Cervical Dysplasia & Colposcopy
Cervical dysplasia is a diagnosis made on pap smear and indicated the presence of abnormal cell on the mouth of the uterus(cervix). Dysplasia can be classified as mild, moderate or severe. One needs to worry about dysplasia as these are precancerous conditions and if left untreated, it can progress to cancer of the cervix.
About 70 percent of mild dysplasia cases regress and cervix becomes normal, however if it cervical dysplasia persists, it is curable. It can take 7-10 years or longer for cervical dysplasia to develop into cancer. Dysplasia is detected on a Pap smear exam and is the single most important step to prevent cervical cancer. Pap smears are recommended to all women who are sexually active as cervical dysplasia usually does not have any signs or symptoms. It is a simple test usually painless and done in the gynaecology office.
If abnormalities are detected on the pap smear, HPV test is done as there is evidence that suggest association between human papilloma virus (HPV) and cervical cancer. If the HPV test is positive for a high-risk strain (16,18), the lesions are more likely precancerous. If the test is negative, then cervical changes are more likely benign.
HPV vaccination can prevent infection with HPV and in turn prevent cervical cancer. Recommended to all girls before the start of sexual activity.
Colposcopy
Depending on the results of pap smear and HPV test, colposcopy is the next step in the diagnostic process. This is an out patient procedure, where cervix is evaluated in magnification to detect abnormal areas and take directed biopsies. A simple procedure that takes about 10 to 15 minutes to perform. Initially a solution of diluted acetic acid (vinegar) is applied to the cervix to remove mucus and clearly visualise the abnormal area. Next a bright light and filters are used to examine cervix under magnification using electronic microscope (called a colposcope). Iodine solution is also used identify lesions for biopsy. Further treatment depends on the biposy result.
Treatment
- Electrosurgery -Loop electrosurgical excision procedure (LEEP or LEETZ) uses electrical current to quickly and safely cut away abnormal tissue. This ensures complete removal of abnormal tissue which is examined by a pathologist to give accurate diagnosis.
- Cryosurgery and cryocauterization- A carbon dioxide-cooled probe (called a cryoprobe) to used freeze and kill abnormal cells. The tissue then sloughs off. The only drawback here is that tissues are not available for histopathological examination.
- Laser vaporization or ablation-Carbon diaoxide laser is used to destroy abnormal surface cells. As with cryosurgery, there is no tissue obtained pathologic examination.
- Cone biopsy -A cone-shaped tissue is surgically removed from the cervix. The specimen is sent to a pathology for detailed microscopic examination. If only dysplasia is reported, no further treatment is necessary If cancer is reported, further treatments are indicated.