Signs of Cervical Dysplasia
Cervical dysplasia does not cause symptoms. Signs and symptoms, if any, are caused by an accompanying infection.
Cervical Dysplasia Diagnosis
The Pap smear is the most important diagnostic procedure for detecting cervical dysplasia. It is a simple and painless test that may cause minor discomfort.
Normal vaginal discharge contains cells that are shed from the cervix and uterus. A gynecologist or other health care practitioner removes some of these cells by brushing or scraping the cervix with a small instrument designed for this purpose. The cells are placed on a glass slide and sent to a laboratory, where they are examined under a microscope for changes and abnormalities.
The Pap smear is not 100 percent reliable. It produces incorrect results in about 15-25% of cases. Cervical cancer is missed in about 5 percent of cases. Reasons for incorrect results include the following:
- Human error (The test should be done by an experienced practitioner and sent to a reputable laboratory.)
- Inadequate number of cells in the sample
- Presence of menstrual blood in the sample
- Temporary changes in cervical cells caused by medications, pregnancy, infection
If atypical cells are found, the physician may recommend further testing.
Because of the association between human papillomavirus (HPV) and cervical cancer, this test can help determine the next step for a woman with atypical cells. This test checks for HPV genetic material, or DNA, within the cervical cells. A swab of cervical cells is taken and the specimen is sent to a laboratory and examined for HPV. If the HPV test is positive for a high-risk strain, the lesions are more likely precancerous. If the test is negative, the cervical changes are more likely benign.
Depending on the severity of the dysplasia, results of the HPV test, and other risk factors, colposcopy is the next step in the diagnostic process. Generally, a colposcopy is performed if the cervical cells are distinctly abnormal.
This relatively simple procedure takes about 10 to 15 minutes to perform. A solution of diluted acetic acid (vinegar) is applied to the cervix to remove mucus and highlight abnormal cells. Using a bright light and a special electronic microscope (called a colposcope), the physician is able to see small areas of the cervix and vagina. The acetic acid and the lens of the colposcope make abnormal cells appear white and normal cells appear pink. If abnormal cells are seen, a biopsy is usually done.
A cervical biopsy usually is performed when the colposcopy reveals abnormal tissue. Using a small biopsy forceps, a tiny sample of abnormal tissue is removed from the cervix and sent to a laboratory for examination. More than one sample may be taken, depending on the amount of abnormal tissue detected by colposcopy.
Another type of biopsy, called an endocervical curettage, may also be done. This procedure is performed if the physician is unable to determine if the abnormal cells go beyond the surface of the cervix. Using a small-spoon shaped instrument called a curette, cells from inside the cervix are biopsied. The procedure takes about 10 to 15 seconds, but it can trigger uterine cramping.
A procedure called dilatation and curettage (D & C) may be performed if the physician suspects that abnormal cells extend beyond the cervix. A curette is used to remove cells from the cervical canal and the lining of the uterus. This procedure requires local anesthesia.
Treatment is based on the biopsy results.