Cervical Dysplasia

(Cervical Intraepithelial Neoplasia [CIN]; Precancerous Changes of the Cervix)

Definition

Dysplasia is abnormal growth or development of cells. Cervical dysplasia happens in the cells covering the surface of a woman's cervix. If cervical dysplasia is not treated, it may lead to cervical cancer.

The Cervix

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Causes

Cervical dysplasia is most often caused by a sexually transmitted virus. The virus is called the human papillomavirus (HPV).

There are different types of HPV. The risk of cervical disease will differ based on the type of HPV.

Risk Factors

Things that may increase the chance of cervical dysplasia include:

Symptoms

There are often no symptoms with cervical dysplasia. Cervical changes are most often found in screening tests.

Diagnosis

Tests to detect cervical dysplasia include:

  • Pap tests—done as part of regular screening. Cells are brushed from cervix. They are sent to a lab to look for abnormal cells.
  • HPV DNA Analysis—to look for signs of HPV. This test can also show what type of HPV is present, if any.
  • Colposcopy and Biopsy—may be done after abnormal Pap test results. A scope is passed into the cervix. It will let the doctor see the area. A biopsy can also be done. A small sample of suspicious tissue will be removed and sent to a lab.

Note: Pap tests will be done more often after abnormal results. Testing may also be done more often if some other conditions, such as immune problems or cervical cancer.

Treatment

Treatment will vary based on type, location, and size of the dysplasia. Some dysplasia does not need treatment or will go away on its own. Regular pap tests will be done to track changes that may need care.

The main goal of treatment is to destroy or remove abnormal cells. Options include:

  • Cone biopsy—a cone-shaped area of tissue is removed. It should remove all abnormal cells.
  • LEEP—a wire loop is used to remove abnormal tissue.
  • Cryosurgery—abnormal tissue is destroys with cold. Not the best option for large areas of dysplasia.
  • Laser Treatment—high-energy beam of light is used to destroy abnormal cells. It tends to cause less damage to nearby healthy tissue than cryosurgery. Laser is not always available.

Prevention

Lifestyle changes may lower the risk of cervical dysplasia.

  • Use safe sex steps to prevent HPV infection. Condom is one choice.
  • Quit smoking.
  • Get HPV vaccine. The HPV vaccine is approved for use in females aged 9 to 26 years old.
RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org

American Sexual Health Association
http://www.ashastd.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

Women's Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016 Jan;127(1):e1.

Cervical cancer screening. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T116761/Cervical-cancer-screening. Updated January 29, 2019. Accessed March 9, 2020.

Immunization schedules. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/schedules/index.html. Updated February 6, 2017. Accessed March 9, 2020.

Management of Abnormal Cervical Cytology. EBSCO DynaMed website. Available at:https://www.dynamed.com/management/management-of-abnormal-cervical-cytology. Updated April 6, 2018. Accessed March 9, 2020.

Massad LS, Einstein MH, Huh WK, et al; 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013 Apr;17(5 Suppl 1):S1-S27

Last reviewed November 2019 by Beverly Siegal, MD, FACOG  Last Updated: 3/9/2020