What is cervical dysplasia. How is it diagnosed. What are the treatment options for cervical dysplasia. Can cervical dysplasia be prevented. What causes cervical dysplasia. What are the symptoms of cervical dysplasia. How does HPV relate to cervical dysplasia.

Understanding Cervical Dysplasia: A Precancerous Condition

Cervical dysplasia is a condition characterized by abnormal cell changes in the cervix, the lower part of the uterus that connects to the vagina. These cellular alterations are considered precancerous, meaning they have the potential to develop into cervical cancer if left untreated. However, it’s crucial to understand that the presence of cervical dysplasia does not automatically lead to cancer.

The severity of cervical dysplasia is typically classified into three stages:

• CIN I (mild dysplasia)
• CIN II (moderate to marked dysplasia)
• CIN III (severe dysplasia to carcinoma in situ)

CIN stands for Cervical Intraepithelial Neoplasia, which is the medical term used to describe abnormal cell growth on the surface of the cervix.

The Silent Nature of Cervical Dysplasia: Recognizing the Importance of Screening

One of the most challenging aspects of cervical dysplasia is its asymptomatic nature. In most cases, women with cervical dysplasia do not experience any noticeable symptoms. This lack of visible signs underscores the critical importance of regular screening through Pap tests.

Why is regular screening so crucial? Regular Pap tests can detect abnormal cell changes long before they progress to cancer, allowing for early intervention and treatment. The American Academy of Family Physicians (AAFP) provides guidelines for routine Pap tests, which vary based on age and other risk factors.

Recommended Screening Schedule

• Women aged 21-29: Pap test every 3 years
• Women aged 30-65: Pap test and HPV test every 5 years, or Pap test alone every 3 years
• Women over 65: May stop screening if they have had consistently normal results

These guidelines may vary for women with certain risk factors or previous abnormal results. It’s essential to consult with your healthcare provider to determine the most appropriate screening schedule for your individual needs.

The HPV Connection: Understanding the Primary Cause of Cervical Dysplasia

Human Papillomavirus (HPV) is widely recognized as the primary cause of cervical dysplasia. HPV is a group of more than 200 related viruses, with approximately 40 types affecting the genital area. These viruses are primarily spread through sexual contact, making HPV the most common sexually transmitted infection in the United States.

While many HPV types are considered low-risk for cancer development, about 12 types are classified as high-risk. Among these, HPV types 16 and 18 are responsible for approximately 70% of cervical cancer cases.

HPV Infection and Cervical Dysplasia: What’s the Link?

When a high-risk HPV type infects the cells of the cervix, it can cause changes in the cell’s DNA. These changes can lead to abnormal cell growth and division, potentially resulting in cervical dysplasia. However, it’s important to note that not all HPV infections lead to dysplasia or cancer. In many cases, the immune system can clear the virus without any lasting effects.

Risk Factors: Identifying Who’s Most Susceptible to Cervical Dysplasia

While HPV infection is the primary cause of cervical dysplasia, several other factors can increase a woman’s risk of developing this condition:

• Early sexual debut (becoming sexually active before age 18)
• Multiple sexual partners
• Compromised immune system (due to illness or medication)
• Tobacco use (smoking or chewing)
• Inconsistent condom use
• Early childbirth (giving birth before age 16)
• Not receiving the HPV vaccine

Understanding these risk factors can help individuals make informed decisions about their sexual health and lifestyle choices. It’s important to remember that while these factors increase risk, they do not guarantee the development of cervical dysplasia.

Diagnostic Procedures: From Pap Smears to Colposcopies

The journey to diagnosing cervical dysplasia typically begins with a routine Pap test, also known as a Pap smear. This simple, painless procedure involves collecting cells from the cervix for laboratory analysis. The results of a Pap test can be normal, inconclusive, or abnormal.

Interpreting Pap Test Results

• Normal: No abnormal cells detected
• Inconclusive: May indicate a simple infection or inflammation
• Abnormal: Indicates the presence of cervical dysplasia

Abnormal results are typically classified as Squamous Intraepithelial Lesions (SIL), which can be further categorized as:

• Low-grade SIL (LSIL): Mild abnormality
• High-grade SIL (HSIL): Moderate to severe abnormality
• Atypical glandular or squamous cells (ASCUS)

If abnormal results are found, further testing is usually required to determine the severity of the cell changes. This often involves a colposcopy, an in-office procedure that allows for a closer examination of the cervix. During a colposcopy, the healthcare provider may take small biopsies of suspicious areas for further analysis.

Treatment Options: Addressing Cervical Dysplasia at Different Stages

The approach to treating cervical dysplasia varies depending on the severity of the condition and the individual’s medical history. In many cases of mild dysplasia (CIN I), no immediate treatment is necessary. Instead, healthcare providers may recommend more frequent Pap tests to monitor the condition, as many mild cases resolve on their own.

For moderate to severe dysplasia (CIN II or CIN III), more aggressive treatment may be required. Common treatment options include:

• Loop Electrosurgical Excision Procedure (LEEP): Uses a thin wire loop to remove abnormal tissue
• Cryotherapy: Freezes and destroys abnormal cells
• Laser therapy: Uses a focused beam of light to remove abnormal tissue
• Conization: Surgically removes a cone-shaped piece of cervical tissue

The choice of treatment depends on various factors, including the extent and location of the abnormal cells, the patient’s age, and desire for future pregnancies. It’s crucial for patients to discuss all available options with their healthcare provider to determine the most appropriate course of action.

