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Cervical Dysplasia

Dysplasia of Cervix (uteri)

Cervical dysplasia is the name for abnormal changes of squamous cells on the surface of the cervix. These changes are not neoplastic but can develop into cancerous cells if left untreated. Changes are usually initiated by the common human papilloma virus (HPV) after spreading through sexual contact.


Presentation

Usually cervical dysplasia is symptomless.

Exposure to Benzene
  • RESULTS: Women in the highest residential exposure categories for benzene and DPM had an increased prevalence of cervical dysplasia compared to the lowest exposure category (Benzene: aOR [95% CI] for high exposure   1.97[1.07-3.62], very high exposure[ncbi.nlm.nih.gov]
Clear Vaginal Discharge
  • Clear vaginal discharge and spotting of blood can occur for a few weeks after these procedures. These procedures are used much less often now.[emedicinehealth.com]
  • A clear vaginal discharge and spotting of blood may occur for a few weeks after the procedure. The complication rate of this procedure is very low. The most common complications are narrowing (stenosis) of the cervical opening and delayed bleeding.[medicinenet.com]
Cervix Disorder
  • (disorder) 92564006 Carcinoma in situ of uterine cervix (disorder) Clinical Pearls HPV is present in virtually all cervical cancers (99.7%), but most HPV infections are transient.[unboundmedicine.com]

Workup

A diagnosis requires a pelvic examination and a Pap-smear (Papanicolaou test) from a sample collected in the endocervical canal.
Unusual findings are usually complemented by more sensitive tests before any therapy is initiated [7].

Squamous intraepithelial lesions (SIL) of the cervix identified with histopathology are graded as:

  • LSIL = Low-grade SIL
  • HSIL = High-grade SIL
  • malignant cells - possibly cancerous
  • Atypical glandular cells (AGUS).


Subsequent testing procedures depend on the nature of the original changes detected.

  1. Mild LSIL changes can be followed with another pap smear;
  2. More severe changes can be investigated with a biopsy – colonoscopy-directed or cone biopsies – or a Loop Electrosurgical Excision Procedure (a LEEP excision) may be performed after a colonoscopy using a thin, low-voltage electrified wire to remove abnormal cervical tissue. 

Cervical intraepithelial neoplasia (CIN) is identified from a biopsy and can be graded into three:

  • mild dysplasia- CIN I
  • moderate to marked dysplasia - CIN II
  • severe dysplasia to carcinoma in situ - CIN III.
Human Papillomavirus
  • KEYWORDS: cervical dysplasia; genital warts; human papillomavirus (HPV)[ncbi.nlm.nih.gov]
  • KEYWORDS: Human papillomavirus; hybrid capture II; meta-analysis; polymerase chain reaction; test accuracy[ncbi.nlm.nih.gov]
  • Despite both cervices sharing stroma in the midline, her right cervix was negative for human papillomavirus (HPV) and dysplasia, while her left cervix was HPV positive with high-grade cervical dysplasia on an excisional specimen.[ncbi.nlm.nih.gov]
  • Cervical cancer caused by infection with the human papillomavirus is the second most common malignancy among women worldwide.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Human papillomavirus (HPV) infection is a major risk factor for cervical cancer. Imiquimod is a topical medication that enhances the immune response to HPV-induced genital warts.[ncbi.nlm.nih.gov]

Treatment

The level of treatment varies with the level of dysplasia. Mild cases (LSIL or CIN I) may resolve with no treatment but should be followed with Pap smears every 6-12 months to ensure they have disappeared [8]

Treatment for moderate-to severe dysplasia or mild dysplasia that does not resolve after two years may include – [9]

  • Cryosurgery (kills abnormal cells with freezing),
  • Laser therapy (burns away abnormal cells with light),
  • LEEP excision – (removes abnormal tissues with low-voltage electricity),
  • Hysterectomy (rare).

Prognosis

The prognosis is very favourable if the condition is diagnosed early, although it may recur.
However, severe dysplasia without treatment may progress into an invasive neoplasm. Critically this may take many years [6].

Etiology

HPV, especially the high-risk HPV types 16, 18,31 and 33, are the major cause of cervical dysplasia causing changes in squamous cells of the cervix [2].

