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Cervical dysplasia

Cervical intraepithelial neoplasia - dysplasia; CIN - dysplasia; Precancerous changes of the cervix - dysplasia; Cervical cancer - dysplasia; Squamous intraepithelial lesion - dysplasia; LSIL - dysplasia; HSIL - dysplasia; Low-grade dysplasia; High-grade dysplasia; Carcinoma in situ - dysplasia; CIS - dysplasia; ASCUS - dysplasia; Atypical glandular cells - dysplasia; AGUS - dysplasia; Atypical squamous cells - dysplasia; Pap smear - dysplasia; HPV - dysplasia; Human papilloma virus - dysplasia; Cervix - dysplasia; Colposcopy - dysplasia

Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

The changes are not cancer. But they are considered to be precancerous. This means they can lead to cancer of the cervix if not treated.

Causes

Cervical dysplasia can develop at any age. However, follow up and treatment will depend on your age.

Most often, cervical dysplasia is caused by the human papillomavirus (HPV). HPV is a common virus that is spread through sexual contact. There are many types of HPV. Some types lead to cervical dysplasia or cancer. Other types of HPV can cause genital warts.

The following may increase your risk for cervical dysplasia:

  • Having sex before age 18
  • Having a baby before age 16
  • Having had multiple sexual partners
  • Having other illnesses, such as diabetes or HIV
  • Using medicines that suppress your immune system
  • Smoking

Symptoms

Most of the time, there are no symptoms.

Exams and Tests

You will have a pelvic exam.

Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). On the Pap smear report, these changes will be described as:

  • Low-grade (LSIL)
  • High-grade (HSIL)
  • Possibly cancerous (malignant)
  • Atypical glandular cells (AGUS)
  • Atypical squamous cells

You will need more tests if a Pap smear shows abnormal cells or cervical dysplasia. If the changes were mild, follow-up Pap smears may be all that is needed.

A biopsy to confirm the condition is often needed, however. This may be done using colposcopy-directed biopsy. A colposcopy is a procedure performed in your health care provider's office. Any areas of concern will be biopsied. The biopsies are very small and most women feel only a small cramp.

Dysplasia that is seen on a biopsy of the cervix is called cervical intraepithelial neoplasia (CIN). It is grouped into 3 categories:

  • CIN I -- mild dysplasia
  • CIN II -- moderate to marked dysplasia
  • CIN III -- severe dysplasia to carcinoma in situ

Some strains of HPV are known to cause cervical cancer. An HPV DNA test can identify the high-risk types of HPV linked to this cancer. This test may be done:

  • As a screening test for women over age 30
  • For women of any age who have a slightly abnormal Pap test result

Treatment

Treatment depends on the degree of dysplasia. Mild dysplasia (LSIL or CIN I) may go away without treatment.

  • You may only need careful follow-up by your provider with repeat Pap smears every 6 to 12 months.
  • If the changes do not go away or get worse, treatment is needed.

Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include:

  • Cryosurgery to freeze abnormal cells
  • Laser therapy, which uses light to burn away abnormal tissue
  • LEEP (loop electrosurgical excision procedure), which uses electricity to remove abnormal tissue
  • Surgery to remove the abnormal tissue (cone biopsy)
  • Hysterectomy (in rare cases)

If you have had dysplasia, you will need to have repeat exams every 12 months or as recommended by your provider.

Make sure to get the HPV vaccine when it is offered to you. This vaccine prevents many cervical cancers.

Outlook (Prognosis)

Early diagnosis and prompt treatment cures most cases of cervical dysplasia. However, the condition may return.

Without treatment, severe cervical dysplasia may change into cervical cancer.

When to Contact a Medical Professional

Call your provider if your age is 21 or older and you have never had a pelvic exam and Pap smear.

Prevention

Ask your provider about the HPV vaccine. Girls who receive this vaccine before they become sexually active reduce their chance of getting cervical cancer.

You can reduce your risk of developing cervical dysplasia by taking the following steps:

  • Do not smoke. Smoking increases your risk of developing more severe dysplasia and cancer.
  • Get vaccinated for HPV between ages 9 to 26.
  • Do not have sex until you are 18 or older.
  • Practice safe sex, and use a condom.
  • Practice monogamy. This means you have only one sexual partner at a time.

References

American Academy of Pediatrics. Committee on Infectious Diseases. Policy statement: HPV vaccine recommendations. Pediatrics. 2012;129(3):602-605. PMID: 22371460 www.ncbi.nlm.nih.gov/pubmed/22371460.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 157: cervical cancer screening and prevention. Obstet Gynecol. 2016;1207(1):e1-e20. PMID: 26695583 www.ncbi.nlm.nih.gov/pubmed/26695583.

American College of Obstetricians and Gynecologists. Committee Opinion No. 641: human papillomavirus vaccination. Obstet Gynecol. 2015;126(3):e38-e43. PMID: 26287792 www.ncbi.nlm.nih.gov/pubmed/26287792.

American College of Obstetricians and Gynecologists. Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338-1367. PMID: 24264713 www.ncbi.nlm.nih.gov/pubmed/24264713.

Kim DK, Bridges CB, Harriman KH; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP); ACIP Adult Immunization Work Group. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older--United States, 2016. Ann Intern Med. 2016;164(3):184-194. PMID: 26829913 www.ncbi.nlm.nih.gov/pubmed/26829913.

Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): etiology, screening, diagnostic techniques, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 28.

Robinson CL; Advisory Committee on Immunization Practices (ACIP); ACIP Child/Adolescent Immunization Work Group. Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 through 18 years--United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(4):86-87. PMID: 26845283 www.ncbi.nlm.nih.gov/pubmed/26845283.

Saslow D, Solomon D, Lawson HW, et al; ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172. PMID: 22422631 www.ncbi.nlm.nih.gov/pubmed/22422631.

Spriggs D. Gynecological cancers. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 199.

    • Female reproductive anatomy

      Female reproductive anatomy - illustration

      External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

      Female reproductive anatomy

      illustration

    • Cervical neoplasia

      Cervical neoplasia - illustration

      Cervical intraepithelial neoplasia (CIN) is the presence of abnormal cells on the surface of the cervix. A Pap smear and colposcopy are two of the procedures performed to monitor the cells and appearance of the cervix.

      Cervical neoplasia

      illustration

    • Uterus

      Uterus - illustration

      The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

      Uterus

      illustration

    • Cervical dysplasia - Series

      Cervical dysplasia - Series

      Presentation

      • Female reproductive anatomy

        Female reproductive anatomy - illustration

        External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

        Female reproductive anatomy

        illustration

      • Cervical neoplasia

        Cervical neoplasia - illustration

        Cervical intraepithelial neoplasia (CIN) is the presence of abnormal cells on the surface of the cervix. A Pap smear and colposcopy are two of the procedures performed to monitor the cells and appearance of the cervix.

        Cervical neoplasia

        illustration

      • Uterus

        Uterus - illustration

        The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

        Uterus

        illustration

      • Cervical dysplasia - Series

        Presentation

      Self Care

       

      Tests for Cervical dysplasia

       

      Review Date: 4/5/2016

      Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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