Cervical dysplasia is considered an outdated name for cervical intraepithelial neoplasia, abbreviated as CIN. All these terms mean the precancer of the cervix – an intermediate state between a healthy cervix of the uterus and cancer.
According to the World Health Organization, about 40 million women in the world have CIN, three-quarters of them CIN, I degree, the remaining CIN II and III degrees, but is found more often CIN II degree.
In half the cases, CIN goes into cancer, so the diagnosis of this disease at an early stage is very important to prevent the development of a malignant tumor. Since the PAP smear appeared in 1941, the death rate from cervical cancer has significantly decreased, since this smear can detect dysplasia of the cervix. In developing countries, where PAP smear is not as widespread as in industrialized, cervical cancer is the leading cause of death among women (Potischman N et al 1996.
In the world of cervical cancer, 11.6% of women die (Giuliano AR et al 1998, Rock CL et al 2000). More than 99% of cases of cervical cancer or cervical dysplasia are caused by human papillomavirus (HPV). HPV or HPV is very common: the risk of lifetime infection through sexual contact is 80% (Bekkers RL et al 2004.
Cervical dysplasia is found in women around 35 years old, but the average age of the diseased is getting younger every year. It takes time for the transition of CIN to cancer, sometimes for several years, during which adequate therapy, with a small surgical intervention and mandatory antiviral treatment, saves a woman’s life.
CIN I (mild dysplasia) is determined when the epithelium of the cervix is afflicted inward by one third of its thickness.
CIN II (moderate dysplasia) of the epithelium of the cervix is affected to a depth of not more than two thirds.
CIN III (expressed dysplasia or cancer in situ) the epithelium of the cervix is affected to a depth of more than two thirds.
The risk factor for developing cervical dysplasia is.
A large number of births.
Long (more than 5 years) use of hormonal contraceptives.
Prolonged use of intrauterine contraceptives.
Deficiency of vitamins A, C and beta-carotene in the diet.
Women whose partners have cancer of the glans penis.
Immunodeficiency conditions, including AIDS.
Individual genetic predisposition to gynecological malignant processes.
Sexually Transmitted Infections.
Number of sexual partners (more than 3.
Smoking (active and passive.
The history of cytological smears with abnormalities.
Low social level.
The pattern of sexual behavior.
Early age of the first sexual intercourse (up to 16 years.
Dysplasia of the cervix symptoms do not have clinical manifestations. But in most cases (90%), dysplasia is accompanied by various kinds of inflammatory diseases, and there may be discharges, more than usual, with an admixture of blood. Similarly, spotting can be secreted by using tampons or after intercourse. In rare cases, patients complain of pain in the lower abdomen. It is revealed when examined by a gynecologist, and sometimes with the use of special diagnostic methods such as enlarged colposcopy, examination of smears and scrapings from the cervix, but the main method of diagnosis of CIN is a targeted biopsy followed by a histological examination of the drug obtained. The results of histological examination allow to establish the diagnosis of CIN and its stage accurately.
When diagnosing CIN, consultations of other specialists, such as oncogynecologist, immunologist, gynecologist-endocrinologist, are required, which allows to determine the best treatment tactics.
Treatment is to save the patient from the affected area on the cervix and eliminate the cause – the human papillomavirus. At different degrees of dysplasia, different methods of treatment are applied, up to an immediate removal.
Treatment of mild and moderate dysplasia includes mandatory antiviral therapy. as well as electrocoagulation, freezing, laser therapy or the use of radio waves. In severe dysplasia, a more radical treatment is needed: from conization of the cervix in young patients who want to maintain their genital function before extirpation (removal) of the uterus in elderly patients in combination with antiviral therapy.
After the treatment, the woman is on clinical check-up, with obligatory examination, advanced colposcopy and cytological examination 4 times during the first year after the operation, and 2 times during the second year after the operation, then once a year, according to the usual screening scheme.