Prevention Strategies: Reducing the Risk of Cervical Dysplasia

While it’s not always possible to prevent cervical dysplasia entirely, there are several steps individuals can take to significantly reduce their risk:

HPV Vaccination

The HPV vaccine is the most effective method for preventing cervical dysplasia and cervical cancer. It protects against the most common high-risk HPV types responsible for cervical cancer. The Centers for Disease Control and Prevention (CDC) recommends vaccination for:

• All children aged 11-12 years (can start as early as age 9)
• Teens and young adults up to age 26 who weren’t vaccinated earlier
• Some adults aged 27-45 who may benefit from vaccination (discuss with healthcare provider)

Safe Sexual Practices

Practicing safe sex can help reduce the risk of HPV infection and, consequently, cervical dysplasia. This includes:

• Using condoms consistently during sexual activity
• Limiting the number of sexual partners
• Delaying sexual debut

Lifestyle Choices

Certain lifestyle factors can influence the risk of cervical dysplasia. To reduce risk, individuals should:

• Avoid tobacco use (smoking or chewing)
• Maintain a healthy immune system through proper nutrition and regular exercise
• Manage stress effectively

Regular Screening

Adhering to recommended screening guidelines is crucial for early detection and prevention of cervical dysplasia progression. Regular Pap tests and HPV testing, as appropriate for age and risk factors, can detect abnormal changes before they develop into more serious conditions.

Living with Cervical Dysplasia: Managing Emotional and Physical Well-being

Receiving a diagnosis of cervical dysplasia can be emotionally challenging for many women. It’s normal to experience feelings of anxiety, fear, or confusion. However, it’s important to remember that cervical dysplasia is a manageable condition, and with proper care and follow-up, the prognosis is generally very good.

Coping Strategies

• Education: Learn as much as possible about cervical dysplasia from reliable sources
• Communication: Maintain open dialogue with healthcare providers and loved ones
• Support: Consider joining support groups or seeking counseling if needed
• Self-care: Prioritize physical and mental health through healthy lifestyle choices

It’s also important to adhere to follow-up appointments and recommended screenings. Regular monitoring allows healthcare providers to detect any changes early and intervene if necessary.

While cervical dysplasia can be a concerning diagnosis, advances in screening and treatment have significantly improved outcomes for women with this condition. By understanding the causes, risk factors, and prevention strategies, individuals can take proactive steps to protect their cervical health and overall well-being.

What Is Cervical Dysplasia? – Treatment & Prevention

What is cervical dysplasia?

Cervical dysplasia is when there are abnormal, or precancerous, cells in and around a woman’s cervix. The vagina opens up into the cervix, which is the lower part of the uterus.

Cervical dysplasia is detected by a pap test (pap smear). It’s diagnosed with a biopsy. Abnormal changes in cells can be mild, moderate, or severe. The presence of cervical dysplasia doesn’t mean you have cervical cancer. But the cells could lead to cancer if they aren’t treated.

Symptoms of cervical dysplasia

People with cervical dysplasia don’t usually have symptoms. This is why it’s important to get screened regularly. The American Academy of Family Physicians (AAFP) recommends routine pap tests to diagnose cervical cancer early. You can check AAFP’s clinical guidelines (at the end of this article) to see when and how often you should be tested.

What causes cervical dysplasia?

The cells on your cervix can change over time. This means that you can develop cervical dysplasia at almost any age.

HPV is the primary cause of cervical dysplasia. There are more than 200 different HPV viruses. About 40 of these affect the genitals. The viruses are spread through sexual contact. Most viruses are low risk for cancer. About 12 are high risk. High-risk HPV types 16 and 18 cause about 70 percent of cervical cancer cases.

In the United States, HPV is the most common sexually transmitted infection.

There are several factors that can increase your risk of cervical dysplasia:

• Becoming sexually active before age 18
• Having a high number of sexual partners
• Having illnesses or using medicines that lower your immune system
• Smoking or chewing tobacco
• Not using condoms (while condoms help prevent HPV, they don’t fully protect you)
• Giving birth before age 16
• Not getting the HPV vaccine

How is cervical dysplasia diagnosed?

Cervical dysplasia is typically detected during a routine pap test. For this test, your doctor swabs your cervix to collect a sample of cells. This is generally not painful. The cells are then sent to a lab. It can take up to 3 weeks for the lab to process the test.

The pap test results can be normal, inconclusive, or abnormal. If normal, you should follow AAFP’s recommendation for regular pap tests.

Inconclusive results don’t indicate cervical dysplasia. You could have a simple infection in your cervix or vagina. Your doctor may order a repeat pap test. Further action or diagnoses will depend on your age and medical history.

