(Cervical Intraepithelial Neoplasia (CIN); Precancerous Changes of the Cervix)
Dysplasia is abnormal growth or development. In cervical dysplasia, it happens in the cells covering the surface of the cervix. In some cases this may be a precancerous change. If not treated, it may lead to cervical cancer]]> .
This condition is caused by a sexually transmitted virus. The virus is called the human papillomavirus]]> (HPV). It causes the abnormal changes in the cells of the cervix. There are different types of HPV. They can be high or low risk. The level of risk is based on their ability to cause significant cervical disease. The most significant disease would be cancer.
Factors that increase your risk of cervical dysplasia include:
- Sex: female
- Multiple sexual partners
- Early onset of sexual activity (before age 18)
- Early childbearing (before age 16)
- Sexually transmitted diseases]]> (especially HPV)
- ]]>Genital herpes]]>
- ]]>HIV infection]]>
- History of in utero exposure to diethylstilbestrol (DES)—an estrogen-like substance given to prevent ]]>miscarriages]]> in high-risk pregnancies
Procedures to detect cervical dysplasia include the following:
Regular pap smears]]> can help diagnose or monitor cervical dysplasia. Cells are collected from your cervix. They are sent to a lab for analysis. If abnormal cell growth is found, a ]]>colposcopy]]> may be done. In this process the cervix is examined through a low power microscope.
HPV DNA Analysis
This will test for both the presence and the type of HPV in cervical tissues. There are many HPV types. Some are more high-risk for cancer than others. The test is often done with the newer liquid-based pap smear. The presence of abnormal cells and high-risk HPV DNA increases the risk of significant disease. In this case, more evaluation and treatment will be needed.
Colposcopy and Biopsy
The cervix is lightly coated with a vinegar solution. This will highlight abnormal cells. A magnifying scope is used to examine the cervix. A ]]>biopsy]]> will be done on any area that shows abnormal changes. A biopsy is the removal of tiny bits of tissue. A sample of the cells of the canal of the cervix will also be taken. This is done with a small brush. The biopsy and the sample of cells from the cervical canal will be sent to a lab for analysis. In the lab abnormal cell growth will be classified as one of the following:
- Severe (carinoma-in-situ)
Treatment depends on the severity of dysplasia, location, and size of the area of abnormal cells. A high or low grade is also an important factor. Low-grade changes do not usually need treatment. They may be followed by periodic pap smears. Low-grade dysplasia often disappears on its own. Treatment methods include:
This biopsy is the removal of a tiny cone-shaped piece of tissue from the opening of the cervix. The biopsy tissue 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 pre-cancerous or cancerous.
Note: Both cone biopsy and LEEP biopsy techniques remove all the abnormal tissue in question. These procedures may be used for cancer treatment and diagnosis.
Cryosurgery freezes and destroys the dysplasia on the cervix. This method is not recommended for treating large areas of dysplasia.
Laser treatment uses a concentrated, high-energy beam of light to destroy abnormal cells. This method is more favorable than cryosurgery. There is less destruction of surrounding normal tissue. Although healing is faster than with other methods, laser treatment is expensive. It is not always available.
If Cancer Is Found
Cone biopsy and LEEP are usual cures for dysplasia. However, if the cone biopsy or LEEP biopsy shows invasive cancer:
- Radiation therapy]]>
Your doctor will discuss these options with you.
Cervical dysplasia should be followed up with often. Talk to you doctor about a Pap test schedule. Test may be scheduled every 3-6 months.
- Safe sex methods to prevent HPV infection
- Regular pap smears at age 18 or at the onset of sexual activity, whichever comes first
- If you smoke, quit]]>
]]>Gardasil]]> is the first vaccine against human papillomavirus (HPV) to prevent:
- Cervical cancer
- Precancerous genital lesions
- ]]>Genital warts]]> due to certain types of HPV
The vaccine is approved for use in females aged 9-26 years old. It is given as a series of three injections. They are given over a 6-month period. There is a catch-up schedule as well. The vaccine blocks four types of HPV:
- Types16 and 18—responsible for the development of cervical cancer
- Types 6 and 11—responsible for genital warts
American College of Obstetricians and Gynecologists
American Social Health Association
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Cancernet. National Cancer Institute. National Institutes of Health website. Available at: http://www.cancer.gov/ .
Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst . 2001;93:293-299.
Hanna E, Bachmann G. HPV vaccination with Gardasil: a breakthrough in women's health. Expert Opin Biol Ther . 2006 Nov;6(11):1223-7. Review.
Human papillomavirus. ACOG Practice Bulletin . Apr 2005;61.
McLemore MR. Gardasil: introducing the new human papillomavirus vaccine. Clin J Oncol Nurs . 2006 Oct;10(5):559-60.
New vaccine prevents cervical cancer. FDA Consum . 2006 Sep-Oct;40(5):37.
Last reviewed January 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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