Cervical Dysplasia

Home » Cervical Dysplasia » Symptoms, Diagnosis, Staging

Signs and Symptoms

Cervical dysplasia does not cause symptoms. Symptoms, if any, are caused by an accompanying infection.

Diagnosis

Pap Smears
The Pap smear is the most important diagnostic procedure for detecting cervical dysplasia. It is a simple and painless test that may cause minor discomfort.

Normal vaginal discharge contains cells that are shed from the cervix and uterus. A gynecologist or other health care practitioner removes some of these cells by brushing or scraping the cervix with a small instrument designed for this purpose. The cells are placed on a glass slide and sent to a laboratory, where they are examined under a microscope for changes and abnormalities.

The Pap smear is not 100% reliable. It produces incorrect results in about 15-25% of cases. Cervical cancer is missed in about 5% of cases. Reasons for incorrect results include the following:

• Human error (The test should be done by an experienced practitioner and sent to a reputable laboratory.)
• Inadequate number of cells in the sample
• Presence of menstrual blood in the sample
• Temporary changes in cervical cells caused by medications, pregnancy, infection

If atypical cells are found, the physician may recommend further testing.

HPV Test
Because of the association between human papillomavirus (HPV) and cervical cancer, this test can help determine the next step for a woman with atypical cells. This test checks for HPV genetic material, or DNA, within the cervical cells. A swab of cervical cells is taken and the specimen is sent to a laboratory and examined for HPV. If the HPV test is positive for a high-risk strain, the lesions are more likely precancerous. If the test is negative, the cervical changes are more likely benign.

Colposcopy
Depending on the severity of the dysplasia, results of the HPV test, and other risk factors, colposcopy is the next step in the diagnostic process. Generally, a colposcopy is performed if the cervical cells are distinctly abnormal.

This relatively simple procedure takes about 10 to 15 minutes to perform. A solution of diluted acetic acid (vinegar) is applied to the cervix to remove mucus and highlight abnormal cells. Using a bright light and a special electronic microscope (called a colposcope), the physician is able to see small areas of the cervix and vagina. The acetic acid and the lens of the colposcope make abnormal cells appear white and normal cells appear pink. If abnormal cells are seen, a biopsy is usually done.

Biopsy
A cervical biopsy usually is performed when the colposcopy reveals abnormal tissue. Using a small biopsy forceps, a tiny sample of abnormal tissue is removed from the cervix and sent to a laboratory for examination. More than one sample may be taken, depending on the amount of abnormal tissue detected by colposcopy.

Another type of biopsy, called an endocervical cutterage, may also be done. This procedure is performed if the physician is unable to determine if the abnormal cells go beyond the surface of the cervix. Using a small-spoon shaped instrument called a curette, cells from inside the cervix are biopsied. The procedure takes about 10 to 15 seconds, but it can trigger uterine cramping.

A procedure called dilatation and curettage (D & C) may be performed if the physician suspects that abnormal cells extend beyond the cervix. A curette is used to remove cells from the cervical canal and the lining of the uterus. This procedure requires local anesthesia.

Treatment is based on the biopsy results.

Staging

Since the Pap smear was introduced in 1943, a number of methods have been developed to classify the results. The two methods commonly used today are the Bethesda System and the CIN Grading System.

The Bethesda System was developed by the CDC and NIH in order to have a comprehensive and standardized method of classifying Pap smear results. It uses the term squamous intraepithelial lesion (SIL) to describe abnormal changes in the cells on the surface of the cervix. Squamous refers to thin, flat cells that lie on the outer surface of the cervix. An intraepithelial lesion occurs when normal cells on the cervical surface are replaced by a layer of abnormal cells, and these changes are classified as high grade or low grade.

Bethesda System

• ASCUS (atypical squamous cells of undetermined significance)—Borderline, some abnormal cells
• LGSIL (low-grade squamous intraepithelial lesions)—Mild dysplasia and cellular changes associated with HPV
• HGSIL (high-grade squamous intraepithelial lesions)—Moderate to severe dysplasia, precancerous lesions, and carcinoma in-situ (preinvasive cancer that involves only the surface cells)

Squamous cell carcinoma
Cervical intraepithelial neoplasia (CIN) refers to new abnormal cell growth. Intraepithelial refers to the surface layers of the cells. The CIN System grades the degree of cell abnormality numerically, CIN I is the lowest and CIN III is the highest.

CIN Grading System
Atypia—correlates with ASCUS
CIN I—mild dysplasia and correlates with LGSIL
CIN II—moderate dysplasia and correlates with HGSIL
CIN III—severe dysplasia and correlates with HGSIL
Carcinoma in-situ
Cervical cancer

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