En Español (Spanish Version)
Definition
Cervical
dysplasia is abnormal changes in the
epithelial cells covering the surface of the
cervix. Dysplasia in some cases is
precancerous. It may lead to
cervical cancer if not treated.
Causes
Abnormal changes
in the cervical epithelial cells are the
result of infection with the
human papillomavirus (HPV).
HPV
infections are sexually transmitted. There
are different types of HPV. They are
categorized as either high or low risk based
on their likelihood to cause significant
cervical disease (eg, cancer).
Risk Factors
A risk factor is
something that increases your chance of
getting a disease or condition.
Risk factors
include:
- Sex: female
- Multiple
sexual partners
- Early onset
of sexual activity (before age 18)
- Early
childbearing (before age 16)
- Smoking
-
Sexually transmitted diseases
(especially HPV)
-
Genital herpes
-
HIV infection
- History of
in utero
exposure to diethylstilbestrol (DES), an
estrogen-like substance prescribed to
prevent
miscarriages in high-risk
pregnancies.
Symptoms
There are
usually no overt symptoms of benign cervical
dysplasia. The cellular changes are detected
by diagnostic tests (see below).
Diagnosis
Diagnosis
techniques to detect includes the following:
Pap Smear
Regular
pap smears can help diagnose or
monitor cervical dysplasia. Cells are
collected from your cervix, and then
sent to a laboratory for analysis. If
abnormal cell growth is found, a
colposcopy may be performed.
HPV DNA Analysis
It is
possible to test for both the presence
and the type of HPV present in cervical
tissues. There are many HPV types. Some
are more high-risk for cancer
development than others. This is most
commonly done in association with the
newer liquid-based pap smear. The
presence of abnormal appearing cells and
high-risk HPV DNA increases the risk of
significant dysplasia and the need for
further evaluation and treatment.
Colposcopy and Biopsy
The cervix
is lightly coated with a vinegar
solution that will highlight abnormal
cells. A magnifying scope is used to
examine the cervix. A tissue sample is
usually taken from the endocervical
canal (the canal that connects the
external cervix with the uterus).
Biopsies or removal of tiny bits of
tissue from any areas that show abnormal
changes will then be done. The biopsy
will be sent to a laboratory for
analysis, where abnormal cell growth
will be classified as mild, moderate,
severe, or cancerous.
Treatment
Treatment of
cervical dysplasia depends on the severity
of dysplasia, location, and size of the area
of abnormal cells. A high or low grade is
also an important factor in treatment
decisions. Treatment methods include:
Cone Biopsy
This biopsy
is the removal of a tiny cone-shaped
piece of tissue from the opening of the
cervix. The biopsy 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 cancerous.
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 because there
is less destruction of surrounding
normal tissue than with some other
methods. Although healing is faster than
with other methods, laser treatment is
expensive, and not always widely
available.
If Cancer Is Found
Cone biopsy
and LEEP are usual curative for
dysplasia. However, if the cone biopsy
or LEEP biopsy shows cancer, surgery,
radiation therapy, or chemoradiotherapy
may be used. Your doctor will discuss
these options with you.
Follow-up:
All women
who have had cervical dysplasia should
continue to follow up with frequent pap
tests every 3-6 months, or as prescribed
by her doctor.
Prevention
Prevention
includes:
- Safe sex
methods to prevent HPV infection
- Regular pap
smears at age 18 or at the onset of
sexual activity, whichever comes first.
- Smoking
cessation
Vaccine
The Food and
Drug Administration has approved
Gardasil. It is the first vaccine
developed to prevent cervical cancer,
precancerous genital lesions, and
genital warts due to certain types of
human papillomavirus (HPV). The vaccine
is approved for use in females aged 9-26
years old. It is given as a series of
three injections over a 6-month period.
There is a catch-up vaccination
recommended for women between the ages
of 13-26, regardless of their sexual
history, who were never vaccinated or
did not complete the recommended series.
The cervical
cancer vaccine is the first vaccine ever
designed to prevent a cancer. The
vaccine blocks two types of HPV—16 and
18—that are responsible for the
development of cervical cancer. Studies
showed that even in women who are
already infected with the two types of
the virus, the vaccine reduced the
disease.
RESOURCES:
The American College of Obstetricians and
Gynecologists
www.acog.org
American Social Health Association
www.ashastd.org
CANADIAN RESOURCES:
Women's Health Matters
www.womenshealthmatters.ca/index.cfm