Cervical dysplasiaDefinition: Cervical dysplasia is the abnormal growth of�cells on the surface of the cervix.�Although this is�not cancer, this is considered a pre-cancerous condition. Depending on the extent of changes,�the condition�is further categorized as: - CIN I -- mild dysplasia (a few cells are abnormal)
- CIN II -- moderate to marked dysplasia
- CIN III -- severe dysplasia to carcinoma-in-situ (cancer confined to�the surface�layer of the cervix)
Alternative Names: Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix
Causes, incidence, and risk factors: Less than 5% of all Pap smear test results�find cervical dysplasia. While the cause is unknown, a number of�risk factors have been identified. Most cases occur in women aged 25 to 35. Other risk factors include: - Multiple sexual partners
- Starting sexual activity before age 18
- Having children before age 16
- DES exposure
- Having had sexually transmitted diseases, especially HPV (genital warts) or HIV infection
Symptoms: There are usually no symptoms.
Signs and tests: A pelvic examination is usually normal. The following tests�may�indicate cervical dysplasia: - Pap smear showing mild, moderate, marked, or severe dysplasia.
- Colposcopy revealing "white epithelium." These are�mosaic-like patterns on the surface of the cervix, caused by changes in the surface blood vessels.
- Colposcopy-directed biopsy to confirm dysplasia and the extent of cervical involvement.
- Endocervical curettage to rule out involvement of the cervical canal.
- Cone biopsy may be necessary to rule out invasive cancer.
Treatment: The treatment depends on the degree of dysplasia. Mild dysplasia, which may�go away�on its own,�usually involves�careful observation with repeat Pap smears every 3 to 6 months.�Other forms may require�methods to�destroy the abnormal tissue, including electrocauterization, cryosurgery, laser vaporization, or surgical removal. Consistent follow-up, every 3 to 6 months or as prescribed, is essential.
Expectations (prognosis): Nearly all cervical dysplasia can be cured with early identification,�proper evaluation and treatment, and careful, consistent follow-up. Without treatment, 30-50% cases of cervical dysplasia may progress to invasive cancer. The risk of cancer is higher for severe dysplasia (CIN III) that is not treated.
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. Call for an appointment with your health care provider if you have not had regular Pap smears at these intervals: - Every year initially
- For women up to age 35 or 40: every 2-3 years after having three negative, consecutive annual Pap smear tests and a single sexual partner or no sexual partner
- Every year for women over age 35 or 40
- Every year for women who have had multiple sexual partners
- Every year for women who are taking oral contraceptives (birth control pills)
- Every 6 months for women who have a history of HPV (genital warts)
- Every year for DES daughters (women whose mothers took DES during the pregnancy)
- The frequency recommended by your health care provider after an abnormal Pap smear or prior dysplasia
Prevention: To reduce the chance of developing cervical dysplasia: - Wait�until�you are�18 or older before becoming sexually active
- Practice monogamy and safe sex
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