Frequently asked questions about Cervical Dysplasia
Cervical dysplasia is the abnormal appearance of cells on the surface of the cervix when they are looked at underneath a microscope. Although this is not cancer, it is considered a precancerous condition.
Dysplasia that is seen on a Pap smear is described using the term squamous intraepithelial lesion (SIL). These changes may be graded as:
* Low-grade (LSIL)
Most cases of cervical dysplasia occur in women ages 25 - 35, although it can develop at any age.
Almost all cases of cervical dysplasia or cervical caner are caused by human papilloma virus (HPV). HPV is a common virus that is spread through sexual contact. There are many different types of HPV. Some types lead to cervical dysplasia or cancer.
The following may increase your risk of cervical dysplasia:
There are many ways to treat cervical dysplasia (CIN). Factors influencing the choice of treatment for cervical dysplasia include the extent and severity of the dysplasia, the age of the woman, and whether or not she has any other gynecological problems. Often the experience of the physician or other clinician, and the availability of equipment are also major factors. The following are the most common methods of treating cervical dysplasia:
Cryotherapy, or freezing, is done by placing a probe against the cervix which cools the cervix to sub-zero temperatures. The cells damaged by freezing are shed over the next month in a heavy watery discharge. The main advantages of freezing are that it is simple to do and uses inexpensive equipment.
The carbon dioxide laser uses a tiny beam of light to vaporize the abnormal cells. This can usually be done in the office with no or very little discomfort. The laser is directed through the colposcope so that the area and depth of treatment can be controlled precisely.
The major disadvantage of the laser over the cryo is that it requires sophisticated equipment, and most gynecologists do not have a laser in their office. It is much more expensive to do laser if it has to be done in the hospital. The laser is often replacing cryotherapy in centers where it is available. I believe that the laser is the treatment of choice for most cases of cervical dysplasia (CIN).
Hysterectomy may be appropriate, if a woman with dysplasia or carcinoma-in-situ does not want to bear children in the future. It has the lowest recurrence rate of any treatment, but it is a major surgical procedure. If one has other problems that may be helped by hysterectomy, then this operation may be the best treatment, one that will take care of all of the problems at the same time. Even after a hysterectomy the dysplasia can come back on the vagina, so it is essential to get regular pap smears even if a hysterectomy is done.
A cone biopsy removes a cone-shaped or cylinder-shaped piece of the cervix. It is usually done in an operating room and can be done with a laser or with conventional surgical instruments (cold-cone). A cone biopsy may be done for diagnosis or for treatment, although a diagnostic cone may treat the problem at the same time.
Also known as "LLETZ" or "LEEP", loop excision uses a fine wire loop with electrical energy flowing through it to remove the abnormal area of the cervix. The tissue removed is sent to the laboratory for examination. This procedure, therefore, can often treat and diagnose the problem at the same time. Loop excision is commonly done under local anesthesia and usually causes little discomfort. This can often be used as a substitute for cone biopsy.
Since many women may prefer time to consider treatment options before choosing a treatment method, during the first visit it is preferred to evaluate the cervix by colposcopy, and discuss treatment options at that time, rather than to treat the cervix before a woman has had time to think about her treatment choices.
Why treat cervical dysplasia?
Dysplasia is not cancer; if it is not treated it can turn into cancer. By proper treatment of dysplasia and by proper follow-up, we can significantly reduce the chances that cancer might develop.
Once dysplasia is treated can one forget about it?
No! No matter how dysplasia is treated there is a possibility that it can recur. Usually a recurrence will not be a serious problem if it is detected early, but it can eventually develop into cancer if it is not treated. It is therefore essential to have regular checkups following treatment.