Cervical Dysplasia: Causes, Risk Factors, and Diagnosis
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Cervical Dysplasia is a condition in which abnormal cells grow on the surface lining of the woman’s cervix. Surgery, cryotherapy, or laser therapy may be used to treat it when caused by certain types of HPV. It is possible to detect cervical dysplasia early by getting a Pap smear regularly.
A common condition affecting many women around the world is cervical dysplasia. Even though it isn’t cancerous, it is considered a precancerous condition that requires attention and treatment. Now, let’s discuss the causes, symptoms, and treatment options of cervical dysplasia!
Cervical dysplasia types:
Cervical dysplasia is categorized into different types based on the severity of the cell changes observed. The common types of cervical dysplasia are as follows:
- Mild dysplasia: The cervix's cells in the skin are multiplying a little bit more quickly than usual when there is minor dysplasia. The cells have larger, darker nuclei and are significantly plumper compared to what they should be. Although this is not cancer, certain women are possibly predisposed to it becoming cancer. The following terms are also used for defining moderate dysplasia:
- A low-grade squamous intraepithelial lesion, or LGSIL
- CIN I (Grade 1 Cervical Intraepithelial Neoplasia)
- Moderate dysplasia (CIN 2): A case of moderate dysplasia consists of one that has advanced past the moderate phase and is characterized by a substantially accelerated progression in cervical skin growth. A tissue biopsy of the cervix reveals premature cells called basal cells that have partially penetrated the appearance of the skin membrane before significantly maturing.
- Moderate dysplasia, also known as CIN II (Cervical intraepithelial neoplasia), is crucial due to the substantially higher chance that, if left untreated, these abnormalities would develop into aggressive cervical cancer. The term "high-grade" lesion, also known as a "high-grade squamous intraepithelial lesion" (HGSIL), is used to describe moderate dysplasia.
- Mild dysplasia: A moderate amount of dysplasia on a Pap smear typically calls for additional colposcopy examination of the cervix. When mild dysplasia is identified, it is typically
- Severe dysplasia (CIN 3, also known as carcinoma): Severe dysplasia represents a more advanced stage of abnormal cell growth on the cervix. The abnormal cells occupy a larger portion of the cervical surface and have the potential to become cancerous if left untreated. Prompt medical intervention, such as a cervical biopsy and treatment, is essential to prevent the development of invasive cervical cancer.
It’s crucial to highlight that “cervical dysplasia” and “cervical intraepithelial neoplasia” (CIN), a categorization system for cervical cancer that is based on the degree of seriousness of cellular alterations, are frequently used synonymously. Consultation with a healthcare provider is advised if you are concerned about cervical dysplasia or have been diagnosed to receive the correct assessment, observation, as well as therapy choices.
Cervical dysplasia risk factors:
Cervical dysplasia is associated with several risk factors & a few of which are linked with HPV risks. Risk elements consist of:
- Getting an immune-suppressing condition or taking immunosuppressive medication
- Had a lot of physical relationships over their lifespan.
- Having a partner who has multiple partners, beginning to behave sexually at a younger age, being exposed to HPV at a younger age, and smoking.
- If you regularly engage in sexual behavior, using a condom for protection or a different technique may lower your chance of contracting HPV. But even without a condom, viral infections can continue to thrive and spread on the skin around the genitalia.
- Cervical cancer is not always caused by HPV infections, but persistent infection with certain high-risk strains, such as HPV 16 and HPV 18, can increase the risk.
- Other factors that may lead to cervical dysplasia like a weak immune system, prolonged use of oral contraceptives, etc.
- Cervical cancer can often be prevented through a combination of vaccination, regular screening, and practicing safe sexual behaviors.
- Before engaging in any sexual activity, it is preferable to get an HPV vaccination for both men and women as it protects against the most common HPV strains that cause cervical cancer. Precancerous abnormalities in the cervix can be detected with the help of screenings such as Pap smears and HPV tests and allow for early treatment. It is crucial to adhere to the suggested screening guidelines recommended by healthcare professionals.
Cervical dysplasia causes:
1. HPV infection:
- One of the most common and main cervical dysplasia causes is Infection with HPV(human papillomavirus).
- HPV is a group of viruses that infects the cervix region of your body.
- HPV can be transmitted through sexual contact, early sexual contact, and multiple sexual partners.
2. Lack of regular pap tests:
- Cervical cancer is more prevalent in women who don’t have frequent pap screenings.
- The Pap test is used to find abnormal cells, and removing or killing them prevents cervical cancer.
3. Smoking:
- Cigarette smoke contains a chemical substance that interacts with the cells of the cervix, triggering precancerous alterations that could eventually turn into cancer.
