Cervical Dysplasia

(Cervical Intraepithelial Neoplasia [CIN]; Precancerous Changes of the Cervix)
  • Definition

    Dysplasia is abnormal growth or development of cells. Cervical dysplasia happens in the cells covering the surface of a woman's cervix. If cervical dysplasia is not treated, it may lead to cervical cancer .
    Female Reproductive Organs
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  • Causes

    Cervical dysplasia is caused by a sexually transmitted virus. The virus is called the human papillomavirus (HPV). This virus causes abnormal changes in the cells of the cervix. The most significant cervical change would be cancer.
    There are different types of HPV. The risk of cervical disease may be high or low depending on the type of HPV.
  • Risk Factors

    Factors that increase your risk of cervical dysplasia include:
  • Symptoms

    There are often no apparent symptoms with cervical dysplasia. Cervical changes are found through screening tests.
  • Diagnosis

    Procedures to detect cervical dysplasia include the following:
    Pap Test
    Regular pap tests can help diagnose or monitor cervical dysplasia. Cells are collected from your cervix. They are sent to a lab for analysis. If abnormal cell growth is found, a colposcopy may be done.
    HPV DNA Analysis
    This will test for both the presence and type of HPV in cervical tissues. The presence of abnormal cells and high-risk HPV DNA increases the risk of significant disease. In this case, more evaluation and treatment will be needed.
    Colposcopy and Biopsy
    If further evaluation of the cervix is necessary, then a colposcopy will be performed. During this procedure, the cervix is lightly coated with a vinegar solution. The solution will highlight abnormal cells. A magnifying scope is then used to examine the cervix.
    A biopsy will be done on any areas that show abnormal changes. A biopsy is the removal of tiny bits of tissue. A sample of the cells of the canal of the cervix will also be taken. This is done with a small brush. The biopsy and the sample of cells from the cervical canal will be sent to a lab for analysis. In the lab, abnormal cell growth will be classified as one of the following:
    • Mild
    • Moderate
    • Severe (carinoma-in-situ)
    • Invasive cervical cancer
  • Treatment

    Treatment depends on the severity of dysplasia, location, and size of the area of abnormal cells. Some cervical changes do not need treatment. They may be followed by periodic Pap tests to monitor for any further changes. Some types of dysplasia may disappear on its own. If dysplasia does not resolve on its own, these treatments options are available:
    Medication
    A topical medication that is used to treat cancer may be applied to your cervix. The medication will help stop the abnormal cells from growing.
    Cone Biopsy
    This biopsy is the removal of a tiny, cone-shaped piece of tissue. The sample is taken from the opening of the cervix and the cervical canal. The biopsy tissue will be analyzed. The results will show whether any of the abnormal cell growth is cancerous.
    Loop Electrosurgical Excision Procedure (LEEP)
    A small biopsy of the cervix is taken with a wire loop heated by electric current. The results will show whether any of the abnormal cells are precancerous or cancerous.
    Note: Both cone biopsy and LEEP biopsy techniques remove all abnormal tissue. These procedures may be used for very early, noninvasive cancer treatment and diagnosis.
    Cryosurgery
    Cryosurgery freezes and destroys the dysplasia on the cervix. This method is not recommended for treating large areas of dysplasia.
    Laser Treatment
    Laser treatment uses a concentrated, high-energy beam of light to destroy abnormal cells. This method is more favorable than cryosurgery. There is less destruction of surrounding normal tissue. Although, healing is faster than with other methods and laser treatment is expensive. It is not always available.
    Cancer Treatment
    Cone biopsy and LEEP are usual cures for dysplasia. However, if the cone biopsy or LEEP biopsy shows invasive cancer, treatment methods may include:
    Your doctor will discuss these options with you.
    Cervical dysplasia requires frequent follow up. Talk to you doctor about a Pap test schedule. A test may be scheduled every 3-6 months.
  • Prevention

    Lifestyle Changes
    To reduce the risk of cervical dysplasia, take these steps:
    • Use safe sex methods to prevent HPV infection.
    • If you smoke, quit .
    • Get vaccinated against HPV infection. The HPV vaccine called Gardasil is approved for use in females aged 9-26 years old. The HPV vaccine called Cervarix is approved for females aged 10-25 years old.
    Talk to your doctor about when you should have Pap tests done. Professional health organizations have differing guidelines.
    • If you are age 21-29 years, you should have the Pap test every two to three years.
    • If you are age 30-65, you should have the Pap test along with the HPV test every three to five years.
    • If you are age 65 or older, you may be able to stop having Pap and HPV tests if you have had normal results (such as, three normal results in a row and no abnormal results in the past 10 years).
    • Note: You will need to have Pap tests done more often if you have abnormal results. You may also need more frequent testing if you have certain conditions, like a suppressed immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.
  • RESOURCES

    American Congress of Obstetricians and Gynecologists http://www.acog.org

    American Social Health Association http://www.ashastd.org

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

    Women's Health Matters http://www.womenshealthmatters.ca

    References

    American Congress of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins. ACOG Practice Bulletin no. 109: Cervical cytology screening. Obstet Gynecol . 2009 Dec;114(6):1409-20.

    Cervical cancer screening: overview. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated August 3, 2012. Accessed October 2, 2012.

    Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst . 2001;93:293-299.

    Hanna E, Bachmann G. HPV vaccination with Gardasil: a breakthrough in women's health. Expert Opin Biol Ther . 2006;6(11):1223-7. Review.

    Human papillomavirus. ACOG Practice Bulletin . 2005;61.

    McLemore MR. Gardasil: introducing the new human papillomavirus vaccine. Clin J Oncol Nurs . 2006 Oct;10(5):559-60.

    New vaccine prevents cervical cancer. FDA Consum . 2006;40(5):37.

    3/19/2012 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Screening for cervical cancer. US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm . Published March 2012. Accessed March 19, 2012. Saslow D, Soloman D, 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: A Cancer Journal for Clinicians . 2012 Mar 14 early online.

    6/17/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Rahangdale L, Lippmann QK, et al. Topical 5-fluorouracil for treatment of cervical intraepithelial neoplasia 2: a randomized controlled trial. Am J Obstet Gynecol. 2014 Apr;210(4):314.e1-8.

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