Cervical dysplasia is an abnormal change in the cells of the cervix in the uterus. Early changes, called low-grade lesions by doctors, may persist and develop into high-grade lesions that can lead to cervical cancer. Mildly abnormal cervical cells will usually clear up on their own.
Both cervical dysplasia and cervical cancer can be best treated effectively when they are caught early. A sexually transmitted virus called HPV(human papillomavirus) causes most cervical dysplasia and all cervical cancers. Cervical dysplasia is common in HIV-positive people who have a cervix.
However, among HIV-positive people living in high-income countries who get regular gynecological monitoring and care, cervical cancer is not common.
Dysplasia is a condition in which the cells of the cervix (the narrow canal that links the lower part of the uterus with the vagina) change in either size or shape. The medical term for dysplasia is cervical intra-epithelial neoplasia (CIN). CIN-I is a mild cell abnormality that will, in some cases, regress without treatment.
CINII is a more extensive abnormality, and CIN-III carcinoma-in-situ (confined to the site of origin). Considered a precancerous condition, CIN-III is virtually 100% curable. If CIN-III lesions are not treated, invasive cancer – into the cervix – can develop from six months to ten or fifteen years later. This is the stage when most women first notice symptoms, such as unusual bleeding. It is also when most deaths occur.
How Is Dysplasia Detected?
The PAP smear – quick painless test that involves collecting a small number of cervical cells and examining them for abnormalities may be a woman’s best protection against cervical cancer as early diagnosis and treatment is the key to survival with any cancer. Even the PAP test is far from perfect, however.
It has a high rate of false negatives (10% to 15%) and it is possible for a woman with dysplasia to have a normal PAP result. Despite the PAP’s imperfections, the screening test has helped to cut the death rate for cervical cancer by 60% in the past 30 years. Sexually active women are urged to get a PAP test every year.
An abnormal PAP could indicate an infection, like vaginitis or HPV, or it could indicate cellular changes. If cellular changes have occurred, the lab will indicate whether the squamous intraepithelial lesion (SIL) is high or low grade. A low grade SIL includes HPV infections and cervical intraepithelial neoplasm (CIN) – I, or mild dysplasia. A high-grade SIL signals CIN II and III or moderate and severe dysplasia.
What Is the Treatment?
When the diagnosis is dysplasia, the most common treatment is cryosurgery which kills abnormal cells by freezing them. This procedure is performed in a gynecologist’s office and takes less than 10 minutes. Most women have some cramping during the procedure and a watery discharge for several days or weeks afterward.
Laser surgery, which vaporizes or heats away the diseased tissue, is another option. It is often the treatment of choice in the case of more advanced lesions. Women may experience a burning sensation during this in office procedure which is usually performed under a local anesthesia.
For advanced lesions, repeat abnormalities, or lesions that can’t be adequately seen by a colposcope, doctors perform conizations, which are surgical or laser removals of a cone-shaped section of the cervix.
Although none of these treatments compromise a woman’s fertility, extensive conization can make it difficult for a woman to bring a pregnancy to term.