What is Cervical Dysplasia?
The Pap smear test has been crucial in reducing the occurrence and deaths from cervical cancer. Here’s how it works: the test gathers cells from a specific area of the cervix, where columnar epithelium, tissue made up of column-shaped cells, meets smooth squamous epithelium, tissue comprised of flat cells. In this region, your body may be experiencing squamous metaplasia, a process where flat cells start to replace the columnar ones. This can potentially open up the possibility for human papillomavirus (HPV) to enter, a virus that causes more than 90% of cervical cancer cases. The Pap smear collects a sample of cells from this area. Doctors use this sample to check for any abnormalities like cervical dysplasia – a condition that could lead to cancer if left untreated.
What Causes Cervical Dysplasia?
Cervical dysplasia is a condition that can lead to cervical cancer if it’s not treated. It’s caused by a continuing infection of human papillomavirus (HPV) in the tissue of the cervix, which is the opening to the womb. The most common type of HPV is HPV 16, which results in half of all cervical cancers. There are also other types of HPV that can lead to cancer. HPV is a common infection that is usually transmitted during sexual contact. It typically goes away on its own within eight to 24 months after you’re exposed to it. But if the infection keeps going, it leads to dysplasia. Without treatment, dysplasia can turn into cervical cancer. This usually happens slowly, over several years.
Because this change happens slowly, it’s something that we can often find and treat before it leads to cancer. Ways to do this include routine screening tests like a Pap smear and/or an HPV test, depending on a woman’s age and medical history.
Risk Factors and Frequency for Cervical Dysplasia
The HPV virus is passed on through close skin contact, usually during sexual activities. Although it can also be transmitted in non-sexual ways, such as through objects that have been in contact with the virus, it is more commonly passed on during intimate physical contact. Having multiple sexual partners, or having a partner who has multiple partners, greatly increases the risk of getting the virus. Younger people also have a higher risk of long-term HPV infection. This is due to the fact that HPV infection is most common in young women between the ages of 18 and 30, and it becomes less common after age 30.
- HPV is often transmitted during sexual contact
- Having many sexual partners increases the risk of exposure to HPV
- Younger people are also more likely to experience persistent HPV infection.
- HPV infection is most common in women aged 18 to 30, and it’s less common after age 30.
Important changes in the cervix happen during puberty and the first pregnancy, and HPV needs to infect these areas to alter the cell’s DNA. The average age for a diagnosis of cervical cancer related to HPV is 49. This means that the exposure to the virus likely happened at a younger age because the abnormal growth that leads to cancer usually takes around 10 to 30 years.
Signs and Symptoms of Cervical Dysplasia
Medical researchers first found a connection between papillomaviruses and a type of cancer called squamous cancers in the 1930s, thanks to the work of Dr. Richard Shope. By the 1950s and 1960s, they noticed that there might be a link between viral infections and cervical cancer. In 1984, Harald zur Hausen found out that certain types of Human Papillomavirus (HPV 16 and 18) caused cervical cancer; he was later awarded a Nobel Prize for his discovery. For the next 15 years, scientists worked hard to prove the link between cervical cancer and HPV, showing that HPV sparks cervical cancer.
Testing for Cervical Dysplasia
If a doctor suspects that a patient might have cervical dysplasia, they often start with a Pap smear. This is a common test that checks for abnormal cells. Today, most Pap smears involve a method called liquid-based cytology, which helps identify if the cells are normal or abnormal.
Sometimes, if it’s needed, a test can be done on the sample obtained from the Pap smear to check for certain high-risk types of HPV (Human Papillomavirus), which can cause cervical dysplasia.
A Pap smear is a screening test, which means it’s used to look for signs of a health problem before any symptoms occur. If the Pap smear shows any abnormalities, the doctor might decide to do a further examination called a colposcopy.
During a colposcopy, the doctor looks at the cervix using a special microscope. They will also apply a solution of 5% acetic acid, which is a type of vinegar, to the cervix. The areas of the cervix that might be dysplastic (which means they have abnormal cells) will turn a white colour when this solution is applied.
In some cases, if the acetic acid does not reveal any abnormal areas, the doctor might use a solution called Lugol to help them see any abnormalities. This solution will leave a non-staining area wherever there are abnormal cells.
Once the doctor identifies any areas that don’t look normal, they will take a sample, or biopsy, from these areas. This sample will then be sent to a laboratory where a pathologist (a doctor specializing in diagnosing diseases by studying cells and tissues) will check for any signs of cervical dysplasia.
Treatment Options for Cervical Dysplasia
Dysplasia, or abnormal cell growth, can vary in severity. According to the Lower Anogenital Squamous Terminology (LAST) project, these abnormal cell growths are classified as either low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL).
LSIL, also known as a CIN1 or mild dysplasia, usually don’t need treatment. Doctors often recommend a “watch and wait” approach with a check-up consisting of a Pap smear and HPV test in a year. This is because most LSILs get better on their own.
HSIL, previously known as CIN2/3 or CIS, often needs an excisional procedure. This means removing the abnormal growth for treatment. While there are non-surgical treatments available, a lot of doctors prefer procedures that allow them to remove and then study the abnormal tissues. This helps to ensure any underlying cancer is found and the right treatment is given.
A loop electrosurgical excision procedure (LEEP) is one of the treatment options for HSIL. In this procedure, the doctor uses a thin electrified wire to remove the abnormal tissue. This procedure is usually done in the doctor’s office.
Another procedure is a cold knife cone (CKC), which is normally performed in the operating room. In CKC, the doctor uses a knife to remove a cone-shaped piece of cervical tissue. The advantage of CKC is that it provides a clearer view for the pathologist to determine if all the cancerous tissue has been removed.
After a successful removal surgery with no remaining abnormal cells, patients need to continue having Pap smears every year. If the test results show that abnormal cells are still present after the surgery, more treatments may be needed or the patient may be monitored closely, depending on their age and desire to have children. If actual cancer cells are found during the procedure, the treatment plan will need to be expanded and a cancer specialist will be involved.
What else can Cervical Dysplasia be?
These are some conditions that might be considered when diagnosing a patient with certain symptoms:
- Cervicitis (inflammation of the cervix)
- Endometrial carcinoma (cancer of the womb lining)
- Pelvic inflammatory disease (infection of the reproductive organs)
- Vaginitis (inflammation of the vagina)