissue sample for testing).
• Endocervical sampling: An additional procedure in which a small brush or sphere collects cells from your endocervix to be examined for cervical dysplasia.
Cervical Dysplasia Causes
Cervical dysplasia precedes cervical cancer, but the transition from one to another is slow and occurs over many years. Cervical dysplasia is caused by a common sexually transmitted infection known as human papilloma virus or HPV. In most cases, the immune system can fight within 8 to 24 months. However, a persistent HPV infection can cause changes in cells and eventually cervical dysplasia. Although there are over a hundred types of HPV, only a few are responsible for developing cervical cancer. HPV 16, for example, is the culprit behind about half of all cervical cancer cases. Other high-risk strains include HPV 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.
Cervical Dysplasia Treatment
Severity is the dominant factor when it comes to treating cervical dysplasia. Mild dysplasia or LSIL is monitored conservatively and tends to resolve on its own before it becomes cancer. On the other hand, HSIL or moderate dysplasia usually requires removal of cells in the form of excisional or ablative procedures. Excisional treatments for cervical dysplasia include:
• Loop electrosurgical excision procedure (LEEP): Here, a thin wire loop uses an electric current to remove the cervical tissue.
• Conization or cold blade cone procedure (CKC): Alternatively, a cone-shaped or cylindrical portion of cervical tissue is excised for testing.
Ablative treatments, in contrast, destroy cervical dysplasia tissue and include:
• Laser therapy: A beam of light is used to destroy abnormal cells in the cervix.
• Cryotherapy: A small probe is made using liquid nitrogen or argon gas to freeze abnormal tissue.
After these procedures have been performed, annual follow-up smear tests should be obtained.
How to Prevent Cervical Dysplasia?
As the main cause behind cervical dysplasia and cancer, HPV unfortunately does not have a cure. However, HPV vaccines can help protect you from infections caused by certain strains. Since HPV vaccines cannot cure pre-existing infections, it is recommended to be taken before becoming sexually active to maximize their effectiveness. Still, it can be administered to sexually active adults from the age of 26. Anyone vaccinated against HPV should discuss this with their doctor. Other factors that can increase the risk of developing cervical dysplasia or cancer include:
• To smoke
• exposure to secondhand smoke
• Having more than one sexual partner
• Partnering with more than one sexual partner
Pap smear and HPV tests are routinely used for HPV and cervical dysplasia screening. While a Pap smear involves taking a sample of cervical cells to detect microscopic changes, an HPV test can detect the virus inside these cells. It is important to pay attention to the following factors:
• All women should begin cervical cancer screening at age 21.
• Between 21 and 29, it is recommended to use a Pap smear every 3 years.
• After the age of 30, both Pap smear and HPV test should be done every 5 years as long as the results remain normal.
• Between 30 and 65, it is recommended to use a Pap smear every 3 years.
Cervical dysplasia refers to abnormal changes in the cells of the cervix that do not progress to stage 1 cervical cancer. Cervical cancer usually lasts for years, and being able to diagnose these changes is key to effective treatment. Regular smear tests and ob-gyn checks are required to detect cervical dysplasia as early as possible.
Most people with cervical dysplasia recover with early diagnosis and prompt treatment. Screening recommendations recommended by the doctor should be followed for early diagnosis. Once treated, cervical dysplasia may return. Cervical cancer may develop in people with severe cervical dysplasia, high-risk HPV, or untreated people. Therefore, it is important to be careful and to have checks done in the specified periods.