| Cervical Dysplasia
What is cervical dysplasia?
Cervical dysplasia is the name for abnormal development of the cells
that grow on the cervix. The cervix is the part of the uterus (womb)
that is located in the vagina. The cells of the cervix are very
active during the years women menstruate. This constant activity
makes the cervix prone to abnormal cell growth when certain conditions
are present. Dysplasia is not cancer. However, abnormal cells can
turn into cancer if not treated.
The presence of a virus called Human Papilloma Virus (HPV) is a
common cause of abnormal cells. HPV can cause warty growths on the
skin, the feet, the genitals or the anus. Some types of HPV infect
the cervix, causing dysplasia. (For more information on HPV see
Cervical Cancer fact sheet).
Good health can also prevent or slow dysplasia. A healthy immune
system can help prevent dysplasia. Women with HIV infection are
more likely than other women to have dysplasia.
Dysplasia is more common in women who:
- smoke
- have genital warts
- have more than one sex partner
- have had first sex at a young age
- have vitamin deficiencies and poor nutrition
How is cervical dysplasia diagnosed?
Cervical dysplasia is diagnosed with a Pap smear. The Pap smear
is a screening test for cervical cancer that is taken during a pelvic
exam. Cells from the cervix are collected with a wooden spatula
and a tiny brush called a cytobrush. The cells are then sent to
the laboratory.
The Pap smear is a good screening test, but it can miss dysplasia.
Therefore, HIV-positive women need to have a Pap test every six
months every year if the Pap smear is normal. If the Pap smear is
abnormal, it should be done more often. In rare cases, dysplasia
can also occur in the vagina and on the vulva. These areas need
to be inspected carefully during the pelvic exam.
What does an abnormal Pap smear mean?
When abnormal cells are seen on a slide, they are called either
Cervical Interepithelial Neoplasia (CIN) or Squamous
Interepithelial Lesion (SIL). It is helpful to learn these
terms because they will appear on Pap smear or biopsy laboratory
reports.
The abnormal cells are also given a grade. CIN is graded as CIN
1, CIN 2, or CIN 3.
- In CIN 1, one third of the cells collected
have dysplasia.
- In CIN 2, two thirds of the cells have
dysplasia.
- In CIN 3, all of the cells seen have dysplasia.
The term SIL is graded as either low-grade (CIN 1) or high-grade
(CIN 2,3). The Pap smear may also show cells with ATYPIA. This is
a non-specific term, which may require the same follow-up as dysplasia.
What happens when a woman has cervical dysplasia?
When dysplasia is found on the cervix, one of three things
may occur:
- The woman’s immune response may heal the affected area
and the low-grade dysplasia may go away.
- The dysplasia may remain on the cervix, unchanged, for many
years.
- The area with the dysplasia may change into cervical cancer.
This change is called progression, and usually takes several years.
What is the treatment for dysplasia?
To confirm the diagnosis, the doctor uses a colposcope, an instrument
that magnifies the cervix. The abnormal areas are removed and examined
carefully. Only then does the doctor know whether it’s dysplasia
or cancer. Colposcopy and the biopsy may cause a little discomfort.
The biopsy site may also cause spotting or bleeding for a few days.
Care must be taken to prevent infection of the cervix. When the
biopsy report returns, your provider should discuss the results
with you and describe the options for treatment.
There are several good treatments for removing the abnormal cells.
The treatment must fit your diagnosis and your preferences.
Treatments include:
- Conization (cone shape wedges of tissue are removed from the
cervix)
- Cryotherapy (freezing the tissue)
- Electrosurgery (heat destroys the affected tissue)
- Electrosurgical excision (abnormal growths are removed using
a thin wire loop and electrical energy)
- LASER (laser light is used to destroy the abnormal tissue)
- Removing genital warts (may also decrease risk of dysplasia
returning)
Can dysplasia be cured?
Sometimes dysplasia never returns after it is treated. In this case
the dysplasia is considered cured. However, it is common for the
condition to return. This is because the virus (HPV) may have been
hiding in areas that were not treated. Unfortunately, dysplasia
usually returns in women with HIV infection.
Getting treated for dysplasia over and over can be very frustrating,
but it is necessary to prevent cervical cancer. HIV-positive women
with returning dysplasia should probably have a colposcopy exam
every four to six months.
There are ways to help your body to do some of the healing. Quitting
smoking, reducing the number of sexual partners, eating a good diet
and a taking multivitamin are an important part of preventing dysplasia.
In HIV-positive women, it is best to think of dysplasia as a condition
that will need regular attention. Instead of eliminating dysplasia,
it may have to be kept under control. Since controlling dysplasia
can prevent cervical cancer, most women agree that it is worth the
effort.
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