Cervical Intraepithelial Neoplasia (Cin) Cervical Dysplasia

Cervical dysplasia is a condition in which a woman has abnormal changes in thetop layer of cells of her cervix. The cervix is the opening between the vaginaand the uterus. The changes are local and have not spread more deeply into thecervix or to other sites in the body.

What is going on in the body?

The cells of the cervix take months or even years to go through precancerous stagesbefore full-blown cancer occurs. These changes are called cervical dysplasia.Catching and treating the changes early can prevent cancer of the cervix.

The cervix is the opening to the uterus. While it is located within a woman’svagina, its cells act very much like skin cells. The cells are exposed totoxins, viruses, and bacteria that may cause abnormal changes.

Each stage of dysplasia, or abnormal changes in the cells, is judged by thethickness of the cells that are abnormal. The earliest microscopic change ismild dysplasia or cervical intraepithelial neoplasia, also referred to as CIN 1. If not treated,the precancerous changes may become moderate (CIN 2) and then severe (CIN3). The fourth and most severe stage of dysplasia is called carcinoma insitu, or CIS. After that, cancer cells may invade deeper layers ofthe cervix or spread to nearby sites. At that point it is called invasivecancer of the cervix.

What are the causes and risks of the condition?

Cervical dysplasia is a precursor to cancer of the cervix, which is the second mostcommoncancer of the female reproductive system. It occurs most often among women aged40 to 55.

No one knows exactly what causes the abnormal changes that we call cervicaldysplasia. Certain health problems, lifestyle choices, and other factors mayraise a woman’s risk for this. These include the following:

having had a sexuallytransmitted disease. Both Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. chlamydia and humanpapilloma virus infections are strongly associated with cervicaldysplasia and cancer of thecervix.

having had an abnormal Papsmear. A Pap smear is an examination, under a microscope, of cellsscraped from the cervix.

becoming sexually active before age 18

having had more than 3 sexual partners

not using condoms with new sexual partners

having had cancer of the vagina or vulva

having a sexual partner whose previous partner had cancer of the cervixor cervical dysplasia, acondition of abnormal cells that precedes cancer

having a sexual partner who has or has had cancer of the penis

smoking

having a weakened immune system, for example, as a result of HIV or another immunodeficiency disorder

being the daughter of a woman who took DES, or diethylstilbestrol, during pregnancy

a history of cancer of the cervix in a woman’s sister or mother

What are the signs and symptoms of the condition?

There are usually no symptoms associated with cervical dysplasia. If there aresymptoms, they may be vague such as vaginal discharge or abnormal vaginal bleeding.

How is the condition diagnosed?

Diagnosis of cervical dysplasia is done with a pelvic examination that includes a Pap smear. During a pelvic exam, the cervix,vagina, and vulva are checked for signs of changes. To do a Pap smear, aprovider uses a small spatula and a brush to gently scrape cells from thecervix. These cells are sent to a lab for testing.

If abnormalities are found, the Pap smear may berepeated in 3 months. Alternately, the healthcare provider may do additionaltests, including:

colposcopy, a procedure in which a special microscope allows theprovider to closely examine the cervix, vagina, and vulva

cervical biopsy, a procedure in which small tissue samples aretaken from the cervix. This procedure is generally done in a healthcareprovider’s office.

cold cone biopsy, aprocedure in which a large tissue sample is taken from the cervix. Thisprocedure is normally done in an operating room under general anesthesia. The cone biopsy often removes all of theabnormal tissue.

What can be done to prevent the condition?

Many times, cervical dysplasia can be stopped in its early stage by earlydetection. Cervical dysplasia can be detected by a pelvic examination that includes a Pap smear. Women should start tohave Pap smears and pelvic exams when they reach the age of 16 or as soon asthey become sexually active.

A woman can lower her risk for developing cervical dysplasia by taking the following steps:

quitting smoking

waiting to have intercourse until age 18 to 20

having only a few sexual partners in a lifetime

using latex condoms and practicing safer sex with each sexual encounter

A woman should ask her sexual partners about their sexual histories,so that those who seem to be high-risk can be avoided.

Identification of early warning signs of cervicaldysplasia and cervical cancer is also important. A woman should see herhealthcare provider and may need to be treated if she has any of the following signs or symptoms:

vaginal discharge that does not seem normal

vaginal bleeding betweenperiods

bleeding with intercourse

painful intercourse, known as dyspareunia

What are the long-term effects of the condition?

With early detection, treatment, and close follow-up care, nearly all cervicaldysplasia can be cured. If untreated, the mild to moderate stages of dysplasiaoften grow more severe. Up to 30% to 50% of carcinoma in situ, or CIS, casesprogress to invasive cancer of thecervix.

What are the risks to others?

Cervical dysplasia is not contagious and does not pose a risk to others.Sexually transmitteddiseasesassociated with cervical dysplasia, such as Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. chlamydia and human papilloma virus, are contagious.

What are the treatments for the condition?

Early dysplasia can usually be treated with one of the following:

cryotherapy, or freezing of the abnormal cells with liquidnitrogen

lasersurgery, with a laser beam directed at the abnormal cells

loop electrocautery excision procedure, or LEEP, a procedure that uses a heated electrical loop to destroyabnormal cells

For more serious cases of cervical dysplasia, the abnormal tissue may beremoved surgically. Options for surgical removal include the following:

cone biopsy, aprocedure in which a portion of the center of the cervix is removed. Thisprocedure is also used to diagnose the dysplasia. During the diagnostic coldcone biopsy, the abnormal tissue is often completely removed.

hysterectomy, or surgical removal of the uterus and cervix

What are the side effects of the treatments?

During cryotherapy,women often feel cramping and pelvic discomfort. For about a month afterward,they have a great deal of watery vaginal discharge.

Laser surgery orLEEP can cause the following:

foul-smelling vaginaldischarge

cervicitis, or inflammation of the cervical tissue

bleeding

an allergicreactionto the local anesthesiaused during the procedure

Possible side effects and complications of hysterectomy are as follows:

inability to control urination

sexual problems

psychological stress

swelling in thelegs

bleeding that requires a bloodtransfusion

allergic reaction toanesthesia

What happens after treatment for the condition?

A woman may be advised to refrain from using tampons, having sexualintercourse, or douching for a period of time following a procedure to treatcervical dysplasia.

How is the condition monitored?

Women who have been treated for dysplasia should be closely followed withpelvic exams andPap smears. During the first yearafterany treatment, Pap smears should be done every 3 to 4 months. In the secondyear, the schedule is every 6 months. Any new or worsening symptoms should bereported to the healthcare provider.