Cervical dysplasia

Disease Description (Causes and Symptoms)

• Definition: Cervical dysplasia is a condition in which the epithelial cells on the surface of the cervix undergo abnormal changes. It is a precancerous lesion (CIN: cervical intraepithelial neoplasia) that can progress to cervical cancer. Grades are classified as CIN1 (mild) → CIN2 (moderate) → CIN3 (severe/pre-stage of carcinoma in situ).
• Causes and pathophysiology: The main cause is infection with high-risk human papillomavirus (HPV), particularly HPV 16 and 18. HPV oncoproteins (E6, E7) inhibit cell-cycle regulatory proteins (p53, Rb), causing abnormal cell proliferation that may gradually become cancerous. Risk factors: early sexual activity, multiple sexual partners, smoking, immunosuppression (e.g., HIV), long-term smoking, etc.
• Main symptoms: Usually asymptomatic. Rarely, irregular vaginal bleeding (postcoital bleeding, bleeding between menstrual periods) or abnormal vaginal discharge may occur; pain is uncommon.
• Summary of diagnostic tests: Cervical cytology (Pap smear), HPV detection testing (HPV DNA/RNA), colposcopy and targeted biopsy (histopathological examination) when abnormalities are found, and endocervical curettage when necessary.

Treatment Methods

• General principles: Treatment is determined according to the lesion grade (CIN1/2/3), the patient’s age (whether fertility preservation is desired), pregnancy status, and adherence to testing and treatment.
• Conservative observation
  • CIN1 (mild): Usually monitored with cytology and/or HPV testing at 6–12-month intervals (many cases resolve spontaneously). Treatment may be considered if it persists for 2 years.
  • CIN2 (in specific cases): Observation may be considered in patients younger than 25 years or those who desire fertility preservation and can undergo follow-up.
• Procedural and surgical treatment
  • Excisional procedures (main recommended approaches): LEEP (Loop electrosurgical excision procedure) and cold-knife conization — these can provide histological confirmation and treatment at the same time.
  • Ablative (non-excisional) treatment: Cryotherapy, laser ablation, etc. — may be selected when the lesion is confined to the surface and there is no involvement of the endocervical canal.
  • For severe lesions (CIN3) or suspected invasive cancer: After appropriate additional evaluation (biopsy, imaging), conization or hysterectomy may be performed.
• Medications: There are no established antiviral medications. The HPV vaccine is recommended to prevent HPV infection (not for treatment purposes). Appropriate antibiotic treatment is used when infection/inflammation is present. Smoking cessation is recommended.
• Follow-up after treatment: In general, cytology plus HPV testing (co-testing) is performed 12 months after the procedure. If the results are negative, repeat testing at 24 months may be followed by a transition to routine screening. Positive or abnormal findings require professional reevaluation.
• Pregnancy and fertility considerations: During pregnancy, treatment should be postponed when possible, particularly for noninvasive lesions; if excision is necessary, clinical judgment should be followed. After conization, the risk of preterm labor/preterm birth may increase due to cervical insufficiency, in proportion to the depth of excision.
• Complications and precautions: Bleeding, infection, cervical stenosis, recurrence, and an increased risk of preterm birth and low birth weight after conization. Smoking cessation before and after treatment, safe sexual practices, and HPV vaccination are recommended when age-appropriate.

Checklist Before an Outpatient Visit (Preparation and Example Questions)

• Materials/information to bring:
  • A list of medications currently being taken (including hormones, anticoagulants, immunosuppressants, etc.) and allergy records
  • Previous Pap smear, HPV test, colposcopy, biopsy, and surgical records and results (photos if available)
  • The date of the most recent menstrual period, sexual history (timing of recent intercourse), and the possibility or status of pregnancy
  • Smoking history and information about chronic diseases (including immunosuppression and HIV)
• Symptoms to record in advance for the outpatient visit:
  • Bleeding (when it occurs, when it began, frequency, association with intercourse), vaginal discharge (color and odor), and presence or absence of pain
• Examples of questions to write down during the visit (for brief personal records):
  • Changes in recent test results (e.g., changes in grade compared with previous results)
  • Future pregnancy plans and related recommendations

Examples of General Questions to Ask the Doctor

• "Which grade (CIN1/2/3) do my test results correspond to, and what does it mean?"
• "What are the advantages and disadvantages of the recommended treatment options (observation vs. excision vs. ablation)?"
• "What is the risk of recurrence after treatment, and how often should follow-up testing be performed?"
• "To what extent could treatment affect a future pregnancy?"
• "Would receiving the HPV vaccine now be helpful?"

Examples of Disease-Specific Questions

• "Based on my current test results (cytology, HPV test, and biopsy), is observation safe, and if I choose observation, at what intervals and with which tests should I be monitored?"
• "After LEEP (or conization), are any additional measures (e.g., cervical cerclage) recommended to reduce the risk of preterm labor or preterm birth during pregnancy?"