Cervical Dysplasia

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Treatment

Treatment of cervical dysplasia depends on the severity, the presence of HPV, risk factors, and patient's preference. For ASCUS and mild dysplasia (low-grade SIL/CIN I), the physician may perform HPV typing. If no virus or a low-risk strain is present, Pap smears may be repeated at 4- to 6-month intervals because ASCUS and mild dysplasia often resolve without intervention.

If a high-risk strain of HPV is present, colposcopy and biopsy may be indicated and treatment depends on the results of the procedures.

High-grade lesions require treatment. There are several methods available to remove the abnormal tissue, including electrocauterization, cryosurgery, laser vaporization, and surgery.

Electrocauterization
Loop electrosurgical excision procedure (LEEP) emits low-voltage, high-frequency radio waves through a thin loop of wire. Electrical current quickly and safely cuts away abnormal tissue. The procedure takes about 10 to 30 minutes and is performed in the doctor's office or as an outpatient in the hospital. LEEP allows the removed tissue to be examined by a pathologist to ensure that the lesion was completely removed and provide an accurate assessment.

Cryosurgery and cryocauterization
These are relatively safe and simple procedures. In cryosurgery, the physician uses a carbon dioxide-cooled probe (called a cryoprobe) to freeze and kill abnormal cells. The tissue then sloughs off. It is performed in the physician's office. In cryocautery, an electric probe is used to cauterize the abnormal cells. These procedures do not allow abnormal tissue to be saved for pathological examination.

Laser vaporization or ablation
This procedure is performed in the hospital under general or local anesthesia. A laser is used to destroy abnormal surface cells. As with cryosurgery, it is impossible to obtain a specimen for pathologic examination. This procedure may cause less cervical scarring than cryosurgery. Cervical scarring makes the cervix more difficult to visualize.

Cone biopsy
This therapy is used to diagnose and remove abnormal tissue. A cone-shaped tissue sample is surgically removed from the cervix under general or spinal anesthesia in an operating room. The specimen is sent to a pathologist for detailed microscopic examination. If dysplasia is found, no further therapy is needed, provided all of the affected cells were removed. If cancer is found, additional treatments are indicated. The cone biopsy is usually performed for high-grade dysplasia, dysplasia that recurs, and suspected cancer.

Screening
The Pap smear is used to screen for cervical changes. Although Pap smears effectively reduce the incidence of cervical cancer, there is an ongoing debate about how often the test should be performed. Guidelines and recommendations vary.

A Pap smear is recommended for all women when they reach the age of 18 or become sexually active, whichever occurs first. After that, a number of factors affect the frequency of screening. The American Cancer Society recommends that women who have three negative Pap smears in 3 consecutive years may have them less often, depending on general health and sexual activity.

The NIH Consensus Conference on Cervical Health recommends that Pap tests can be done less often (after three consecutive negative results) if the patient is low risk. Low risk means no more than two lifetime sexual partners and a partner with no more than two lifetime partners. Most women should continue to have a yearly Pap smear.

A history of cervical dysplasia, genital warts, HIV infection, and in utero DES exposure may warrant Pap smears at more frequent intervals. Women should discuss screening frequency with their physicians.

Prognosis

The prognosis for cervical dysplasia is excellent. About 70% of mild dysplasia cases resolve on their own, and most dysplasia is curable with proper treatment and follow-up.

Prevention

Women can minimize risk for cervical dysplasia and reduce the chances of developing cancer by taking these preventative measures:

• Pap smear—A Pap smear screens for changes in cervical tissue. Identifying dysplasia early may prevent it from developing into cervical cancer.
• Avoid high-risk sexual behavior—Practicing monogamy or limiting the number of sexual partners decreases exposure to STDs, as does consistent use of condoms or other barrier methods. Sexual contact can transmit the HPV virus and condoms do not offer full protection against the virus. While HPV may cause genital warts, it often remains asymptomatic and undetected.
• Smoking cessation—Cigarette smoking is associated with changes in cervical cells.
• Nutrition—The National Cancer Institute recommends that women consume 5 servings of fresh vegetables and fruits each day. Nutrients including beta carotene, folic acid, vitamin A, and vitamin C may protect against cervical dysplasia. Some experts recommend taking a multivitamin to ensure adequate intake of these vitamins.

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