Cervical Dysplasia Diagnosis and Treatment
Often referred to as cervical intraepithelial neoplasia (CIN), cervical dysplasia is a premalignant condition where abnormal cells are found on the surface of the cervix, the part of the uterus that connects to the vagina. Intraepithelial indicates that the abnormal cells are limited to the surface layer of the cervix, while neoplasia is referred to as abnormal cell growth.
Cervical dysplasia is a condition characterised by the presence of abnormal cells on the surface of the cervix. If left untreated, these cells can develop into cervical cancer over time. However, when detected early and treated appropriately, progression to cancer can be effectively prevented.
Is the disease serious?
Hearing the term "precancerous" can be concerning, but it's worth noting that most cases of this condition do not lead to cancer. A diagnosis of cervical dysplasia signals a potential for cancer development if untreated, but the process typically takes years. This slow progression provides ample time for medical professionals to intervene and remove abnormal cells before they become cancerous.
Categorisation of cervical dysplasia
Historically, cervical dysplasia was categorised into severe, moderate, or mild based on the likelihood of atypical (abnormal) cells becoming cancerous. A more modern classification system assesses the extent of abnormal cell growth within the epithelial tissues of the cervix, categorising the condition as follows:
- CIN (cervical intraepithelial neoplasia) I: Abnormal cells affect roughly one-third of the epithelial thickness. CIN 1 often resolves without intervention and rarely progresses to cancer.
- CIN (cervical intraepithelial neoplasia) II: Abnormal cells involve one-third to two-thirds of the epithelial tissue.
- CIN (cervical intraepithelial neoplasia) III: Abnormal cells extend beyond two-thirds of the epithelial tissue and may require treatment to prevent cancer development.
Who is affected?
Cervical dysplasia primarily affects individuals with a cervix who are sexually active, including cisgender women, transgender men, and nonbinary individuals. It is most common in individuals aged 25 to 35 and is strongly linked to infection with the human papillomavirus (HPV), the most prevalent sexually transmitted infection.
In the United Kingdom, approximately 250,000 to 1 million people are diagnosed with cervical dysplasia annually.
Diagnosing cervical dysplasia
This condition is typically identified during a regular Pap smear. If abnormal cells are detected, further examination with a colposcopy (a procedure to closely inspect the cervix using a magnifying device) may be conducted. A biopsy might also be performed to collect tissue samples for laboratory analysis. In some cases, an HPV DNA test is used to determine whether a high-risk strain of the virus is present.
Causes of cervical dysplasia
Cervical dysplasia is caused by HPV, a virus transmitted through sexual contact. While the immune system typically clears the infection, persistent infection with high-risk strains such as HPV-16 and HPV-18 can lead to abnormal cell changes over time.
Symptoms of cervical dysplasia
This condition often presents no noticeable symptoms. It is usually detected during routine cervical screening (Pap smear). Occasionally, some individuals may experience irregular vaginal spotting or bleeding after sexual intercourse.
Can cervical dysplasia occur without human papillomavirus?
No, HPV infection is necessary for the development of cervical dysplasia. However, not all individuals with HPV will develop this condition. Factors such as infection duration and the high-risk HPV strains may influence its progression.
Risk factors of cervical dysplasia
- Weakened immune system: Conditions like HIV or the use of immunosuppressant medications can increase susceptibility.
- Age: HPV infections often persist longer in individuals over 55.
- Smoking: Tobacco use can double the risk of cervical dysplasia.
Management and Treatment
Monitoring abnormal cells
For mild cases (CIN 1), treatment may not be necessary as the condition often resolves naturally. Regular monitoring through Pap smears is recommended to observe any changes.
Destroying or removing abnormal cells
For moderate to severe dysplasia (CIN 2 or CIN 3), treatment options include:
- LEEP (Loop electrosurgical excision procedure): Utilises an electrically charged wire loop to remove abnormal tissue.
- Cold knife cone biopsy (Conisation): Removes a cone-shaped section of abnormal tissue.
- Hysterectomy: In rare cases, the uterus may be removed if dysplasia persists or does not respond to other treatments.
These procedures are generally effective, with around 90% of cases being successfully treated.
Ways to prevent cervical dysplasia
The best method of preventing cervical dysplasia is by reducing the risk of HPV infection:
- Avoiding tobacco products: Smoking increases the risk of cervical dysplasia.
- Routine pap smears: Regular screening can detect abnormal cells early, preventing progression to cancer.
- HPV vaccination: Vaccines like Cervarix® and Gardasil® can protect against the most high-risk strains of HPV. Vaccination is recommended for individuals aged nine to twenty-six, with possible benefits for those aged twenty-seven to forty-five.
- Safe sexual practices: Using dental dams or condoms and limiting the amount of sexual partners can reduce the risk of HPV.
Prognosis and outlook
With early detection and treatment, the outlook for cervical dysplasia is excellent. Following treatment, the risk of cervical cancer is reduced by 95% over the subsequent eight years. Regular follow-up appointments and screenings ensure that abnormal cells do not return.
When to contact your medical professional
Your healthcare provider will schedule follow-up pap smears every three to six months for one to two years after treatment. After that, annual screenings may be sufficient.
Questions to ask your medical professional
- What is the severity of my cervical dysplasia?
- What follow-up tests and frequency are recommended for monitoring my condition?
- How might treatment affect future pregnancies?
- Am I at high risk of developing cervical cancer?
- Should I consider HPV vaccination?
Receiving a diagnosis of cervical dysplasia can feel overwhelming, but it does not mean you will develop cancer. Early diagnosis and treatment are highly effective in preventing cancer. Protect yourself by getting vaccinated, practising safe sex, and attending routine screenings.
For further details or to book an appointment, get in touch with us today.
Frequently Asked Questions
Is HPV the cause of cervical dysplasia?
Yes, an infection with the human papillomavirus (HPV) is the primary risk factor for the development of cervical dysplasia.
What is cervical dysplasia?
A diagnosis of cervical dysplasia indicates the presence of abnormal cells on the cervix, which may progress to cervical cancer if left untreated. The subsequent steps depend on the severity of your condition, your overall health, and other personal factors.
Can you detect cervical dysplasia by feeling it?
No, cervical dysplasia does not produce noticeable symptoms. However, some individuals may experience light vaginal spotting. Abnormal cells are usually detected through a routine cervical screening (Pap test).
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