Cervical Dysplasia

Cervical Dysplasia is a pre-cancerous change of the cervix. It is not cancer and should never become cancer because there is a simple office procedure to treat dysplasia. Cervical dysplasia is diagnosed from a colposcopy. Cervical dysplasia can be classified as mild (CIN 1), moderate (CIN 2), severe (CIN 3), or Carcinoma in Situ (CIS). Dysplasia is not dangerous in and of itself except that it has the potential to turn into a cancer if ignored. It rarely causes any symptoms, it will not cause pain or discharge. Occasionally women with dysplasia may experience bleeding with intercourse.

The cervix is made up of 2 cell types, squamous and glandular cells. The squamous cells are similar to the type of cells on the skin; they are tough and designed to interact with the outside world. The glandular cells are more fragile and found on the inner cervix. There is a transformation zone where the junction between the squamous and glandular cells are found. This is like a fluid border between two waring countries causing the boundary to change over time. It is in this transformation zone that dysplasia is typically found. Dysplasia has two naming systems, one is mild, moderate, and severe dysplasia, the other is CIN (cervical interepithelial neoplasia). CIN 1 = mild dysplaia, CIN 2 = moderate dysplasia, and CIN 3 = severe dysplasia.

The squamous cells have a basement membrane that separates this layer from the deeper tissues. The cells at the basement membrane divide and then the cells die and move up towards the surface until they are eventually sloughed off. When actively dividing cells are found above the layer on the basement membrane this is defined as dysplasia. If the dividing cells are up to 1/3 of the way up towards the surface, this is defined as mild dysplasia or CIN 1. If the dividing cells are between 1/3 and 2/3 of the way towards the surface, this is defined as moderate dysplasia or CIN 2. If the dividing cells range from 2/3 to full thickness, this is defined as severe dysplasia or CIN 3. If the dividing cells go all the way to the surface, this is a special form of severe dysplasia called CIS (carcinoma in situ), this is not cancer. Cancer occurs when the dividing cells breach the basement membrane and move down into the deeper tissue.

Mild dysplasia rarely advances to the more severe form and usually goes away on its own with no treatment. Typically when women have mild dysplasia no treatment is needed. It is typically just followed to make sure it has gone away. Typical follow up time is 6 months. if it advances to moderate dysplasia treatment becomes necessary. If the mild dysplasia is found deep in the inner cervix (endo-cervix), treatment may be indicated.

Moderate and severe dysplasia are almost thought of as a different disease than mild dysplasia. Only a rare variety of mild dysplasia can advance to these later stages. Moderate or severe dysplasia as well as CIS are almost always best treated with a LEEP cone biopsy ( LEEP stands for loop electrosurgical excision procedure). The LEEP procedure is a mild office procedure that is very safe and not very painful. It almost always cures the dysplasia.

There are rare cases in which the glandular cells can be affected rather than the squamous cells. This can become an adenocarcinoma in situ. This is also not cancer but a precancer change. It is in deeper tissues and can have what is called skip lesions making it harder to excise it completely. This is generally treated with a cold knife cone biopsy if future childbearing is desired, rather than with a LEEP. Hysterectomy is often recommended if the woman is finished with childbearing. A cold knife cone biopsy is a larger excision of the cervix, this is done in the operating room as a same day procedure.

Women are often frightened by dysplasia, however this is unnecessary. Dysplasia is very treatable and can be cured with a LEEP, a simple, minimally painful, office procedure. The only way displasia will cause a problem is if it is ignored. If you have dysplasia the last thing you want to do is get frightened and ignore it. Ignoring dysplasia is the only way it can cause problems.