4. Others:
- Weakened immune system.
- Taking birth control pills over a longer period of time
- Having many children
Cervical dysplasia diagnosis:
If cervical dysplasia is suspected, a healthcare provider may perform the following diagnostic tests:
- Pap smear: For this test, a sample of cervix cells is taken and examined under a microscope to check for any abnormalities. A pap smear test is the gold standard but has limitations.
- Colposcopy: If an abnormality is found, a colposcope (a magnifying instrument) is used to closely examine the cervix for any visible signs of cancerous or precancerous cells.
- Biopsy: A small tissue sample is obtained and sent to a lab for additional investigations if abnormal cells are found.
Treatment:
The treatment of cervical dysplasia depends on various factors, including the stage of the cancer, the woman’s age, and her desire to have children in the future. These may include:
- Surgery: Removal of the cancerous tissue, including procedures such as a cone biopsy, hysterectomy, or pelvic lymph node dissection.
- Radiation therapy: This therapy involves using high-energy X-rays or other radiation to destroy the cancer cells in the body.
- Chemotherapy: Drugs/medications are used to either kill or inhibit the growth of cancer cells in the body.
- Laser surgery: In laser surgery, a narrow beam of intense light is used to kill cancerous cells. The laser destroys cells while leaving behind healthy cells.
- Cryosurgery: In this procedure, liquid nitrogen is passed through a probe and applied to cancerous tissue. The freezing temperatures cause the cancer cells to die.
It’s important to consult with a doctor for an accurate diagnosis and personalized treatment plan if you suspect any symptoms related to cervical cancer. Go for regular check-ups and screenings because early detection yields better results.
How fast does cervical dysplasia progress?
Depending on the individual, cervical dysplasia may progress differently. It might advance gradually over several years in some circumstances, while it might advance more quickly in others. The degree of dysplasia, the existence of risk factors like smoking, and the immune system response of the individual can all affect how quickly the disease progresses. To monitor the development of cervical dysplasia and choose the best course of treatment, regular monitoring and follow-up with a healthcare professional are crucial.
As it spreads from the initial site to other parts of the body as well, It usually goes through several stages. One of the most popular and commonly used staging methods to assess the severity of cervical dysplasia is the FIGO (International Federation of Gynecology and Obstetrics) staging system. Here are the stages of cervical cancer:
- Stage 0: Also known as pre-cancer, abnormal cells are found on the surface of the cervix but have not spread deeper into the cervical tissue.
- Stage I: The cancer is limited to the cervix region and does not spread to the nearby organs or lymph nodes.
- Stage IA: The cancer is microscopic, and it’s visible only through a microscope. It does not spread deeper into the cervical tissue.
- Stage IA1: The cancer invasion confines to an area less than 3mm.
- Stage IA2: The cancer invasion will be seen between 3 mm & 5 mm.
- Stage IB: The cancer spreads further into the cervical tissue and is visible now.
- Stage IB1: The size of the cancer invasion is more than 5 mm but less than 2 cm.
- Stage IB2: Cancer invasion is greater than 2 cm but smaller than 4 cm in size.
- Stage II: In this stage, the cancer spreads beyond the cervix but not to the pelvic sidewall or bottom portion of the vagina.
- Stage IIA: The cancer spreads to the upper portion of the vagina but not to the uterine tissues.
- Stage IIB: Cancer invasion extends to the uterine tissues (parametrium).
- Stage III: Cancer invasion extends to the lower third portion of the vagina, pelvic sidewall or causes kidney problems due to blockage of ureters.
- Stage IIIA: The cancer spreads to the lower third portion of the vagina.
- Stage IIIB: The cancer spreads to the pelvic sidewall or causes kidney problems.
- Stage IV: The cancer spreads to the nearby/distant organs or lymph nodes.
- Stage IVA: The cancer spreads to nearby organs like the bladder or the rectum.
- Stage IVB: The cancer spreads to other body organs like the lungs, liver, or bones.
This is an overview of the different stages of cervical dysplasia, and some details may vary based on the case. Proper staging is determined by medical professionals based on various factors, including physical examination, imaging tests, and biopsies. Treatment for cervical dysplasia varies according to its stage of severity.
Clinical manifestations:
- Cervical dysplasia is not painful usually, even though it may be in advanced stages.
- Bleeding that occurs between regular menstrual periods.
- Bleeding after sexual intercourse, douching
- Painful sexual intercourse
- Painful urination
- Edema of lower extremities
- Weight loss
- Anaemia
- Vaginal discharge slowly worsens, turning dark and foul-smelling
- The watery vaginal discharge after intercourse
- Pelvic and Low back pain.
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