An abnormal result is known as cervical dysplasia. It’s called a squamous intraepithelial lesion (SIL). On the pap test, the precancerous cells may be classified as:

• Low-grade SIL (LSIL), indicating mild abnormality
• High-grade SIL (HSIL), indicating moderate to severe abnormality
• Atypical glandular or squamous cells (ASCUS)

Additional testing is needed to see if the cell changes are mild, moderate, or severe. A colposcopy is an in-office procedure that gives your doctor a closer look at your cervix. He or she may take a biopsy of the cervix to help identify the abnormal area. These biopsies are small and don’t cause much discomfort.

Cervical dysplasia that is found on a biopsy is called cervical intraepithelial neoplasia (CIN). There are 3 levels:

• CIN I (mild dysplasia)
• CIN II (moderate to marked dysplasia)
• CIN III (severe dysplasia to carcinoma in situ)

An HPV test can be completed at the same time or separately as the pap test. It will identify the presence and type of HPV.

Can cervical dysplasia be prevented or avoided?

The best way to prevent cervical dysplasia is to get the HPV vaccine. It’s proven to lower your risk of HPV. It doesn’t fully prevent cervical dysplasia. Consult your doctor to know if you meet all criteria for the vaccine. For best results, girls and boys between the ages of 9 and 26 should get vaccinated before becoming sexually active. However, vaccination can be helpful after onset of sexual activity and up to age 45.  Consult your doctor to discuss the vaccine criteria and if you should be vaccinated.

You can also take the following steps to reduce your risk of developing cervical dysplasia:

• Get the HPV vaccine if you’re between the ages of 9 and 26.
• Don’t smoke.
• Delay the onset of sexual activity as long as possible or until you are in a long-term relationship.
• Use a condom whenever you have sex.
• Have as few sexual partners as possible.

Cervical dysplasia treatment

Treatment for cervical dysplasia will depend on the degree of abnormal cells and your medical history. Most mild cases will clear up without treatment. Your doctor may suggest getting a pap test every 6 to 12 months, instead of every 3 to 5 years. But if the changes don’t go away or get worse, treatment will be needed.

Instances of moderate or severe cervical dysplasia could require immediate treatment. Options include:

• Cryosurgery to freeze off the abnormal cervical tissue
• LEEP (loop electrosurgical excision procedure) to burn off the abnormal cells with an electric looped wire
• Surgery to remove the abnormal cells with a laser, scalpel, or both

Rare cases of severe cervical dysplasia could require a hysterectomy to fully remove the cervix.

Living with cervical dysplasia

Early diagnosis and prompt treatment cures most cases of cervical dysplasia. Follow your doctor’s and AAFP’s screening recommendations for early detection.

Once treated, cervical dysplasia can return. People who have severe cervical dysplasia, high-risk HPV, or whose condition goes untreated could develop cervical cancer.

Questions to ask your doctor

• Can I get the HPV vaccine?
• How can I prevent cervical dysplasia?
• Does cervical dysplasia or HPV affect my chances of getting pregnant?
• Is there an HPV test for men?
• If my partner tested positive for HPV, can he or she give it to me? What about same-sex partners?

Resources

American Academy of Family Physicians: Cervical Cancer Clinical Preventive Service Recommendation

Centers for Disease Control and Prevention: Cervical Cancer Screening

National Institutes of Health, MedlinePlus: HPV Vaccine

Cervical dysplasia

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix.

This page was reviewed on January 21, 2022.

The cervix is the lower portion of the uterus that connects to the vagina. Changes to the cells that line the cervix can be early precursors to cervical cancer, which happens when abnormal cells begin to grow and spread in an uncontrolled manner. Cervical dysplasia isn’t cancer, but treating it may help you prevent cervical cancer from developing in the future.

What is cervical dysplasia?

Precancerous cervical cell changes are referred to as cervical dysplasia, cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesion (SIL). All cervical cancers begin with these cellular changes, but not all women with cervical dysplasia will go on to develop cancer. In most cases, cervical dysplasia resolves on its own without treatment. In some instances cervical dysplasia must be treated.  The good news is treatment almost always prevents cervical cancer from forming.

After cervical cell samples are evaluated in a laboratory, cervical dysplasia is ranked from 1 to 3 on a scale of increasing severity, and the cervical dysplasia stages may be described as mild, moderate or severe.

• CIN1 (mild dysplasia/low-grade SIL): The least severe type of dysplasia. Here, a small amount of tissue appears abnormal.
• CIN2 or CIN3 (moderate to severe dysplasia/high-grade SIL): These precancers are more serious, with a greater amount of tissue appearing abnormal.

Cervical dysplasia causes

The most common cause of cervical dysplasia is the human papillomavirus. Also known as HPV, this is a prevalent sexually transmitted virus, spreading from person to person during skin-to-skin sexual contact. According to the Centers for Disease Control and Prevention (CDC), 91 percent of all cervical cancers are caused by HPV.

The CDC reports  that at least 80 percent of women will have had HPV by age 50. And the American Cancer Society notes that there are more than 150 strains of HPV—14 of which are known to cause cervical cancer.

Although most cases of HPV go away on their own within two years, sometimes your body’s immune system is unable to fight off the infection, and it causes cervical dysplasia. The most common type of cervical cancer-causing HPV is HPV 16, which accounts for about half of all cervical cancers caused by this virus. Others include HPV 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68.

