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.

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.

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.

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. 

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.

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.

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.