- Cervical dysplasia - causes
- Cervical dysplasia - symptoms
- Cervical dysplasia - diagnosis
- Cervical dysplasia - treatment
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Cervical dysplasia is a precancerous condition. Cervical dysplasia can turn into cervical cancer - the second most common malignant neoplasm in women (after breast cancer). However, the risk depends on the severity of the lesion. Consequently, the sooner cervical dysplasia is diagnosed, the greater the chance of a cure. What are the causes and symptoms of cervical dysplasia? What is the treatment?
Cervical dysplasia , also known as cervical intraepithelial neoplasia (CIN), is an abnormal change in the structure of the tissues of the cervix. These changes can become malignant and turn into cervical cancer. The risk of developing cervical dysplasia into cancer depends on its stage:
- minor changes (in medical terminology - CIN1)
- large degree changes (HG-CIN)
- moderate and high grade intraepithelial neoplasia (CIN2 and CIN3 respectively)
- adenocarcinomain situ
Cervical dysplasia - causes
Cervical dysplasia is most often the result of chronic infection with oncogenic (cancer-related) types of the human papillomavirus (HPV).
The greatest association with the occurrence of precancerous lesions (as well as cervical cancer) is shown by HPV types 16 and 18 ( although there are known cases of cervical dysplasia caused by non-cancerous types).
Cervical dysplasia - symptoms
Dysplasia is usually asymptomatic. Occasionally there may be discharge and spotting after intercourse.
Cervical dysplasia - diagnosis
Cervical dysplasia can be detected by cytology (assessed according to the Bethesda system or, in the past - according to the Papanicolau scale).
If minor changes are diagnosed in women aged 21-24, the cytology should be repeated twice at intervals of 12 months. If the correct result is obtained twice, subsequent cytologies are performed as standard - once every 3 years.
The basic examination in the diagnosis of cervical dysplasia, as well as in the early forms of cancer, is colposcopy. Cervical dysplasia cannot be diagnosed and appropriate treatment cannot be undertaken based on the results alonePap tests.
If the test results are incorrect, a colposcopic examination (endoscopy of the cervix) is necessary, which allows for a precise diagnosis of changes on the cervix and allows for the selection of an appropriate treatment method.
If, after cytological examination and colposcopy, there are indications for further diagnosis, tissue material from the cervix is collected for histopathological examination, the purpose of which is to definitively exclude or confirm the suspicion of the presence of changes on the cervix.
Additionally, a human papillomavirus infection test is performed to determine if the virus is present and the risk of developing cervical cancer.
The procedure is different in women over 25 years of age. If they are diagnosed with minor lesions, cytology is not performed, but colposcopy is performed immediately, and if necessary, a histopathological examination, and an HPV test.
Cervical dysplasia - treatment
Low grade lesions (CIN1) often regress without treatment. In addition, they rarely transform into large-scale lesions within two years of observation. Therefore, they are only subject to regular checkups by the gynecologist.
In the case of medium and high degree neoplasia (CIN2 and CIN3), surgical or laser conization is performed. Then, follow-up colposcopy and cytology (every 6 months) and test for the presence of HPV should be performed.
In the case of a positive test result and abnormal cytological and colposcopic examination results, a biopsy should be performed and the cervical canal should be cured. If the test results are normal, screening tests should be performed every year (for 20 years).
In the event of adenocarcinomain situ , one of the following three methods is recommended:
- surgical conization
- trachelectomy (cervical amputation)
- hysterectomy, i.e. removal of the uterus (in women who are not planning to have children anymore) along with the lymph nodes. After hysterotomy, radiotherapy and chemotherapy are performed.
Cervical dysplasia is preventable
The Team of Experts of the Polish Gynecological Society recommends HPV vaccinations in girls aged 11-12 and between 13 and 18 (if they have not been vaccinated before).
The results of the clinical trials conducted so far on the effectiveness of prophylactic vaccinations are very promising (90% effectiveness of vaccines in the prevention of high-grade lesions (CIN 2+) and adenocarcinoma in situ, caused byinfection with HPV types 16 and 18. However, the HPV vaccine is still controversial.