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Re: cervical dysplasiaFrom: Richard M. Chudacoff, MD (anonymous@obgyn.net)Wed, 19 Mar 1997 11:00:05 -0600 (CST)
At Wed, 19 Mar 1997, Dennis wrote: > >My wife has been diagnosed with minimal cervical dysplasia. We are >trying to determine the appropriate treatment, either LEEP or to take a >"wait and see" position and test again in 4 to 6 months. What is the >current research on the subject. The doctor seems to have little >concern, but is very careful not to express an opinion. > >We are also concerned about the possible recurrence if the dysplasia >should disappear on its own or if the LEEP procedure is performed. Minimal cervical displasia is not a term I am familar with. Do you mean there is little dysplasia or it is minimally invasive? There is a big difference. Assuming you mean there is minimal disease, the way we classify it is either low grade or high grade dysplasia. The former system called it mild, moderate or severe dysplasia. In any case, depending the the grade the treatment options vary. In cases of low grade, I generally use the rule of 'thirds', although this is not exact. One third will go on to a worse, or high grade and possibley invasive lesion, one third never changes and one third may resolve. No way really, in a practical sense, of telling which will do what. If my patient is reliable and known to me, I'll give the option of watching or treating the lesion. If not reliable, then I'll strongly suggest treatment. If the lesion is high grade, I treat. Now, this all depends on the colposcopy results, which all patients with abnormal pap smears should have, to rule out worse lesions than found on pap smear. The Papanicolaou (Pap) test is the best screening test we have in medicine. Countries that perform the test, like the USA, prevent over 90% of cervical cancers. Pap tests should not detect cervical cancer, because it is the cervical cancer we want prevent. Our goal is to detect pre-cancerous changes, and treat cases in their pre-cancerous state. Earlier findings require less costly and less painful treatment. The cervix is the part of the uterus that extends into the vagina. Through the canal in the cervix the shedding lining of the uterus flows during the menstrual period. The cervix has two main types of cells: squamous cells on the outer portion of the cervix, like those that line the vagina, and columnar cells which line the canal of the cervix. Most of the cervical pre-cancerous changes occur in the squamous cells at the squamo-columnar junction. Cells, shed normally in the female, are collected by the physician during the Pap smear, placed on a slide and sent to the pathologist. The cells that the pathologist views on the Pap test slide are these cells. It is important to note that a Pap test is not performed every time the physician conducts an internal exam. Cervical cells are read as normal, cancerous, or as a progression between these margins. It can take 1.5 years to 4.5 years to transform from a normal cell to a cancerous cell. That is the reasoning for a yearly Pap exam. Not all abnormal Pap tests are cancer, nor do all abnormal Pap tests need treatment. Treatment depends on the severity of the cell abnormality, and the physician-patient relationship. All abnormal Pap tests must be followed by a physician, and not ignored. There are factors that can promote abnormal cells on the cervix. Early ages of sexual intercourse, increased numbers of sexual partners, and cigarette smoking each increase the risk of cervical cell abnormalities. Cervical cancer is a sexually transmitted disease associated with the human papilloma virus, HPV, the same type of virus that causes genital warts. Cervical cancer does not generally have a family pattern. The incidence of cervical cancer also increases after the age of 18. We recommend to every woman a yearly Pap test once she has had sexual intercourse, or once she is 18 years old. I would talk to your wife's gynecologist frankly about her situation, and determine which is the best option for you both.
-- Richard Chudacoff, MD Baylor College of Medicine BaylorMedCare Houston/Richmond, TX
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