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August 25, 2024
Have you or someone you know has been diagnosed with cervical dysplasia?
We know you must have hundreds of questions in your mind.
In this article, we will deal with this condition in detail, understanding its causes, symptoms and other associated aspects. And yes, we will also examine whether this is cancer.
Let’s start with an overall understanding of the condition.
A precancerous condition, in cervical dysplasia abnormal cells grow on the surface of the cervix. The opening to the uterus, which is attached to the top portion of your vagina known as the cervix. It is strongly associated with sexually transmitted human Papillomavirus (HPV) infection. While cervical dysplasia is most common in women below the age of 30, it can develop at any age.
Cervical dysplasia is also known as intraepithelial neoplasia or CIN. The term ‘intraepithelial’ refers to the presence of abnormal cells on the surface, but not beyond the surface layer. The growth of abnormal cells is referred to as ‘neoplasia’.
NO, it is not cancer. The cells in cervical dysplasia look different from those normally found on the surface of the cervix. Cervical dysplasia can range in seriousness. We will understand more about this, later in this article.
YES, we know the term ‘precancerous’ can be scary. However, it is important to remember, that it also means it is not cancer. Cervical dysplasia may or may not develop into cancer, and even if it becomes cancer, it can take years to develop. Obtaining timely treatment is crucial in improving prognosis.
Earlier, cervical dysplasia used to be classified as mild, moderate and severe, based on the likelihood of abnormal cells becoming cancerous. However, currently, the classification is based on the extent of abnormal cells in your epithelial tissue.
Based on this, cervical intraepithelial neoplasia is classified on a scale from 1 to 3:
CIN1 type of cervical dysplasia rarely develops into cancer and usually goes away on its own. CIN2 and 3 require treatment to prevent them from progressing into cancer.
In many cases of cervical dysplasia, HPV is found in the cervical cells. HPV infection is common in both women and men and usually affects women who are sexually active and under the age of thirty.
Our immune system is very strong and hence, in most cases, eliminates HPV and clears the infection However, in some cases, the infection may not go away, leading to cervical dysplasia. About one-third of HPV strains have been found to be sexually transmitted. Two strains in particular, HPV16 and HPV18 are strongly linked to cervical cancer.
HPV is generally passed from one person to another during sexual contact such as vaginal intercourse, oral sex or anal intercourse. But it can also be transmitted by skin-to-skin contact with an infected person. The virus is capable of spreading from one body part to another, including the cervix.
Among women who suffer from chronic HPV infection, smokers are twice at risk of developing cervical dysplasia than non-smokers. Why? Because smoking suppresses the immune system.
The causes of cervical dysplasia are also linked to other factors that weaken the immune system such as treatment which requires the use of immunosuppressive drugs such as after an organ transplant, an HIV infection, AIDs causing virus and others.
The simple answer is no. Cervical dysplasia cannot develop without HPV. However, the reverse is not true. If you have HPV, it doesn’t necessarily mean that you will develop cervical dysplasia.
The reason for some people developing cervical dysplasia after being infected with HPV and others don’t is unknown. The duration of the infection and the strain of HPV play a role.
The most common risk factor for cervical dysplasia is persistent HPV infection. Risk factors associated with an increase in the risk of persistent HPV infection in women are:
Well, getting the HPV vaccine is the best way to prevent cervical dysplasia. It can lower your risk of HPV, but it cannot fully prevent cervical dysplasia. Contact your doctor to understand more about the vaccine. It is usually suggested for boys and girls between the ages of 9 and 26 before they become sexually active. The vaccination can be helpful once they start sexual activity and up to the age of 45. However, consult a doctor to know if you should be vaccinated.
Some of the other steps that you can take to reduce the risk of developing cervical dysplasia are:
Well, women suffering from cervical dysplasia don’t usually have symptoms. This is why it is crucial to get screened regularly. Your routine Pap smear test will be able to identify abnormal cells in your cervix. Some women may also experience spotting after intercourse or irregular vaginal spotting.