Cervical dysplasia risk factors

Several risk factors may increase your odds of developing cervical dysplasia, including:

• Smoking
• Multiple sex partners
• Human immunodeficiency virus (HIV)
• Having sex before age 18
• Giving birth before age 20
• Immunosuppressant drugs for example status-post organ transplant
• Maternal exposure to DES (diethylstilbestrol)
• Three or more full-term pregnancies
• Family history of cervical cancer

Not everyone with these risk factors will develop cervical dysplasia, but if you’re experiencing them, it’s a good idea to discuss them with your physician. That way, your provider is better able to tailor your screening frequency to your individual risk level.

Cervical dysplasia symptoms

Typically, there are no symptoms associated with cervical dysplasia, so it’s important to undergo regular Pap tests or cervical cancer screenings on a schedule recommended by your doctor so your care team can monitor for cervical dysplasia and look for signs of cervical cancer.

HPV testing will likely also be performed at this time. During a Pap test, your doctor will collect a sample—or smear—of cervical cells to be checked for abnormalities. If any are found, further testing may be recommended. Because cervical cancer is slow-growing, precancerous changes are usually caught early.

If dysplasia has advanced to cervical cancer, you may experience symptoms such as:

• Abnormal bleeding
• Vaginal discharge
• Painful sex
• Back and pelvic pain

Cervical dysplasia diagnosis

Abnormal changes to cervical cells may be detected through a Pap smear. Cells that are collected during a Pap test are viewed microscopically in order to determine if cervical dysplasia is present. Cellular changes to the cervix are characterized in the following ways:

• LSIL, or low-grade squamous intraepithelial lesion
• HSIL, or high-grade squamous intraepithelial lesion
• Possibly malignant
• AGC, or atypical glandular cells
• ASC, or atypical squamous cells

In cases of mild dysplasia, your doctor will likely monitor with future Pap tests or may refer for further testing with colposcopy. If the dysplasia is more severe, usually colposcopy is recommended. During a colposcopy, an instrument called a colposcope is used to view the cells more closely, and a biopsy of the area of concern may be taken.

Dysplasia results from a biopsy are referred to as cervical intraepithelial neoplasia (CIN) and categorized as follows:

• CIN1, mild dysplasia
• CIN2, moderate to marked dysplasia
• CIN3, severe dysplasia or carcinoma in situ

These terms can be a handful. Your doctor can help you understand what your results mean. Always ask questions. This can help you share decision-making with your care team.

Cervical dysplasia treatment

Most often, mild cervical dysplasia will go away on its own without treatment. However, in more severe cases, treatment may be recommended. Treatment for cervical dysplasia may consist of:

• Cryosurgery, a procedure to freeze abnormal cervical cells
• Laser therapy, to burn abnormal cells
• Loop electrosurgical excision procedure (LEEP), a tissue-removal procedure using electrocautery
• Cone biopsy, which is surgery to remove the abnormal area of tissue
• Hysterectomy, the surgical removal of the uterus and cervix

If you have cervical dysplasia, your doctor may recommend increasing the frequency of your Pap tests to monitor cellular changes. If any signs of cervical cancer are noted, it’s important to work with a gynecologic cancer specialist to plan out your treatment regimen.

Cervical dysplasia – causes, symptoms, treatment of the disease

Diagnosis “cervical dysplasia” is a signal of the female body that requires attention and help. The female body is not able to overcome the critical thresholds of the disease alone. Women often compare cervical dysplasia with erosion. Indeed, cervical erosion and cervical dysplasia can be caused by similar etiological factors, but the tactics of managing and treating these diseases are fundamentally different.

Cervical dysplasia is classified as a precancerous condition of the cervical epithelium. However, this does not mean that cervical dysplasia is necessarily realized in cancer. To the question of whether it is possible to cure cervical dysplasia, the answer is obvious: it is possible, if treatment is started on time and correctly!

What is cervical dysplasia? How to clearly and figuratively explain the diagnosis to a simple woman. We will try to help you.

Imagine that normally the epithelium covering the cervix has a strict layering. The layers of the epithelium are arranged strictly sequentially. The lower layer (basal), then comes the parabasal, intermediate, superficial layers of the epithelium. Imagine your cervix in the form of a salad “under – a fur coat.”

When the layers are misplaced, a chaotic, dysplastic process occurs. Depending on the severity of changes in the epithelium of the cervix, there are mild, moderate and severe cervical dysplasia.

Dysplasia of the 1st degree is diagnosed when polymorphic cells with special (hyperchromic) nuclei and a high nuclear-cytoplasmic ratio are detected, as well as when differentiation is impaired in the lower third of the layer of stratified squamous epithelium. Differentiation in the upper two-thirds of the epithelium occurs normally.

Cervical dysplasia grade 2 is characterized by the presence of cellular atypism and numerous mitoses (cell divisions) in the lower half of the epithelial layer. In the upper half, cell differentiation is not changed.

Grade 3 cervical dysplasia is characterized by cellular atypism in two-thirds of the epithelium thickness.

Among the causes contributing to the occurrence of cervical dysplasia, there are exogenous: (HSV, herpes simplex virus and other sexual infections) and endogenous factors (chronic inflammatory diseases of the pelvic organs and genitourinary organs, impaired hormonal homeostasis, decreased immune response, etc. ) and mixed factors.

