(Cervical Intraepithelial Neoplasia (CIN), Precancerous Changes of the Cervix)
Definition
Cervical dysplasia is abnormal changes in the epithelial cells covering the surface of the cervix. Dysplasia is considered precancerous, and may lead to cervical cancer if not treated.
Cervix with Precancerous Growth
Causes
The cause for abnormal cell changes in the cervical cells are the result of infection with the human papillomavirus (HPV). HPV infections are sexually transmitted. There are different types of HPV, categorized as either high- or low-risk based on their likelihood to cause significant cervical disease.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Sex: Female only
• 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 of dysplasia 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 on a pap smear, 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. 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
A magnifying scope is used to examine the cervix, which has been lightly coated with a vinegar solution that will highlight abnormal cells. 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 type of dysplasia, location, and size of the area of abnormal cells, and whether it is graded as high or low. Treatment methods include:
Cone Biopsy
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 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
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 healthcare provider.
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, the first vaccine developed to prevent cervical cancer and 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.
