Cervical & Gynecologic Dysplasia Clinic

“Dysplasia” is the scientific term for “abnormal cells,” which don’t look the way they’re supposed to under a microscope. These abnormal cells are not considered cancer in and of themselves, but they do have the potential to become cancer someday, if left untreated. That’s why dysplasia is considered a precancerous condition.  

So, how do you know if you have dysplasia? What causes it? And, how is dysplasia treated? Here, I’ll answer these questions and more. 

HPV is the most common cause of dysplasia

The term “dysplasia” is probably used most frequently when describing cells from the throat, cervix and anus. That’s because the vast majority of abnormal cells found in those areas have a common source: the human papillomavirus, or HPV. 

HPV is spread through intimate physical contact. More than 80% of people will be infected with it at some point. Fortunately, the immune system can usually clear up an HPV infection on its own.  

Problems arise only when the immune system can’t, and an HPV infection persists. When that happens, high-grade dysplasia may develop in certain areas, including the throat, tonsils, cervix, vagina, vulva, penis and anus. And that type of dysplasia can eventually become cancerous. 

Not all dysplasia will become cancer

The good news is that not all dysplasia will become cancerous. That’s why only some types of dysplasia warrant immediate attention, rather than careful observation.  

Cervical dysplasia, for instance, is normally divided into three categories:  

• mild or low-grade 
• moderate or intermediate grade 
• severe or high-grade  

If you only have mild cervical dysplasia, we may just opt to watch it and see if it resolves on its own. That’s because abnormal cells can be caused by many different things, including infections, a weakened immune system, and even age. 

If you have severe or high-grade cervical dysplasia, on the other hand, we will likely recommend prompt treatment, because the cells are very abnormal and have a much higher probability of turning into cancer. 

Treatment options for cervical dysplasia

Which treatments you’re offered will depend on the type and grade of your dysplasia. 

Here in the United States, we usually treat high-grade cervical dysplasia with excision, or surgical removal. Your doctor may perform:  

• a loop electrosurgical excision procedure (LEEP), which uses a heated wire loop to remove abnormal cells, or  
• a cold knife conization (CKC or cone biopsy), which uses a scalpel to remove a cone-shaped wedge of cervical tissue.  

With anal dysplasia, you might be prescribed topical creams or ablation therapy. Abnormal cells found in the throat or esophagus may also be treated with ablation.  

Worried about dysplasia? Don’t skip your checkups and cancer screenings

Regardless of its location, dysplasia doesn’t usually cause any symptoms. It’s also not visible to the naked eye. So, the best way to find out if you have it is to get regular checkups and schedule any cancer screenings you might be eligible for at the recommended intervals. 

Why?  

Because well-woman exams often include an HPV test and a pelvic exam. The latter includes inspections of the vulva, vagina and anal areas, which can help identify both cervical cancer and cervical dysplasia. And, any exam that involves a doctor or dentist looking inside your mouth can help spot irregularities in your throat, tonsils, and other areas, which could prove to be cancerous. 

So, don’t put yours off or skip any of them. 

Kathleen Schmeler, M.D., is a gynecologic oncologist at MD Anderson.

Request an appointment at MD Anderson online or call 1-877-632-6789.

It's a procedure that goes by many names: Pap smear, Papanicolaou test, Pap test, cytology or simply a ‘Pap.’

At MD Anderson, we refer to it as a Pap test, but whatever you call it, you may have questions about this procedure, who needs it and what to expect at your appointment.

I’m answering those questions here and sharing some exciting news about how Pap tests may be changing in the near future.

What does a Pap test look for? 

Pap tests are used to screen people with a cervix for abnormal cells in the cervix caused by an HPV infection. These abnormal cells can be a sign of a precancerous condition called cervical dysplasia.

What happens at a Pap test appointment?

At your Pap test appointment, you will first undergo a pelvic exam. Your provider will place a tool called a speculum in your vagina to see the cervix. Next, they will use a small brush to collect a sample of cervical cells that can be used for both Pap and HPV tests. This process only takes a few minutes.

After your sample has been collected, it is sent to a lab to be tested. In the past, the cells that were collected were smeared on a slide and examined under a microscope – that's where the name Pap smear comes from. But today, many Pap tests are liquid-based. Cells are placed in a liquid vial before they are transferred to a slide and examined. 

Your provider will look at your Pap and HPV tests and contact you with the results.

What’s the difference between a Pap test and an HPV test?

The Pap test and HPV test are often used together to screen for cervical cancer.

HPV tests screen for an infection caused by the human papillomavirus (HPV). Your result can be positive or negative. 

HPV is the most common sexually transmitted infection; about 80% of women are infected at some point in their lives. Most women’s bodies clear the virus, and they never have any problems. However, sometimes the infection won’t go away on its own. When that happens, it can lead to pre-cancerous lesions that can turn into cancer if they aren’t treated.