Recent studies have shown that in 50-80% of samples of moderate and severe dysplasia of the cervical epithelium, HPV of a high degree of oncogenic risk (mainly types 16 and 18) was found.

Cervical dysplasia, symptoms

With cervical dysplasia as an independent disease, patients’ complaints and symptoms are often absent. Pain in the lower abdomen and bloody discharge from the genital tract appear only in especially advanced cases, when the disease has developed over several years.

Cervical dysplasia can be detected during a routine check-up. It should be noted that cervical dysplasia is a completely preventable disease for a woman who regularly monitors her health and performs a mandatory cytological examination at a preventive visit to a gynecologist or a specially trained nurse.

If a woman has changes in cytology indicating grade 1, 2 or 3 dysplasia, then an in-depth examination is carried out according to the treatment protocol approved by the Ministry of Health.

When dysplasia is combined with an underlying disease of the cervix, patients may complain of leucorrhea, itching of the external genital organs, etc. In this situation, sexual infections are excluded, including gonorrhea, HPV, herpes. Anti-inflammatory treatment is carried out taking into account diagnostic findings.

With the help of a special device (colposcope), the nature of the disease is specified, the presence, prevalence and severity of colposcopic manifestations of cervical dysplasia are identified, followed by sampling of material from the lesion for targeted cytological examination. Cytology smears allows you to establish the severity of dysplasia.

To further establish the diagnosis, a biopsy of the cervix is ​​taken, an endocervical scraping is done and they are examined histologically. The results of the study are decisive in the diagnosis of dysplasia or cervical cancer!

What is a cervical biopsy?

Cervical biopsy is an invasive examination of the cervix. From a suspicious area of ​​the cervix, 1 or several sections (pieces) of cervical tissue are taken with a special tool. At the Harmony Medical Center, a biopsy of the cervix is ​​​​performed by the radio wave method using the American Surgitron apparatus with a special radio wave loop.

Manipulation is performed without blood (two modes of radio wave exposure of the Surgitron apparatus are used: incision and coagulation of cervical vessels) and painlessly. The resulting material is placed in a special tube with formalin, fixed and then transferred for in-depth study to the histological laboratory, where it is placed in a paraffin medium. Next, the paraffin blocks are examined by a pathologist under a special microscope. The pathologist makes the final diagnosis.

Treatment of cervical dysplasia

Treatment depends on whether the dysplasia has occurred on the basis of previous cervical diseases: cervicitis, cervical erosion, viral infection of the cervix, etc. or diagnosed for the first time as an independent disease.

The method of treatment is determined strictly individually, based on the characteristics of colposcopy, the degree of dysplasia: mild, moderate or severe. Also, the treatment depends on the age of the patient and the characteristics of the childbearing function, the structure of the neck of the localization of the dysplastic process, concomitant diseases. However, the radicalness of the intervention is determined by the degree of dysplasia.

Medical treatment

Most often indicated for patients with mild dysplasia. When it is prescribed, two methodological approaches are used: expectant management and immediate local destruction. In our medical center, we use the radio wave method of treatment.

Expectant management is based on the fact that spontaneous regression of cervical lesions is possible in 30-60% of patients. Then constant cytological studies in dynamics (1-3 months), drug relief of the inflammatory process, suppression of proliferative changes, and regulation of the menstrual cycle are necessary. If there is no effect (regression of dysplasia) within 3 months, the treatment tactics should be changed towards more radical measures.

Drug treatment is also indicated for patients with mild dysplasia, drugs that suppress proliferative activity, have antiviral and immunomodulatory effects. Retinoids (precursors and analogues of vitamin A) inhibit proliferation, stimulate killers and the activity of cytotoxic cells. Podophyllin, trichloroacetic acid are ineffective and toxic. They are also able to suppress pathological mitoses with an efficiency of 86%. 5-Fluorouracil is used according to the method of treatment of flat papillomas or in the form of an ointment (cream), which is applied to the surface of the cervix 2 times a day for 2 weeks. Interferon stimulates the activity of lymphocytes, increases the level of immunoglobulins, has antiproliferative and antiviral activity. It is prescribed by injection, topically in the form of a gel or ointment up to 4 times a day for 20 days.

The second methodological approach is local removal (destruction) of the pathological focus or radical therapy.

Surgical removal of dysplasia, regardless of the method of destruction of the pathological tissue, must be of sufficient depth. Typically, crypts in the cervical canal are up to 7.8 mm deep, with an average of 3.4 mm. The defeat of the crypts by severe dysplasia and intraepithelial cancer is up to 5.2 mm long (the average depth of their penetration through the crypts is 3.2 mm). Therefore, with destruction to a depth of 3 mm, the entire pathological focus is completely destroyed in 95% of patients, and to a depth of 4 mm – in 99%.

Cryogenic exposure is the ideal and optimal treatment for mild to moderate dysplasia, especially pathological lesions up to 2.5-3 cm in size. Cryotherapy for severe dysplasia is allowed, but not the method of choice. Typically, large temperature regimes are used with an exposure of 8–10 minutes. The procedure is carried out in two stages. However, when it is necessary to freeze more than half the length of the cervix and histological control after surgery is impossible, it is better to refuse such destruction.

