Cervical dysplasia

Answer 1

Definition

Cervical dysplasia is the abnormal appearance of cells on the surface of the cervix when they are looked at underneath a microscope. Although this is not cancer, it is considered a precancerous condition.

Dysplasia that is seen on a Pap smear is described using the term squamous intraepithelial lesion (SIL). These changes may be graded as:

• Low-grade (LSIL)
• High-grade (HSIL)
• Possibly cancerous (malignant)

Dysplasia that is seen on a biopsy of the cervix uses the term cervical intraepithelial neoplasia (CIN), and is grouped into three categories:

• CIN I -- mild dysplasia
• CIN II -- moderate to marked dysplasia
• CIN III -- severe dysplasia to carcinoma in situ

Alternative Names

Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix

Causes, incidence, and risk factors

Most cases of cervical dysplasia occur in women ages 25 - 35, although it can develop at any age.

Almost all cases of cervical dysplasia or cervical caner are caused by 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:

• Becoming sexually active before age 18
• Giving birth before age 16
• Having multiple sexual partners
• Having other illnesses or using medications that suppress your immune system
• Smoking

Symptoms

There are usually no symptoms.

Signs and tests

A pelvic examination is usually normal.

A Pap smear that shows abnormal cells or cervical dysplasia needs further testing.

• Colposcopy-directed biopsy is done to confirm the condition and determine its severity
• Cone biopsy
• Follow-up Pap smears may be done for mild abnormalities

An HPV DNA test can identify the high-risk types of HPV that are known to cause Cervical cancer. This 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

It can take 10 years or longer for cervical dysplasia to develop into cancer.

Treatment depends on the degree of dysplasia.

• Mild dysplasia (LSIL or CIN I) may go away on its own. You may only need careful observation by your doctor with repeat Pap smears every 3 - 6 months. If it lasts for 2 years, treatment is usually recommended.

Treatment for moderate to severe dysplasia or mild dysplasia that does not go away may include:

• Cryosurgery
• Electrocauterization
• Laser vaporization to destroy the abnormal tissue
• LEEP procedure using electrocautery to remove abnormal areas
• Surgery to remove the abnormal tissue (cone biopsy)

Rarely, a hysterectomy may be recommended. Women with dysplasia need consistent follow-up, usually every 3 to 6 months or as recommended by their provider.

Expectations (prognosis)

Early diagnosis and prompt treatment cure nearly all cases of cervical dysplasia.

Without treatment, 30 - 50% of cases of severe cervical dysplasia may lead to invasive cancer. The risk of cancer is lower for mild dysplasia.

Complications

The condition may return.

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.

See: Physical exam frequency

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 by 70%.

To reduce the chance of developing cervical dysplasia:

• Don't smoke, as it increases your risk of developing more severe dysplasia and cancer if you do have an HPV infection
• Get vaccinated for HPV between ages 9 and 26
• Practice monogamy
• Use condoms during intercourse
• Wait until you are 18 or older before becoming sexually active

References

ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcihnoma in situ. Am J Obstet Gynecol. 2007;197(4):340-345.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4):346-355.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.

Answer 2

Definition

Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix that are seen underneath a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

Although these changes are not cancer, 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

Most cases of cervical dysplasia occur in women ages 25 - 35, although it can develop at any age.

Almost all cases of cervical dysplasia or cervical cancer are caused by 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:

• Becoming sexually active before age 18
• Giving birth before age 16
• Having multiple sexual partners
• Having other illnesses or using medications that suppress your immune system
• Smoking

Symptoms

There are usually no symptoms.

Signs and tests

A pelvic examination is usually normal.

Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). These changes may be graded as:

• Low-grade (LSIL)
• High-grade (HSIL)
• Possibly cancerous (malignant)

If a Pap smear shows abnormal cells or cervical dysplasia, further testing or monitoring will be recommended:

• Follow-up Pap smears may be recommended for mild cases
• Colposcopy-directed biopsy can confirm the condition
• Cone biopsy 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 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 on its own.

• You may only need careful observation by your doctor with repeat Pap smears every 3 - 6 months.
• If the changes do not go away or get worse, treatment is necessary.

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 (See: Electrocauterization)
• Surgery to remove the abnormal tissue (cone biopsy)

Rarely, a hysterectomy may be needed. Women treated for dysplasia need close follow-up, usually every 3 to 6 months or as recommended by their provider.

Expectations (prognosis)

Early diagnosis and prompt treatment cure nearly all cases of cervical dysplasia. Sometimes, the condition returns.

Without treatment, severe cervical dysplasia may develop 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.

See: Physical exam frequency

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 by 70%.

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, which means you only have one sexual partner at a time

References

Cervical cancer in adolescents: screening, evaluation, and manage- ment. Committee Opinion No. 463. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;116:469–72.

ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcihnoma in situ. Am J Obstet Gynecol. 2007;197(4):340-345.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4):346-355.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.

Reviewed By

Review Date: 02/28/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; 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 David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.