Pap tests look for abnormal cells, or dysplasia, caused by an HPV infection. Your result can be normal or abnormal.

While HPV and Pap tests sound similar, the key difference is whether abnormal cells are found. Having the HPV infection does not mean you have dysplasia. You can have a positive HPV test, but a normal Pap test.

Pap tests may also pick up on other conditions such as yeast or trichomonas infections, but these results often need to be confirmed using another kind of test. 

Right now, Pap tests and HPV tests are often used together. But cervical cancer screening guidelines are changing. Most guidelines are moving towards using HPV testing alone as it is more reliable than the Pap test. 

Recently, the Food and Drug Administration (FDA) even approved HPV tests with self-collection. This testing option allows a woman to self-collect her own sample using a vaginal swab. This will likely become the preferred method for most women.

What happens if my Pap test is abnormal?

If the results of either your Pap test or HPV test are abnormal, your provider may recommend further testing. This includes: 

Colposcopy: A tool called a colposcope is used to look more closely at the cervix.

Cervical biopsy: A small sample of cervical tissue is removed and examined under a microscope.

If high grade pre-cancerous cells are found during a colposcopy or cervical biopsy, your provider may recommend a loop electrosurgical excision procedure (LEEP). During this procedure, your doctor will remove the pre-cancerous cells using an instrument with a heated wire loop.

Who needs cervical cancer screening? 

Cervical cancer screening recommendations vary by age and cancer risk. Women and their providers should follow screening guidelines to ensure adequate screening and prevent unnecessary procedures and treatments.

Here are the screening guidelines MD Anderson recommends for women at average risk of cervical cancer.

• Women age 21 to 29 should get a Pap test every three years OR get an HPV test every 5 years starting at age 25.
• Women age 30 to 64 should get an HPV test, with or without a Pap test, every five years OR a Pap test every 3 years. 
• Women age 65 and older should discuss screening exams with their doctor. Women who haven’t had abnormal Pap or HPV tests in the past 10 years may be able to stop screening.

Some women may need to be screened for cervical cancer earlier or more often. This includes if you have:

• A history of severe cervical dysplasia 
• Persistent HPV infection after age 30  
• A compromised immune system 
• History of human immunodeficiency virus (HIV)
• Diethylstilbestrol exposure before birth

Why do you encourage people to get cervical cancer screening? 

Cervical cancer is preventable. First, there is a very effective HPV vaccine that prevents most cervical cancers. All children should get this vaccine. It works best when given at ages 11 or 12 but can be given as early as age 9. Some adults may benefit from the HPV vaccine, so if you haven’t already gotten the vaccine, talk to your doctor to learn more. The vaccine does not work against existing HPV infections.  

Additionally, if we can find cervical cancer while it is still in the pre-cancerous phases, we can treat it. However, pre-cancerous cells don’t cause cervical cancer symptoms. The only way to know if you are at risk is to get screened using HPV and Pap tests.

Request an appointment at MD Anderson online or call 1-877-632-6789.

We all hope the awkwardness is over after we get our Pap and HPV tests. So hearing that you have tested positive for HPV can be a blow. What happens next?

Well, for one, you’re not alone.

“More than 80% of people will be infected at some point in their lifetime,” says gynecologic oncologist Lois Ramondetta, M.D.

The good news is that, in most cases, your immune system clears the virus before any health problems develop. The risk for cancer increases if your body cannot fight off the virus for some reason, and it stays in your system.

Ahead, Ramondetta shares more information on HPV and what to know if you have it.

What is HPV?

HPV stands for human papillomavirus. There are more than 100 strains of the virus.

The virus lives on your skin and is spread during intimate contact, Ramondetta says. This includes:

• Intercourse
• Oral sex
• Genital contact

Most strains of HPV do not cause cancer – or any symptoms at all. However, in cases where HPV does have symptoms, they might include:

Genital warts

Some HPV strains cause genital papillomas, or warts, in both men and women. These warts will usually show up a few months after you are exposed to HPV. They can be treated with prescription medication or removed. The Centers for Disease Control and Prevention (CDC) writes that genital warts may disappear on their own, stay the same or grow in size or number.

Certain cancers

Other strains of HPV are known to be high-risk and can cause cancer. HPV 16 and HPV 18 are two strains commonly linked to cancer, but there are also a handful of other high-risk subtypes, Ramondetta says.

In women, these strains can cause:

• Cervical cancer
• Vaginal cancer
• Vulvar cancer
• Anal cancer
• Oropharyngeal (throat) cancer

In men, high-risk strains of HPV can cause:

• Penile cancer
• Anal cancer
• Oropharyngeal (throat) cancer

Other health issues

Ramondetta says HPV can cause other health issues, including:

• Pre-cancers of the vulva and cervix
• Respiratory papillomatosis, or papillomas on the voice box
• Papillomas in young children. In rare cases, HPV can be passed from a mother to her child as they exit the birth canal.

How is HPV diagnosed?