In our Harmony Medical Center, we use a modern method of treating cervical dysplasia – radio wave therapy (RVT).

RVT is indicated for patients with mild to moderate dysplasia. Before RVT, a woman is fully examined according to regulatory protocols. Exclude sexual infections, syphilis, HIV, hepatitis C and B. Perform ultrasound of the pelvic organs, cervical biopsy, curettage of the cervical canal, aspirate from the uterine cavity or RFE. The cervix is ​​treated with markers (Lugol’s solution) to determine the boundaries of the lesion.

Basic conditions for

radio wave therapy

• no data (cytological-endoscopic screening) indicating cervical cancer;
• treatment should be carried out by a specialist who knows the basics of colposcopy.

In case of grade 3 dysplasia, the treatment of dysplasia is decided jointly with an onco-gynecologist. Recently, surgical treatment of dysplasia has been performed quite often. Amputation of the cervix according to Sturmdorf is indicated for patients in whom dysplasia is combined with cervical elongation during uterine prolapse.

Main indications for surgical treatment:

• age of patients older than 50 years,
• lack of conditions for conization due to anatomical changes,
• cervical atrophy, plasia throughout the endocervix;
• failure of previous treatment or impossibility of other treatment.

According to the guidelines of Belarusian oncogynecologists, it is advisable to treat dysplasia individually, depending on the clinical picture of the disease and the woman’s age.

In women under 40 years of age with moderate dysplasia, radio wave treatment of the cervix is ​​acceptable. Patients in whom moderate dysplasia is combined with extensive ectropion, cervical deformity, and over 45 years of age, require diathermoelectroexcision of the cervix or an operation such as the operation of Sturmdorf, Emmett. Surgical intervention should be expanded to remove the cervix with the body of the uterus in patients with concomitant moderate dysplasia tumors and tumor-like formations of the uterus and appendages (especially in women in menopausal and menopausal periods).

Cervical dysplasia may be associated with cancer in the early stages. Then basically perform a cone-shaped excision or amputation of the cervix. Due to the smoothness of the vaginal vaults, atrophic changes in the genital apparatus in women older than 45-50 years, it is impossible to perform organ-preserving interventions, so the operation should be extended to a simple hysterectomy (removal of the cervix and uterine body).

Surveillance of operated patients is carried out by obstetrician-gynecologists of the general medical network through control examinations with colposcopic and cytological studies.

It is enough to examine a patient with mild dysplasia 2 times a year. Women with moderate dysplasia need follow-up examinations every 3 months, and women with severe dysplasia at least once a month. Operated patients are removed from the dispensary register upon receipt of three negative results of colposcopic and cytological studies, but not earlier than after 2 years. If, after special treatment, signs of dysplasia are again revealed, the woman should be referred to an oncogynecologist for an in-depth examination and treatment in an oncological institution.

The information on the site is for informational purposes only and cannot be used independently.

You can get qualified help from our gynecologists, who have received special training in cervical pathology. Booking by phone or on the website.

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Cervical dysplasia of the 2nd degree – treatment in 1 procedure and WITHOUT SURGERY!

Cervical dysplasia of the 2nd degree is treated today in one procedure and without surgery

Afanasiev Maxim Stanislavovich. Doctor of Medical Sciences, professor, oncologist, surgeon, oncogynecologist, gynecologist-immunologist, expert in the treatment of dysplasia and cancer of the cervix and uterine body.

Cervical dysplasia is a formidable and, alas, common female disease. Open any gynecological forum and you will see that every third question is about how to treat dysplasia and is it possible to hope for a favorable prognosis. I wrote this material in order to dispel ingrained misconceptions about cervical dysplasia of the 2nd degree – both overly optimistic and unreasonably negative. In my article I will try to answer all the questions. You will learn how to treat grade 2 cervical dysplasia and the dangers of expectant management in relation to this diagnosis. However, I will not urge you to do the operation.

For more than 15 years I have been dealing with cervical pathology, for the last 8 years I have been practicing the treatment of precancerous conditions using the non-surgical method of photodynamic therapy. And in my material I will dwell in detail on this new non-surgical technique, which allows you to cure dysplasia in one session.

What is cervical dysplasia of 1-2 degrees and why is it dangerous?

Dysplasia is a mucosal process in which the epithelium of the cervical canal and the vaginal part of the cervix is ​​replaced by atypical cells.

This process in 99% of cases starts after infection with the so-called high oncogenic risk papillomavirus 16, 18, 31, 33, 35, 45 or 66 serotypes. The DNA of the virus is integrated into the DNA of the epithelial cell and causes numerous negative changes in it. The accumulation of damage leads to the progression of the disease and causes, over time, the degeneration of cells into malignant ones.

Smoking, unfavorable heredity, reduced immunity, aggressive urban environment and other factors reduce the body’s resistance, make it easier for the virus to destroy it and accelerate this process.

The initial stages of this process are classified as mild grade 1 dysplasia. The most severe degree of dysplasia in the domestic classification is the third. Cervical canal dysplasia of the 2nd degree in oncogynecology is considered a process of moderate severity.

