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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    TOP

Cervical dysplasia is caused by a sexually transmitted virus. The virus is called the human papillomavirus (HPV). This virus causes abnormal changes in the cells of the cervix. The most significant cervical change would be cancer.

There are different types of HPV. The risk of cervical disease may be high or low depending on the type of HPV.

Risk Factors    TOP

Factors that may increase your chance of cervical dysplasia include:

Symptoms    TOP

There are often no apparent symptoms with cervical dysplasia. Cervical changes are found through screening tests.

Diagnosis    TOP

Procedures to detect cervical dysplasia include the following:

Pap Test

Regular Pap tests 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.

HPV DNA Analysis

This will test for both the presence and type of HPV in cervical tissues. 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    TOP

If further evaluation of the cervix is necessary, then a colposcopy will be performed. During this procedure, the cervix is lightly coated with a vinegar solution. The solution will highlight abnormal cells. A magnifying scope is then used to examine the cervix.

A biopsy will be done on any areas that show 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:

  • Mild
  • Moderate
  • Severe (stage 0 cervical cancer or carinoma-in-situ)
  • Invasive cervical cancer

Treatment    TOP

Treatment depends on the severity of dysplasia, location, and size of the area of abnormal cells. Some cervical changes do not need treatment. They may be followed by periodic Pap tests to monitor for any further changes. Some types of dysplasia may disappear on its own. If dysplasia does not resolve on its own, these treatments options are available:

Medication

A topical medication that is used to treat cancer may be applied to the cervix. The medication will help stop the abnormal cells from growing.

Cone Biopsy

This biopsy is the removal of a tiny, cone-shaped piece of tissue. The sample is taken from the opening of the cervix and the cervical canal. The biopsy tissue will be analyzed. The results will show whether any of the abnormal cell growth is cancerous.

Loop Electrosurgical Excision Procedure (LEEP)    TOP

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 precancerous or cancerous.

Note : Both cone biopsy and LEEP biopsy techniques remove all abnormal tissue. These procedures may be used for early, noninvasive cancer treatment and diagnosis.

Cryosurgery    TOP

Cryosurgery freezes and destroys the dysplasia on the cervix. This method is not recommended for treating large areas of dysplasia.

Laser Treatment    TOP

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 and laser treatment is expensive. It is not always available.

Cancer Treatment    TOP

Cone biopsy and LEEP are usual cures for dysplasia. However, if the cone biopsy or LEEP biopsy shows invasive cancer, treatment methods may include:

Your doctor will discuss these options with you.

Cervical dysplasia requires frequent follow-up. Talk to your doctor about a Pap test schedule. A test may be scheduled every 3-6 months.

Prevention    TOP

Lifestyle Changes

To help reduce your chance of cervical dysplasia:

  • Use safe sex methods to prevent HPV infection.
  • If you smoke, talk to your doctor about ways to quit. Smoking is associated with cervical cancer development.
  • Get vaccinated against HPV infection. The HPV vaccine is approved for use in females aged 9-26 years old.

Talk to your doctor about when you should have Pap tests done. Professional health organizations have differing guidelines.

  • If you are age 21-29 years, you should have the Pap test every 3 years.
  • If you are age 30-65, you should have the Pap test along with the HPV test every 5 years.
  • If you are age 65 or older, you may be able to stop having Pap and HPV tests if you have had normal results (such as, 3 normal results in a row and no abnormal results in the past 10 years).
  • Note: You will need to have Pap tests done more often if you have abnormal results. You may also need more frequent testing if you have certain conditions, like a suppressed immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.

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 Congress of Obstetrics and Gynecology. Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338-1367.
Cervical cancer screening. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 2, 2016. Accessed September 29, 2016.
Immunization schedules. Centers for Disease Control and Prevention website. Available at:
...(Click grey area to select URL)
Updated February 7, 2017. Accessed May 22, 2017.
Solomon D, Schiffman M, tarone R, ALTS study group. 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(4):293-299.
3/19/2012 DynaMed Systematic Literature Surveillance
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Screening for cervical cancer. US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening. Updated March 2012. Accessed March 19, 2012.
6/17/2014 DynaMed Systematic Literature Surveillance
...(Click grey area to select URL)
Rahangdale L, Lippmann QK, Garcia K, et al. Topical 5-fluorouracil for treatment of cervical intraepithelial neoplasia 2: a randomized controlled trial. Am J Obstet Gynecol. 2014;210(4):314.e1-e8.
Last reviewed December 2015 by Karli-Rae Kerrschneider, RN
Last Updated: 12/20/2014

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