Cervical dysplasia

  • Definition
    • 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.

  • Alternative Names
    • 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

  • 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

      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

      American College of Obstetricians and Gynecologists. Committee Opinion No. 641: human papillomavirus vaccination. Obstet Gynecol. 2015;126(3):e38-e43. PMID: 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

      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

      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

      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

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