HPV usually doesn’t have any symptoms, so it can be hard to tell you have it, Ramondetta says. For this reason, she says everyone should assume they will be exposed to HPV at some point in their lives, with most being exposed in their 20s.

HPV is diagnosed through an HPV test. Currently, only women can be screened for HPV. This screening is usually done at a doctor’s office at the same time as a Pap test. Your practitioner will use a soft brush to take a sample of cells from your cervix. This sample will be sent to a lab for testing.

Here’s how often MD Anderson recommends women at average risk for cervical cancer should get HPV tests.

Women ages 21 to 29

Women ages 21 to 29 should get a Pap test every three years. Women who choose not to get Pap tests should begin HPV tests every five years beginning at age 25.

Women ages 30 to 64

MD Anderson recommends women 30 and over get a Pap and HPV test every five years.

Women over age 65

Some women may be able to stop screening at 65 depending on their medical history. Women should speak with their gynecologist to decide how to proceed.

What’s my cancer risk if I have HPV?

If you get a positive HPV test, your physician has detected one or more high risk strains of the virus.

Our experts say the most important thing to know if you have HPV is that the risk of cancer is very small but should be taken seriously.

“Don’t panic, and don’t ignore it,” Ramondetta says. “Make sure you follow up with your doctor on the next steps and try to keep things in perspective. If you have HPV, there’s a very good chance it won’t be a long-term problem for you.”

Your immune system will attack the virus, and it will likely be gone within two years. Of the millions of cases of HPV diagnosed every year, only a small number become cancer. Most of those cases are cervical cancer; almost all cervical cancer cases are caused by the HPV virus.

The HPV vaccine can help the body recognize and eliminate the virus more effectively, Ramondetta says.

“The vaccine is so effective because it essentially gives your immune system the ‘cheat sheet’ for recognizing the virus,” she says.

Other HPV-related cancers are rare. Routine screening is not recommended or available at this time.

While dentists are starting to check for oropharyngeal (throat) cancer, they are not able to test for HPV. Additionally, because oropharyngeal cancer forms deep in the throat, it is more challenging to detect early. It is often found after a lump develops.

Making healthy lifestyle choices can give your body the best chance of clearing the virus.

“Choosing healthy foods filled with antioxidants, staying active, lowering your stress levels and avoiding tobacco are all ways to keep your immune system strong,” Ramondetta says.

Do I need additional HPV testing?

The results of your Pap and HPV test are used to determine if you need additional testing.

Positive HPV test, normal pap

If you test positive for HPV and your Pap test is normal, your doctor will most likely recommend repeating the Pap and HPV screening exams in one year.

If your second HPV test comes back negative, continue regular Pap and HPV tests.

If your second HPV test comes back positive, your doctor may recommend a colposcopy.

During a colposcopy, your doctor will look more closely at the cervix, vagina or vulva with a special microscope called a colposcope. The doctor is looking for abnormal cells or blood vessels, which may require further treatment.

Positive HPV test, abnormal pap

If you test positive for HPV and your Pap test was abnormal, your doctor will probably follow up with a colposcopy. Try to see a physician who specializes in this procedure.

Talking to your partner about HPV

With any medical problem, it's natural to wonder: “How did this happen?” With HPV, it can be very difficult to pinpoint when you were exposed. It's possible that the virus was in your system for a long time before it was detected. People often never know they have caught it or passed it on.

“HPV could’ve been there for years before it shows up, if it ever does,” Ramondetta says.

When talking to your partner about your diagnosis, remember 80% of people will have HPV at some point in their life.

Your partner can catch it from you. However, they have probably already been exposed by you or someone else.

If your partner is a woman, she should be sure to follow screening guidelines described above in order to keep up with her own Pap and HPV testing so if a problem does develop, it is found early.

Protect yourself from HPV

Because HPV lives on your skin, condoms don’t fully protect you from it.

The best way to protect yourself from HPV-related cancers is to get the HPV vaccine.

Ramondetta says that getting the HPV vaccine after being infected doesn’t make the infection go away. However, getting the vaccine before you're exposed to HPV can prevent against 7 high risk subtypes and 2 low risk subtypes.

All males and females should get the HPV vaccine. Ideally, to be best protected, children should be vaccinated between 9-14 years of age; the earlier, the better. Unvaccinated adults ages 27–45 should talk to their doctor about the benefits of the vaccine.

If you get your first dose of the HPV vaccine between ages 9 and 14, only two doses are required. Those who get their first dose of the vaccine after age 15 will need three doses for full immunity.

You can’t get HPV from the HPV vaccine, which is safe and has no serious side effects, Ramondetta says.

“The vaccine has been proven again and again to be safe and effective and long lasting," she says. “It is something I didn’t hesitate to give my children. I try to encourage every parent to get their 9- or 10-year-olds the first shot so they only need two total for decades of protection.”

Request an appointment at MD Anderson online or call 1-877-632-6789.