Squamous dysplasia, also known as cervical dysplasia, is the abnormal development of the cells that line the cervix. Considered a precancerous condition, squamous dysplasia can be triggered by a variety of factors. Treatment depends on the degree of dysplasia and may involve destruction or removal of affected tissue. The prognosis associated with cervical dysplasia depends on timely diagnosis and proper treatment. If left out, squamous dysplasia can develop into cervical cancer.
Cervical dysplasia is most commonly caused by the presence of the sexually transmitted infection known as human papillomavirus (HPV). In general, a woman's immune system can neutralize the virus and prevent the infection from progressing. In some women, the presence of HPV can negatively affect cervical cell development, leading to dysplasia and ultimately cervical cancer. Squamous cell carcinomas are considered the most common form of cervical cancer resulting from the presence of HPV.
Women who develop squamous dysplasia may remain asymptomatic, meaning they do not experience any symptoms. For some women, the presence of precancerous cells can lead to abnormal vaginal bleeding, pelvic discomfort, or vaginal discharge that is watery or foul-smelling blood. Abnormal cervical cells that don't cause symptoms are usually found during a routine Pap test.
When abnormal squamous cells are found, additional tests are usually done to assess the degree of cell development. People can undergo a cervical exam, known as a colposcopy, which involves the use of a colposcope to assess the condition of the cervix. If abnormalities are found, a biopsy may be performed to remove a sample of the abnormal cells and surrounding cervical tissue for further laboratory analysis. Biopsy can be performed as a punch or cone procedure, which requires circular or cone-shaped excision of cervical tissue, respectively.
After a determination of cancer has been made, further tests may be done to determine the staging of the condition. A physical exam of the bladder and rectum, as well as imaging tests, including magnetic resonance imaging (MRI) and computed tomography (CT), may also be done to assess whether the cancer has metastasized or spread to tissues or surrounding organs. . If the cancer remains non-invasive and limited to the cervix, it may be given a stage of zero or one. Stages two and three are given when the cancer has spread to the uterus and pelvic wall, respectively. A stage of four is assigned to cancers that are invasive and have metastasized to surrounding organs, such as the bladder or lungs.
Cancers determined to be noninvasive and confined to the cervix can be treated with a variety of procedures. During a loop electrosurgical excision procedure (LEEP), an electrical current is passed through a wire loop that is used like a knife to remove cancer cells from the cervical opening. Cancer cells can be frozen and removed during a procedure known as cryosurgery. Additional procedures include the use of conization, which is the cone-shaped removal of malignant cells with a scalpel, and laser surgery to remove cancer cells.
Invasive cancers that affect the deeper layers of the cervix may need a hysterectomy. Considered a major surgery, a hysterectomy that requires removal of the uterus and cervix is known as a simple hysterectomy, while additional removal of part of the vagina and surrounding tissues is called a radical hysterectomy. Women who have a hysterectomy may also require radiation therapy and chemotherapy to kill residual cancer cells. Radiation therapy uses high-powered, highly focused beams of energy to target and eradicate malignant cells and can trigger side effects including fatigue and swelling at the site of administration. Chemotherapy involves the oral or intravenous administration of anticancer drugs and can cause nausea, vomiting, and fatigue.
People who undergo treatment for invasive cervical cancer become infertile. Women diagnosed with early-stage cervical cancer may undergo a radical trachelectomy, which is the removal of the cervix and immediate lymphatic tissue, to prevent infertility. Those who undergo radical trachelectomy and later become pregnant should be closely monitored due to an increased risk of miscarriage. Factors that can increase a woman's risk of developing squamous dysplasia include multiple sexual partners, smoking, and compromised immunity.