Cervical Dysplasia

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Cervical Dysplasia refers to the presence of abnormal cells on the surface of the cervix that could potentially progress to cervical cancer. It is often detected through routine cervical screening (Pap smear) and is classified based on the severity of the abnormal changes.

Aetiology

The primary cause of cervical dysplasia is infection with high-risk types of the human papillomavirus (HPV), particularly HPV types 16 and 18. These viruses can cause changes in the cervical cells that may lead to dysplasia. Other contributing factors include smoking, immunosuppression, and long-term use of oral contraceptives.

Pathophysiology

HPV infection is the main driver of cervical dysplasia. The virus infects the basal cells of the cervical epithelium, leading to the integration of viral DNA into the host cell genome. This process disrupts normal cell cycle regulation, causing abnormal cell proliferation and the development of dysplastic changes. Without intervention, these abnormal cells can accumulate additional genetic mutations and progress to invasive cervical cancer.

Risk Factors

• Persistent infection with high-risk HPV types.
• Early onset of sexual activity and multiple sexual partners.
• Immunosuppression, including HIV infection.
• Smoking, which can increase the risk of progression from dysplasia to cervical cancer.
• Long-term use of oral contraceptives.
• History of sexually transmitted infections (STIs).

Signs and Symptoms

Cervical dysplasia is typically asymptomatic and is most often detected through routine cervical screening (Pap smear or HPV testing). In some cases, women may experience abnormal vaginal bleeding, spotting, or discharge, especially after intercourse, though these symptoms are more commonly associated with advanced cervical changes or cancer.

Investigations

• Pap Smear: The primary screening tool for detecting cervical dysplasia. Abnormal results are classified as low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), depending on the severity of the cellular changes.
• HPV Testing: Identifies the presence of high-risk HPV types, particularly in women with abnormal Pap smear results. Co-testing with HPV and Pap smear is common in cervical screening programmes.
• Colposcopy: A detailed examination of the cervix using a colposcope to visualise abnormal areas and guide biopsy if necessary.
• Cervical Biopsy: A tissue sample taken during colposcopy to confirm the presence and extent of dysplasia. The results are classified as cervical intraepithelial neoplasia (CIN) grades 1, 2, or 3, indicating the severity of the dysplasia.

Management

• Primary Care:
  • Routine Screening: Encourage regular cervical screening as part of preventive healthcare for women, with frequency depending on age and previous screening results.
  • HPV Vaccination: Promote HPV vaccination to reduce the risk of cervical dysplasia and cervical cancer, particularly in younger women before they become sexually active.
  • Smoking Cessation: Advise women who smoke to quit, as smoking is a significant risk factor for the progression of cervical dysplasia.
• Specialist Care:
  • Colposcopy and Biopsy: Referral to a gynaecologist for colposcopy is indicated for women with abnormal Pap smear results or positive high-risk HPV tests.
  • Excisional Procedures: In cases of high-grade dysplasia (CIN 2 or 3), excisional procedures such as loop electrosurgical excision procedure (LEEP) or cone biopsy may be necessary to remove the abnormal tissue and prevent progression to cancer.
  • Follow-Up: Women treated for cervical dysplasia require regular follow-up with repeat Pap smears and/or HPV testing to monitor for recurrence or progression of disease.

References

1. NHS (2024) Cervical Dysplasia: Causes, Symptoms, and Treatment. Available at: https://www.nhs.uk/conditions/cervical-dysplasia/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Cervical Dysplasia: Assessment and Management. Available at: https://cks.nice.org.uk/topics/cervical-screening-abnormal-cytology/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Management of Cervical Dysplasia in Primary and Specialist Care. Available at: https://www.bmj.com/content/350/bmj.h4600 (Accessed: 24 June 2024).
4. Centers for Disease Control and Prevention (2024) HPV and Cervical Dysplasia. Available at: https://www.cdc.gov/std/hpv/stdfact-hpv.htm (Accessed: 24 June 2024).

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