The main test to diagnose cervical dysplasia is a Pap test, during which your doctor will swab your cervix to collect a sample of cells. This test is usually not painful. It may take up to 3 weeks to obtain the results.
The Pap test results can be of three types – normal, inconclusive or abnormal. If it is normal, there’s nothing to worry about. Consult your gynaecologist to know how often you should do the regular Pap test and follow it up regularly.
If you get an inconclusive result, don’t get hassled. It doesn’t mean you have cervical dysplasia. It means you have a simple infection in the vagina or cervix. Your doctor may give you medicines based on the kind of infection and also recommend another test after a certain period. Your doctor may consider your age and medical history for diagnosis and treatment.
An abnormal result indicates cervical dysplasia. This is called a squamous intraepithelial lesion (SIL). The precancerous cells may be classified in the Pap test as:
Additional testing can indicate whether the cell changes are severe, moderate or mild. Your doctor may ask for a colposcopy, an in-clinic procedure that enables the doctor to take a closer look at your cervix. Your doctor may also conduct a biopsy of the cervix to identify the abnormal area. Don’t worry, these biopsies are minor and do not cause much discomfort.
Cervical dysplasia is graded into CIN1, CIN2 and CIN3 based on the findings of the biopsy.
Usually, an HPV test is done during the Pap test or separately to identify the presence of HPV and its type.
Treatment of cervical dysplasia depends on a variety of factors such as your age, health, severity of the cervical dysplasia and treatment preferences. The procedure followed can have an impact on future pregnancies. So, do disclose your pregnancy plans to your doctor to enable them to create a treatment plan that suits you the best.
The treatment procedure will consist of the following steps:
In most cases, women diagnosed with CIN 1 or low-grade cervical dysplasia don’t need treatment as the cells usually go away by themselves. Only 1% of such cases progress to cervical cancer. If you have been diagnosed with CIN 1, your doctor may choose a conservative approach by going for Pap smears regularly to monitor changes in the abnormal cells.
More severe cervical dysplasia requires an active treatment approach by removing or destroying abnormal cells that may become cancerous.
Any of the following procedures can be followed for this:
Yes, cervical dysplasia can be cured. Removing and destroying abnormal cells works in almost 90% of cases. Most cervical dysplasia cases do not progress to cancer. And even if it does, it progresses slowly, giving your healthcare provider enough to intervene.
Let’s talk about some aspects of living with the disease.
Following a diagnosis, your doctor would like to monitor you closely to ensure the cells don’t grow back or become cancerous. The doctor may ask for frequent Pap smears and HPV tests too. Your doctor may suggest you to get a Pap smear done every three to six months at least for the next one or two years. After this, they may ask for a Pap smear to be done once a year.
Asking questions is essential to ensure you understand the disease, prognosis and what to do. Here are some of the questions that you should ask your doctor.
As cervical dysplasia does not have symptoms, it can be difficult to understand that you are developing the condition. Hence, getting tested regularly is most important, especially if you have any of the risk factors mentioned in this article.
Keep in mind most cervical dysplasia cases do not progress into cancer. So, don’t lose heart if you receive a diagnosis. Ask informed questions to your doctor to understand the stage of your disease and prognosis. With proper treatment and regular monitoring, most cervical dysplasia patients get cured and can live a healthy life.
Cervical dysplasia refers to the abnormal growth of cells on the cervix’s surface. This precancerous condition is often caused by a sexually transmitted infection with the Human Papillomavirus (HPV), a common virus.
Cervical dysplasia is usually treated in two ways: monitoring abnormal cells and removing abnormal cells. The most commonly used method for the removal of abnormal cells is LEEP the loop electrosurgical excision procedure. However, Cold knife cone biopsy (conization) and hysterectomy may also be used to treat sever cases.
Dr Raja Arif Shah Raja Ismail
Consultant Obstetrician & Gynae-Oncologist
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