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Cervical dysplasia
Definition
Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
The changes are not cancer. But they can lead to cancer of the cervix if not treated.
Alternative Names
Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix
Causes, incidence, and risk factors
Cervical dysplasia is most often seen in women ages 25 to 35, but can develop at any age.
Most often, cervical dysplasia is caused by the human papilloma virus (HPV). HPV is a common virus that is spread through sexual contact. There are many different types of HPV. Some types lead to cervical dysplasia or cancer.
The following may increase your risk of cervical dysplasia:
- Having sex before age 18
- Having a baby before age 16
- Having multiple sexual partners
- Having other illnesses or using medicines that suppress your immune system
- Smoking
Symptoms
There are usually no symptoms.
Signs and tests
A pelvic exam is usually done.
Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). These changes may be:
- Low-grade (LSIL)
- High-grade (HSIL)
- Possibly cancerous (malignant)
- Atypical glandular cells (AGUS)
If a Pap smear shows abnormal cells or cervical dysplasia, you will need further testing:
- Follow-up Pap smears may be recommended if the condition is mild
- Colposcopy-directed biopsy to confirm the condition
- Cone biopsy or LEEP excision may be done after colposcopy
Dysplasia that is seen on a biopsy of the cervix is called cervical intraepithelial neoplasia (CIN). It is grouped into three categories:
- CIN I -- mild dysplasia
- CIN II -- moderate to marked dysplasia
- CIN III -- severe dysplasia to carcinoma in situ
Some strains of human papillomavirus (HPV) are known to cause cervical cancer. An HPV DNA test can identify the high-risk types of HPV linked to such cancer. This test may be done:
- As a screening test for women over age 30
- For women of any age who have a slightly abnormal Pap test result
Treatment
Treatment depends on the degree of dysplasia. Mild dysplasia (LSIL or CIN I) may go away without treatment.
- You may only need careful observation by your doctor with repeat Pap smears every 6 to 12 months.
- If the changes do not go away or get worse, treatment is needed.
Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include:
- Cryosurgery to freeze abnormal cells
- Laser therapy, which uses light to burn away abnormal tissue
- LEEP (loop electrosurgical excision procedure), which uses electricity to remove abnormal tissue
- Surgery to remove the abnormal tissue (cone biopsy)
- Hysterectomy (in rare cases)
If you have had dysplasia, you will need close follow-up. This is usually every 6 months or as recommended by your doctor.
Expectations (prognosis)
Early diagnosis and prompt treatment will cure nearly all cases of cervical dysplasia. Sometimes, the condition returns.
Without treatment, severe cervical dysplasia may change into invasive cancer. It can take 10 or more years for cervical dysplasia to develop into cancer. The risk of cancer is lower for mild dysplasia.
Calling your health care provider
Call for an appointment with your health care provider if you are age 21 or older and have never had a pelvic examination and Pap smear.
Prevention
Ask your health care provider about the HPV vaccine. Girls who receive this vaccine before they become sexually active reduce their chance of getting cervical cancer.
You can reduce your risk of developing cervical dysplasia by taking the following steps:
- Do not smoke. Smoking increases your risk of developing more severe dysplasia and cancer.
- Get vaccinated for HPV between ages 9 and 26.
- Do not have sex until you are 18 or older.
- Practice safe sex, and use a condom.
- Practice monogamy. This means you have only one sexual partner at a time.
References
American Academy of Pediatrics, Committee on Infectious Diseases. Policy Statement: HPV vaccine recommendations. Pediatrics. 2012. DOI: 10.1542/peds.2011-3865.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: Management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444. Reaffirmed 2010.
American College of Obstetricians and Gynecologists. Practice Bulletin No. 131: Screening for cervical cancer. Obstet Gynecol. 2012;120:1222-1238.
American College of Obstetricians and Gynecologists. Committee Opinion No. 463: Cervical cancer in adolescents: screening, evaluation, and management. Obstet Gynecol. 2010;116:469-472.
Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): etiology, screening, diagnostic techniques, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 28.
Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-72.
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
