What Is Cervical Dysplasia

Overview

Cervical dysplasia is also called Cervical intraepithelial neoplasis. Cervical dysplasia is a precancerous condition, in which there is abnormal growth of the cells on the surface lining of the cervix or endocervical canal, an opening between the uterus and the vagina.

Most commonly, cervical dysplasia is seen in women under the age of 30 years, but it can occur at any age, and cervical dysplasia is strongly associated with the sexually transmitted human papillomavirus (HPV) infection.

Pap tests are most often performed for diagnosis of Cervical Dysplasia. Usually, cervical dysplasia is not associated with any symptoms.

Cervical dysplasia has an excellent prognosis, seen in women who receive proper follow-up and treatment. There is a high risk of developing cervical cancer seen in women who go undiagnosed or who are not able to receive appropriate care.

The mild form of cervical dysplasia sometimes resolves on its own without receiving any treatment, it only requires close observation by your healthcare provider and with proper follow-up  Pap tests. Sometimes the mild case of cervical dysplasia which persisted for more than two years may also require treatment.

But in the case of moderate to severe forms  of cervical dysplasia, it usually requires proper treatment with complete removal of abnormal cells from the surface of the cervix and follow-up Pap tests to reduce the risk of cervical cancer.

Classifications of cervical dysplasia

Cervical  dysplasia can be classified into  three stages:

• Mild cervical dysplasia
• Moderate cervical dysplasia
• Severe cervical dysplasia

The cervical dysplasia is classified based on how the growth of abnormal cells on the surface of the cervix look under a microscope and also on the amount of the cervical tissue affected by the cervical dysplasia. The mild form of cervical dysplasia is also called low-grade intraepithelial lesions (LSIL).

The moderate and severe form of cervical dysplasia is also known as high-grade intraepithelial lesions (HSIL). The low-grade intraepithelial lesions (LSIL) and  high-grade intraepithelial lesions (HSIL) may or may not develop into cervical cancer.

The Cervical intraepithelial neoplasia (CIN) is also classified on a scale of one to three based on the thickness of the epithelium of the cervix affected: 

• CIN 1: refers to one-third of the thickness of the epithelium is affected by the abnormal cells
• CIN 2:  refers to one-third to two-thirds of the epithelium is affected by the abnormal cells
• CIN 3: refers to more than two-thirds of the epithelium being affected by the abnormal cells

CIN 1 is less likely to develop cervical cancer and it subsides on its own, while CIN 2 and 3 are more likely to develop cervical cancer, hence they require treatment to prevent cancer.

Causes of cervical dysplasia

The Human Papillomavirus (HPV) is found in the cervical cells of many women who have cervical dysplasia.

In most cases, the immune system of the body eliminates the HPV and clears the infection caused by HPV. But in some of cases, this infection persists in women causing cervical dysplasia.

Of more than 100 different strains of  Human Papillomavirus (HPV), more than one-third of them are sexually transmitted; two particular types of HPV that are HPV 16 and HPV 18 have a strong association with cervical cancer.

During sexual contact such as anal intercourse, vaginal intercourse, or oral sex, HPV is usually passed from person to person. However,  HPV can also pass from skin-to-skin contact with an infected person. Once the HPV is established in the body it has the capability to spread from one part of the body to other parts, including the cervix region.

The women suffering from chronic  Human Papillomavirus (HPV) infection, among them smokers, are at high risk of developing cervical dysplasia as compared to non-smokers because smoking suppresses the immune system of the body.

Chronic  Human Papillomavirus (HPV) infection and cervical dysplasia are also associated  with many other factors that can result in the weakening of the immune system of the body, such as treatment with immunosuppressive drugs for certain diseases or after an organ transplant, or infection with HIV, the virus responsible for causing AIDS.

Signs and symptoms of cervical dysplasia

Usually cervical dysplasia is not associated with any kind of symptoms. It is usually diagnosed by your healthcare provider during a Pap smear, where abnormal cells may be found in the cervix indicating cervical dysplasia. Some people may have irregular vaginal spotting or spotting after intercourse. 

Management and treatment for cervical dysplasia

The treatment for cervical dysplasia depend on many factors such as the severity of cervical dysplasia, age, health, and treatment preferences. 

• Monitoring abnormal cells: in low-grade cervical dysplasia, which is classified as CIN 1, no treatment is needed. In most of these cases, the condition subsides on its own. Only in 1% of cases does the condition progress towards cervical cancer. The healthcare provider will perform the Pap smears to monitor any changes in abnormal cells
• Removing or destroying abnormal cells: In case of severe cases of cervical dysplasia, your healthcare provider may remove the abnormal cells which have the potential to develop into cervical cancer

Theses procedures may includes:

1. Cold knife cone biopsy ( conization): A cone-shaped piece of tissue containing abnormal cells is removed by your healthcare provider. Earlier this was the most ideal method performed to treat cervical dysplasia, but nowadays it is only performed at times of severe cases
2. Loop electrosurgical excision procedure (LEEP): a small, electrically charged wire loop is used to remove the tissue. About 1% to 2% of people may face complications after this procedure, such as narrowing of their cervix (stenosis) or delayed bleeding
3. Hysterectomy: the uterus is removed completely in this procedure. The  hysterectomy is performed when the cervical dysplasia persists  or it doesn’t heal after performing other procedures

Diagnosis of cervical dysplasia

The signs of cervical dysplasia are usually noticed by your healthcare provider during a routine Pap smear. If the Pap smear reveals abnormal cells or it is unclear, then the next step is to perform a colposcopy to examine your cervix.

• A colposcopy is performed by your healthcare provider in his office. During the colposcopy procedure, your healthcare provider checks for abnormal cells in your cervix or vaginal walls with the help of a lighted instrument called a colposcope
• By performing a biopsy, a tissue sample is removed from your cervix or vaginal walls by your healthcare provider; then it will be examined in a laboratory. They may also order a DNA test to see whether the presence of a high-risk form of the Human Papillomavirus (HPV) is present, too

Risk factors

Women with persistent  Human Papillomavirus (HPV) infection are at high risk of developing cervical dysplasia, especially moderate-to-severe cervical dysplasia.

In women, an increased risk of a persistent  Human Papillomavirus (HPV) infection is associated with:

• Having multiple sex partners
• Early initiation of sexual activity
• Having a partner who has had multiple sex partners
• Having sex with an uncircumcised man

Complications

The major complication associated with cervical dysplasia is cervical cancer.

FAQs

How can I prevent cervical dysplasia

The only possible way to prevent cervical dysplasia is to avoid getting HPV. If you already have an HPV infection, then cervical dysplasia can be prevented by routine Pap smears, which can prevent cervical dysplasia from converting into cervical cancer.

One can prevent it by:

• Get vaccinated against HPV infection.
• Practice safe sex
• Get regular Pap smears.

How common is cervical dysplasia

Cervical dysplasia affects nearly between 250,000 and one million women every year, throughout the United States. 

When should I see a doctor? 

The healthcare provider will closely monitor your condition by routine Pap smears every three to six months for one to two years. Afterwards, the Pap smear may resume yearly.

Summary

Cervical dysplasia is a precancerous condition, where there is growth of abnormal cells on the inner lining of the cervical surface. HPV infection is the leading cause of  cervical dysplasia. The cervical dysplasia is classified into CN1, CN2 and CN3 depending upon the severity of the cervical dysplasia. The cervical dysplasia is treated in many ways like conization, loop electrosurgical excision procedure, or hysterectomy depending upon the age, health, severity of the cervical dysplasia, and also treatment preference.