For some reason, the conservative drug treatment of second-degree dysplasia with immunomodulators is still considered effective. The literature for gynecologists also encourages the tactics of completely refusing treatment: in anticipation of spontaneous recovery, a woman is recommended to be monitored regularly and thereby keep the development of the process under control. It is believed that from the moment the first symptoms of dysplasia appear, the development of cervical cancer takes 3-5 years. That epithelial dysplasia 1 2 degrees within 1 – 2 years does not progress in any way, and in 30% of cases self-healing occurs. According to the medical literature, in the case of progression, the transition between degrees takes from 1 to 2 years. The transition from grade 3 dysplasia to invasive cancer takes 2-3 years.

Without detracting from the merits of immunomodulators and surveillance tactics, I want to state with all responsibility that the situation today is fundamentally different from that described in textbooks. In my practice, I increasingly observe the unreliability of these data and a significant shortening of the intervals for the transition of dysplasia between stages. The most terrible consequence of dysplastic changes is cancer. Observation and drug treatment of dysplasia of 2 and 3 degrees lead to sad consequences. Patients come to me who are regularly observed by a gynecologist for dysplasia, when a seemingly harmless process turns into invasive cancer in just 6 months. In the latter case, the only possible treatment is the complete removal of the uterus and ovaries for health reasons and radiation therapy.

There are two reasons for this phenomenon. On the one hand, the papilloma virus itself is becoming more and more aggressive. On the other hand, antenatal clinic doctors do not always adequately assess the severity of dysplasia and the risks associated with it. Therefore, when HPV 16, 18, 31, 33, 35, 45, 66 serotypes are identified in the analyzes or dysplasia is suspected, I recommend getting advice from a narrow specialist – oncogynecologist . The diagnosis of “epithelial dysplasia of the 2nd degree” indicates an active, pronounced process, is is a true precancer of and requires immediate treatment.

What does cervical CIN grade 1 2 mean?

In the international classification, other terms are used, some of them have taken root in our country.

Cervical dysplasia CIN 2 stands for cervical intraepithelial neoplasia and means a moderate degree of mucosal damage. CIN 3 – the third, severe degree of damage and cancer in situ, that is, without germination in the surrounding tissues. Meanwhile, in the latest international classification of 2012, there is no division into the second and third degrees of dysplasia. Today, only mild LSIL and severe HSIL are distinguished. LSIL (low grade squamous intraepithelial lesion) means mild grade 1 dysplasia, HSIL (high grade squamous intraepithelial lesion) corresponds to grade 2–3 dysplasia. In this classification, dysplasia 2 and 3 are combined, since they have a high potential for degeneration and require the same approach to treatment. With the introduction of a new classification, medical circles actually confirm the serious danger of second-degree dysplasia. International protocols recommend using exclusively surgical excision in HSIL and categorically leave no room for conservative treatment with immunomodulators and passive surveillance tactics.

How dysplasia is diagnosed

The disease has no visible symptoms, so a gynecologist’s examination once a year is necessary for timely diagnosis. This could be your local doctor. But neither a gynecological smear nor an ultrasound helps in the detection of precancerous diseases of the cervix. Remember the standard international algorithm:

• Cytology – examination of scrapings from the cervix by the method of liquid cytological examination .
• Colposcopy – examination of the cervix under a microscope.
• Biopsy of the cervix and histological examination of the biopath (histology, or pathomorphological examination).
• A new method for diagnosing pathological changes in the cervix – fluorescent diagnostics.

If the diagnosis of epithelial dysplasia grade 1 2 is confirmed, then from this very moment you should start visiting oncogynecologist 1 time in 6-12 months. In my practice, I adhere to the most sparing approach, especially in relation to nulliparous women. A biopsy of the cervix for dysplasia of the 2nd degree seems to me an unreasonably traumatic procedure. Therefore, I am trying to avoid it and use a complex of three modern methods for diagnosis. Liquid cytology with video colposcopy and fluorescent diagnostics allows me not to perform a biopsy and still make the correct diagnosis.

Features of the course of the disease today

For convenience, I will give my observations in the form of a list.

• In all my practice, I have not seen a single case of self-healing with a diagnosis of cervical dysplasia of 1-2 degrees.
• Dysplasia and cancer occur even in young nulliparous girls and women aged 25-39 and are asymptomatic.
• The human papillomavirus has become more aggressive. It can take as little as a year from a diagnosis of dysplasia 1 to a diagnosis of invasive cervical cancer. Unfortunately, gynecologists do not inform their patients about the danger of dysplasia and, accordingly, do not refer them to a gynecological oncologist for professional advice.
• Each stage of treatment makes the virus more and more resistant. So, 2–3 conizations lead to phenomenal resistance of the virus and its resistance to other methods of treatment. Accordingly, in this case, the woman’s health has to be preserved by removing the uterus.

