What Is Dysplasia of the Cervix (Cervical Dysplasia)?

What Is Cervical Dysplasia?

Cervical dysplasia is a precancerous condition involving abnormal growth of cells developing on the surface of the cervix.

Human papillomavirus (HPV) infection causes cervical dysplasia. Although it is not cancer, specialists describe this condition as a precursor of cervical cancer. Regular Pap smears and cervical cancer screening help detect cervical dysplasia. After diagnosis, treatment can be provided through procedures such as conization to prevent disease progression.

In the United States alone, an estimated 250 thousand to 1 million women are affected by this condition each year.

What Are the Symptoms of Cervical Dysplasia?

Cervical dysplasia usually causes no symptoms. Similarly, most people with HPV have no health problems or symptoms. Cervical dysplasia is generally diagnosed after a routine Pap smear.

If cervical dysplasia leads to cervical cancer, symptoms may develop. It is important to remember that early-stage cervical cancer may not present with symptoms. However, advanced cervical cancer may cause abnormal bleeding and discharge. This includes bleeding after sexual activity.

What Causes Cervical Dysplasia?

According to a paper published in 2021, cervical dysplasia occurs as a result of HPV infection. HPV refers to a group of more than 200 viruses. Among these, HPV 16 causes 50% of cervical cancer cases.

HPV is the most common sexually transmitted infection

Most sexually active people are exposed to this virus, and in 90% of cases, the immune system clears the virus from the body within 2 years.

However, HPV can become a persistent infection in some individuals. When this happens, the infection can lead to cervical dysplasia, which, if untreated, may lead to cervical cancer.

The process from HPV infection of the cervix to recovery, dysplasia, or cancer is illustrated below.

What Are the Risk Factors for Cervical Dysplasia?

Cervical dysplasia is a precursor to the development of cervical cancer. Factors increasing the likelihood of developing cervical cancer include:

• HPV
• Becoming sexually active at a young age, especially before 18
• Sexual activity with multiple partners
• Smoking
• A weakened immune system
• Chlamydia (a sexually transmitted disease caused by chlamydia bacteria)
• Long-term use of birth control pills
• Having many births
• Pregnancy before age 20
• Exposure to diethylstilbestrol (a synthetic form of the female hormone estrogen)
• A family history of cervical cancer

The paper published in 2021 stated that exposure to HPV at a young age can increase the likelihood of persistent HPV infection.

Cervical Dysplasia and Disease Progression

The US National Cancer Institute reports that cervical dysplasia can be mild, moderate, or severe.

Specialists classify cervical dysplasia as follows:

• Low-grade squamous interepithelial lesion (LSIL): This is a mild form of dysplasia also referred to by specialists as CIN-1. Cells with low-grade abnormalities are present on the cervical surface. These lesions generally resolve without treatment. However, if they spread to nearby tissues, they may become cancerous.
• High-grade squamous interepithelial lesion (HSIL): This is a moderate or severe form of dysplasia, also referred to by specialists as CIN-2 or CIN-3. In CIN-2, moderately abnormal cells are present on the cervical surface, while CIN-3 involves a higher proportion of abnormal cells on the cervical surface.

Both forms of cervical dysplasia can progress to cancer.

Progression from cervical dysplasia to cervical cancer may take 10 to 30 years. Specialists therefore suggest that most people who develop cervical dysplasia may have been exposed to HPV at a young age.

How Is Cervical Dysplasia Diagnosed?

Cervical dysplasia can be diagnosed through a routine Pap smear. If the results indicate LSIL, further tests are requested to ensure the changes are not more serious. If the results indicate HSIL, however, the person may need colposcopy. Colposcopy is a procedure involving close examination of the cervix (uterus), vagina, and vulva for signs of disease.

Specialists may also request a biopsy, which involves taking a small piece of cervical tissue. Laboratory results can show whether cells are cancerous. Appropriate treatment is recommended based on these results.

How Is Cervical Dysplasia Treated?

The paper published in 2021 indicates that a watch-and-wait approach may be adopted for mild cases. Specialists will probably recommend a Pap smear after one year. For moderate to severe cases, specialists will recommend surgical removal of the growth.

Potential options include:

• Surgical removal of part of the cervix, also known as cervical conization or cone biopsy
• Laser therapy, in which concentrated light damages the cells
• Loop electrosurgical excision, which removes abnormal cells with an electrified wire
• Freezing the abnormal area with extreme cold, also known as cryocauterization or cryosurgery

It is important to remember that cervical dysplasia does not always progress to cervical cancer. Treatment options are available to remove abnormal cells before cancer develops.

Measures to Prevent Cervical Dysplasia

To prevent cervical dysplasia, people can receive the HPV vaccine. Vaccination is recommended for children aged 11–12 and sexually active people under 26. People should also undergo regular cervical cancer screening, including Pap smears. In addition, in October 2018, an additional application to the FDA (US Food and Drug Administration) for the 9-valent human papillomavirus (HPV) vaccine Gardasil 9 to include women and men aged 27 to 45 was approved. However, the 9-valent vaccine has not yet arrived in Turkey.

Another preventive measure is safe sexual activity. Protective methods such as condoms should be used. This can also reduce the likelihood of acquiring HPV.

Questions to Ask Your Doctor

People are likely to have many questions when diagnosed with cervical dysplasia. Some questions you can ask your doctor before or after diagnosis, which may also vary with your circumstances, include:

• What does my Pap smear result mean?
• What is the next step?
• Can I receive the HPV vaccine?
• When should I have my next Pap smear?
• What treatment is recommended for my condition?
• What should I expect after treatment?
• Should I see an oncologist?

Summary

Cervical dysplasia is not cancer, but precancerous growths involving abnormal cells on the cervical surface. It results from persistent HPV infection. People with this condition have no symptoms. Screening such as Pap smears can help diagnose the condition at an early stage.

To prevent cervical dysplasia, people can receive the HPV vaccine and use protective methods in their sex lives. This may reduce the risk of acquiring HPV, which in turn reduces the risk of developing cervical dysplasia.