Dysplasia

What is the cervix? >
The cervix is the lower part of the uterus. The outside of the cervix and vagina are covered by a layer of flat cells called squamous cells. The canal of the cervix is lined by tall column-like gland cells called columnar cells. These layers of cells lie on the surface of the cervix referred to as the epithelial lining that overlies the inner substance of the cervix called the stroma. The stroma contains the "highways" of the body such as blood vessels and lymphatics that supply nutrients.

Somewhere on the cervix the two covering cell types, squamous and columnar, meet at a place called the squamo-columnar junction or the Transformation Zone. This is the area which should be sampled at the time of cervical smear test and examined under a microscope. It is in this transformation zone that abnormal cell grow or dysplasia, develops.
This junction may be on the outside of the cervix or it may be within the cervical canal where it is difficult to see.


What is dysplasia? >
The term "plasia" means growth. Dysplasia means disordered growth. It is easier to understand dysplasia if we first examine the normal cervix. When we look at the lining of the normal cervix under a microscope we see layers of cells. The normal distribution is that the bottom layer is made of round young cells. As the cells mature they rise to the surface and flatten out, so that on the surface the cells are flat.

In dysplasia there is a lack of this organized growth process. In mild dysplasia only a few cells are abnormal, while in moderate dysplasia the abnormal cells involve about one half of the thickness of the epithelial surface.

In severe dysplasia or carcinoma-in-situ the entire thickness of the epithelium is disordered, but the abnormal cells have not yet spread below the "basement" of the epithelium.

In invasive cancer the cells are not only disordered throughout the entire thickness of the lining, but they invade the stromal tissue underlying the surface as well. In this location the abnormal cells can spread to other parts of the body either directly or through blood or lymphatic channels. Invasive cancer is treated entirely differently than dysplasia.


Important terms

Please note that at the West London Colposcopy Unit, the CIN and Bethesda classifications of cervical abnormalities are also used. CIN stands for Cervical Intraepithelial Neoplasia.

CIN I = mild dysplasia (low grade)

CIN II = moderate dysplasia (high grade)

CIN III = severe dysplasia or (high grade)

carcinoma-in-situ (high grade)

The Bethesda classification is very popular in the USA. CIN I is the same as a low-grade lesion in the Bethesda system and CIN II and III are both classified as high-grade lesions in Bethesda terminology.

Why did I get dysplasia? >
There are a number of epidemiological factors associated with dysplasia. They include a history of infection with viruses such as herpes and the human papilloma virus (HPV), smoking, intrauterine exposure to DES, and use of drugs that suppress the immune system.. Women who develop dysplasia do not necessarily have all or any of these factors.

At the present time the most common associated factor is infection with a virus called the human papillomavirus (HPV). This virus is usually transmitted sexually (but not always) and some sub-types may cause warts to form on the cervix, vagina, vulva, or on the male partner. The virus may also be capable of transforming cells on the cervix so that they are more likely to turn into dysplasia. HPV is a latent virus and may be transmitted years before it causes visible changes.

There is growing evidence that smoking is a major associated factor. Even if you are just an occasional smoker and have dysplasia it is strongly advisable that you stop. Women with dysplasia who continue to smoke are more likely to develop recurrent dysplasia despite adequate medical therapy. These patients are also at greater risk to developing dysplasia or cancer at stomach etc.

How is dysplasia (CIN) treated? >
There are many ways to treat dysplasia. Factors influencing the choice of treatment include the extent and severity of the dysplasia, the age of the woman, her desire for future childbearing, and whether or not she has any other gynaecologic problems. The following are the most common methods of treating dysplasia:

After treatment can I forget about dysplasia? >
Dysplasia is treated to stop cancer from developing but no matter how dysplasia is treated there is a possibility it can recur. Usually a recurrence will not be a serious problem if it is detected early, but it could turn into a cancer if not treated. Therefore it is essential to have frequent pap tests and colposcopy check-ups during the first year after therapy and yearly thereafter for ten years for the high grade lesion. For the low grade lesion (CIN I) first check 6 months after treatment by smear test and if negative then annually for five years. Thus your check ups for the first one after the treatment should be done in this unit.