Obsolete treatments for grade 2 dysplasia

Video of a scientific report from a conference in Astrakhan

Borderline dysplasia between grades 2 and 3 is a direct indication for conization of the cervix. Some surgeons even recommend radical removal of the cervix for grade 2 dysplasia. In my practice, I rarely resort to conization of the cervix for any degree of dysplasia, since this surgical operation has a number of disadvantages:

• It is psychologically difficult to tolerate.
• Requires extended recovery.
• It is fraught with complications – from bleeding to a decrease and complete loss of reproductive function – subsequently there are both serious difficulties with conception and with the possibility of bearing a fetus.
• The main disadvantage of conization as a treatment method is that it does not eliminate the cause of the disease – the human papillomavirus. Even with high conization , the epithelium affected by the virus remains in the upper parts of the cervical canal of the cervix.
• Immunity correction methods prescribed after conization do not have a direct effect on papillomavirus. Therefore, it is not necessary to talk about the final cure after conization.
• Conization has a high recurrence rate. According to various official data, during the year dysplasia “returns” in 50-70% of treated women.
• Relapse is always accompanied by an aggravation of the diagnosis: dysplasia of the second degree turns into the third, the third – into cancer in situ of the cervix.
• Against the background of relapse, repeated conization is required.
• Often re-conization is not possible, then amputation of the cervix is ​​performed.

Let’s take a closer look at some points. The cervix is ​​a protective barrier between the internal environment of the body and the external environment. The operation of conization, and even more so of amputation, leads to the fact that this barrier becomes untenable. For comparison, imagine a window overlooking a busy street. The window is closed – everything is fine in the room: noise, dust and cold remain outside. But it is worth opening the window – and everything immediately penetrates inside. The same is true if the cervix is ​​removed. Operated women are more likely to experience inflammatory diseases. The chances of getting pregnant and giving birth on their own are reduced. Since the cervix becomes shorter after the operation, it often cannot withstand the weight of the fetus and after the 16th week it opens spontaneously. Since the cervical canal heals with the formation of a scar after conization, the cervix does not open enough during childbirth and cannot ensure the passage of the child through the birth canal.

Conization cannot be considered an effective treatment for dysplasia, as it only helps in 30% of cases. Part of the cervix with altered cells is removed, but the virus remains in the cervical canal and actively begins a new expansion. In 70% of cases, it causes a relapse just a year after surgery.

Modern treatment of cervical dysplasia of the 2nd degree does not require surgery

Medical and surgical methods for dysplasia are ineffective and do not lead to recovery. What do I suggest?

The modern therapeutic method of photodynamic therapy (PDT) is devoid of all the shortcomings of previous methods, provides 95% recovery after the first session and is a guarantee against the development of relapses in the future.

I have been working in this area for more than eight years – I treat dysplasia and other virus-associated diseases: leukoplakia, ectropion, papillomas. I treat cervical cancer up to stage 2 inclusive. Of course, during the oncological process, more than one session is required, but the fact remains that you can get rid of the initial stage of cancer without resorting to surgery.

95% positive results and no recurrence during 8 years of follow-up speak for themselves.

What is photodynamic therapy

The treatment is based on the action of a laser beam and takes place in several stages.

• The procedure begins with intravenous administration of the photosensitizer Photoditazine or Revixan 2 hours before the PDT session. This is a substance that selectively accumulates in dysplastic and inflamed cells of the cervix.
• I irradiate the cervix and the cavity of the cervical canal using special light guides according to a special technique developed by me. At each stage, I individually select the necessary dose of light to achieve an adequate photodynamic effect.
• Under the action of a laser beam, the photosensitizer enters into a chemical reaction with oxygen with the release of the so-called active singlet oxygen and other toxic products that mechanically destroy diseased cells. But his action does not end there. Oxygen itself is an aggressive environment for the papillomavirus and other infections and destroys them.
• Light does not affect healthy cells and does not damage them in any way.
• Some time after the session, immune mechanisms are launched – an attack occurs on atypical cells and their decay products.

By getting rid of a viral and bacterial infection, I eliminate the very root cause of the disease and prevent its recurrence. Treatment of moderate dysplasia of the 2nd degree is carried out in an operating room under general anesthesia. Although the procedure is considered relatively painless, absolute immobility is required to achieve maximum effect, which is not achievable if the patient experiences discomfort, burning and tingling. In addition, I try to protect patients from any discomfort.

Healing process

After 6-7 weeks after the session of photodynamic therapy, the mucosa heals without scarring. Focal dysplasia of the 2nd degree is eliminated, healthy tissue is formed in its place. Subsequently, I conduct a 3-fold follow-up examination with an interval of three months, at each examination I perform colposcopy and liquid cytology. After treatment, I maintain feedback with all patients.

Pregnancy with dysplasia of the 2nd degree

Focal dysplasia of the 1st-2nd degree during pregnancy does not require any active actions and aggressive treatment. Only supervision at the oncogynecologist is shown. The disease does not affect the tactics of pregnancy management – however, in certain cases it is recommended to choose the operative tactics of delivery by Caesarean section. A woman is treated only after the birth of a child.

I must point out that even successful treatment of cervical CIN 2 is no guarantee against future human papillomavirus infection. Therefore, you should be very careful when choosing a sexual partner and be sure to use condoms.

Dysplasia of the squamous epithelium of the 2nd degree is the state of the sword of Damocles constantly hanging over the head, from which it is better to be treated once and rid yourself of the risks of malignancy for the rest of your life.