Epidemiology

Cervical dysplasia can develop at any age, but is more often identified in women between 25 and 35 years of age [3].
It is generally caused by HPV of which there are several types, including ones that can cause genital warts [4].
Factors which increase the risk of cervical dysplasia include -

Sex distribution
Age distribution

Pathophysiology

The HPV virus can be introduced into the female tract by a symptomless carrier and once inside the womb it causes cytological abnormalities of the surface squamous cells. Transient infections will be removed from the body as a result of the immune defences and the abnormal cells will disappear. Oncogenic viruses, however, will cause more serious changes that will lead to larger lesions and, if untreated, these may develop into a cervical squamous cell carcinoma [5].

Prevention

Routine clinical examination and Pap-smears are recommended with patients who have suffered from dysplasia with a re-examination at least every 12 months.

An HPV DNA test can be used to identify high-risk types of virus that are linked with cancer. This test can be done either as a screening test for women over 30 years or those who return a mildly abnormal Pap-test result.

HPV vaccines are available that should be administered before both boys and girls become sexually active [10].

Prevention includes:

  • Good diet;
  • No smoking;
  • HPV vaccination between the ages of 9 and 25 years;
  • No sexual activity until 18 years or older;
  • Practise safe-sex with a condom;
  • Practise monogamy;
  • Routine pap smears to detect early changes (recommendations on frequency vary depending on an individual’s associated risk factors).

Summary

Early changes of the squamous cells of the cervix are frequently initiated by HPV. Cervical dysplasia is symptomless but, if left untreated, these changes can often develop into cervical squamous cell carcinoma. This may take many years – it has been recorded a range of between 3-40 years [1].

Patient Information

Definition: Cervical dysplasia is the name for abnormal changes of squamous cells on the surface of the cervix that are not neoplastic but can develop into a malignant cancer if left untreated.

Cause: Changes are usually initiated the common human papilloma virus (HPV) after spreading through sexual contact.

Symptoms: The condition is symptomless.

Diagnosis: Diagnosis requires a pelvic examination and a Pap-smear (Papanicolaou test) from a sample collected in the endocervical canal. Histopathology will identify the nature of the changes and lead to recommendation of specific treatment for more advanced cases.

Treatment: Mild cases usually resolve themselves without treatment but smears should be repeated at least every 12 months.
Treatment for moderate-to severe dysplasia or mild dysplasia that does not resolve after two years may include:

  • Cryosurgery (kills abnormal cells with freezing),
  • Laser therapy (burns away abnormal cells with light),
  • LEEP excision – (removes abnormal tissues with low-voltage electricity),
  • Hysterectomy (rare).

Prevention: Prevention of cervical dysplasia includes:

  • Good diet;
  • No smoking;
  • HPV vaccination between the ages of 9 and 25 years;
  • No sexual activity until 18 years or older;
  • Practise safe-sex with a condom;
  • Practise monogamy,
  • Routine pap smears to detect early changes (recommendations vary depending on and individual’s associated risk factors.

References

Article

  1. Sánchez-Alemán MA, Uribe-Salas FJ, Lazcano-Ponce EC, Conde-Glez CJ. Human papillomavirus incidence and risk factors among Mexican female college students. Sex Transm Dis. Apr 2011;38(4):275-8.
  2. Chaturvedi AK, Katki HA, Hildesheim A, et al. Human papillomavirus infection with multiple types: pattern of coinfection and risk of cervical disease. J Infect Dis. Apr 1 2011;203(7):910-20.
  3. Dunne EF, Unger ER, Sternberg M, et al. Prevalence of HPV infection among females in the United States. JAMA. Feb 28 2007;297(8):813-9.
  4. Chuang TY. Condylomata acuminata (genital warts). An epidemiologic view. J Am Acad Dermatol. Feb 1987;16(2 Pt 1):376-84
  5. Nebesio CL, Mirowski GW, Chuang TY. Human papillomavirus: clinical significance and malignant potential.Int J Dermatol. Jun 2001;40(6):373-9.
  6. Becker TM, Stone KM, Alexander ER. Genital human papillomavirus infection. A growing concern. Obstet Gynecol Clin North Am. Jun 1987;14(2):389-96
  7. Clifford GM, Smith JS, Plummer M, Muñoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. Jan 13 2003;88(1):63-73.
  8. Syrjänen K, Syrjänen S. Epidemiology of human papilloma virus infections and genital neoplasia. Scand J Infect Dis Suppl. 1990;69:7-17.
  9. Bergman A, Bhatia NN, Broen EM. Cryotherapy for treatment of genital condylomata during pregnancy. J Reprod Med. Jul 1984;29(7):432-5.
  10. Haug CJ. Human papillomavirus vaccination--reasons for caution. N Engl J Med. Aug 21 2008;359(8):861-2.

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Last updated: 2019-06-28 11:40