Cervical dysplasia

Cervical dysplasia is the abnormal growth of cells on the surface of the cervix . Although this is not cancer, this is considered a precancerous condition.

Cervical dysplasia is grouped into three categories:

CIN I -- mild dysplasia (a few cells are abnormal)
CIN II -- moderate to marked dysplasia
CIN III -- severe dysplasia to carcinoma-in-situ (precancerous cells only in the top layer of the cervix)

Alternative Names: Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix

Causes, incidence, and risk factors:

Most cases of cervical dysplasia occur in women aged 25 to 35.

The cause is unknown. However, the following may increase your risk:

Multiple sexual partners
Becoming sexually active before age 18
Giving birth before age 16
If your mother took a drug called diethylstilbestrol (DES) during pregnancy
Sexually transmitted infections, especially HIV or HPV (genital warts )

Symptoms:

There are usually no symptoms.

Signs and tests:

A pelvic examination is usually normal.

A Pap smear shows abnormal cells. A colposcopy-directed biopsy is done to confirm the condition and determine its severity.

Other tests may be done to find out if the abnormal cells have spread outside the cervix:

Endocervical curettage
Cone biopsy

Treatment:

Treatment depends on the degree of dysplasia. Mild dysplasia may go away on its own . You may only need careful observation by your doctor with repeat Pap smears every 3 to 6 months.

Treatment for moderate to severe dysplasia or dysplasia that does not go away may include:

Cryosurgery
Electrocauterization
Laser vaporization to destroy the abnormal tissue
Surgery to remove the abnormal tissue

Women with dysplasia need consistent follow-up, usually every 3 to 6 months or as recommended by their provider.

Support Groups:

Expectations (prognosis):

Early diagnosis and prompt treatment cures nearly all cases of cervical dysplasia.

Without treatment, 30-50% of cases of severe cervical dysplasia may lead to invasive cancer. The risk of cancer is lower for mild dysplasia.

Complications:

The condition may return.

Calling your health care provider:

Call for an appointment with your health care provider if you are a woman who is sexually active or aged 20 or older and you have never had a pelvic examination and Pap smear.

See: Physical exam frequency

Prevention:

To reduce the chance of developing cervical dysplasia:

Wait until you are 18 or older before becoming sexually active
Practice monogamy and use condoms during intercourse

References:

Noller KL. Intraepithelial Neoplasia of the Lower Genital Tract (Cervix, Vulva) : Etiology, Screening, Diagnostic Techniques, Management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap. 28.

Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ; ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002 Apr 24;287(16):2120-9. Review.

Hoffman MS, Martino MA. 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia. Am J Obstet Gynecol. 2004 Sep;191(3):1049

Review Date: 5/26/2008
Reviewed By: Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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