What is cervical dysplasia?
Cervical dysplasia is a precancerous condition, an abnormal growth of epithelial cells of the mucous membrane of the cervix or cervical canal. Another name for dysplasia is cervical intraepithelial neoplasia (CIN). "Intraepithelial" means that it is inside the epithelium, not outside it, and this is how dysplasia is different from cancer. The disease does not cause any symptoms and is detected only during monitoring of the cervix. Dysplasia does not always require immediate treatment, but it always requires close medical attention. The prognosis is optimistic under the condition of constant medical control. Dysplasia, left out of attention, can transform into cervical cancer.
Cervical dysplasia: causes
The cause of abnormal cell growth is HPV, the human papillomavirus, namely its oncogenic strains, 16 and 18. The route of infection is usually sexual, through mucous membranes, less often it can be close skin contact. HPV is extremely common among sexually active people. When it enters the body, the immune system detects it. If the system is strong enough, immune cells destroy the virus, but sometimes only suppress it. As a result, it persists in the body in a latent state. Immunity weakening activates the virus, and cervical intraepithelial neoplasia can become one of the manifestations of its vital activity
A risk factor is something that weakens the immune system. It has been established that CIN develops more often in women who smoke, and in them it more often acquires a severe character, since smoking weakens the immune system. Treatment with immunosuppressants, as well as HIV, seriously increases the risk.
Is dysplasia without HPV found? Sometimes, when diagnosing CIN, doctors do not detect HPV. What is the cause of its appearance in this case is an open question. Probably the same decrease in immunity, hormonal imbalance, repeated childbirth. But, most likely, the absence of the virus is a consequence of the activation of immunity, which destroyed it already after it caused dysplasia. Indirect confirmation of this theory is that without HPV, dysplasia of the uterus usually does not progress to a severe stage, and vice versa — a large amount of the virus is associated with a more severe nature of CIN. In 98% of cases, there is no doubt about the connection with HPV.
Diagnosing cervical dysplasia
Cervical dysplasia is detected using the following studies:
- Pap test (Papanikolau test, cytological smear). If dysplasia is detected, the test is repeated.
- Colposcopy is a visual exam of the epithelium of the cervix under magnification. During colposcopy, the doctor takes samples of the affected epithelium (biopsy) for further analysis.
- Endocervical curettage is performed for the purpose of biopsy to obtain a sample of the epithelial cells lining the cervical canal.
- PCR is a polymerase chain reaction to detect HPV and determine its strain.
Degrees of cervical dysplasia
The degree of damage is crucial for the prognosis and the choice of treatment tactics. There are only three of them:
- Cervical dysplasia of the 1st degree (mild or dysplasia I, or CIN I) - abnormal cells affecting about one-third of the thickness of the epithelium.
- Cervical dysplasia of the 2nd degree (moderate or dysplasia II, or CIN 2) - abnormal cells affecting about one-third to two-thirds of the epithelium.
- Cervical dysplasia of the 3rd degree (severe or dysplasia III, or CIN 3) - the epithelium surface is affected to the entire depth, the division into layers is not determined
Medium and severe dysplasia of the cervix can turn into a malignant tumor.
Cervical dysplasia: treatment
The approach to treatment primarily depends on the dysplasia degree and the patient's age, as well as some other factors. Mild cervical dysplasia in young women does not require treatment, as in most cases it resolves on its own within two years. Only constant monitoring with repeated Pap smears are required. Elderly women having mild dysplasia are also subject to medical control, but have a higher probability that the pathology will progress. If dysplasia does not disappear within two years, as well as if dysplasia of moderate and severe degree is diagnosed, treatment is required. There are two options: drug therapy and surgical treatment.
Drug treatment consists in taking drugs that stimulate the immune system. These are interferons, interferon inducers and other immunomodulatory drugs. The goal is to activate the immune system to destroy HPV. If the therapy does not work, they go to surgery.
Surgical treatment consists of a minimally invasive intervention: removal of the affected part of the cervix epithelium. For this, cryodestruction, laser or radio wave therapy, electrocoagulation methods are used. One of the most frequent requests regarding PRICE is "cervical dysplasia surgery price." In advance, we can say the cost of a minimally invasive intervention is lower than a major operation. The price of the operation depends on the method and the clinic, so you can find it out by contacting a specific clinic
When the treatment is finished, patients should undergo a Pap test and an analysis for HPV after six months, one year, and then regularly with a frequency prescribed by the doctor.
Prevention of cervical dysplasia
The most effective method of prevention is vaccination against oncogenic strains of HPV with the vaccine Gardasil or Cervarix. It is optimal to get vaccinated at the age of 13–15, before the beginning of sexual life. But if this has not been done, you can get vaccinated up to the age of 26, and in some cases even later.
Prevention also includes everything that reduces the risk of infection and strengthens the immune system. The risk of infection with oncogenic strains decreases if a woman has a regular sexual partner or if she uses barrier methods of contraception. Healthy lifestyle helps to strengthen immunity: proper rest, balanced nutrition, regular physical activity.
