Description
Cervical lesions are abnormal changes in the cells that make up the cervix.
The cervix is the lower part of the uterus that connects to the vagina.
Cervical lesions are often caused by a viral infection called human papillomavirus (HPV). HPV is a common sexually transmitted infection that can cause genital warts and other health problems. Most women who have HPV never develop cervical lesions or cancer.
However, some types of HPV can lead to abnormal cell growth in the cervix.
Cervical lesions are typically classified as low-grade or high-grade, depending on the severity of the abnormal cells. Low-grade cervical lesions may go away on their own without treatment. High-grade cervical lesions are more likely to progress to cancer if left untreated. The most common symptom of cervical lesions is abnormal bleeding or discharge. Other symptoms may include pain during sex or urination, or a lump or growth on the cervix. Cervical lesions can be diagnosed through a Pap smear or other tests that examine cells from the cervix. If cervical lesions are detected, additional tests may be needed to determine their severity and potential for cancer. Treatment for cervical lesions may include removal of the abnormal cells or more extensive surgery, depending on the severity of the lesions.
In some cases, a hysterectomy (removal of the uterus) may be necessary to treat cervical lesions that have progressed to cancer.
Résumé
- The cervix is the lower portion of the uterus, featuring an internal orifice connecting to the uterine cavity and an external orifice opening into the vagina. It consists of the ectocervix (outer part) and the endoservix (inner part), along with three layers: endometrium, myometrium, and cervical mucus.
- The transformation zone, located between the old and new squamocolumnar junctions, is a critical area of the cervix where pre-malignant and malignant lesions commonly develop. It's where columnar epithelial cells from the endoservix meet squamous epithelial cells from the ectocervix. Pap smears target this zone to detect abnormal cells, aiding in early cervical cancer prevention.
- Normal cervical cells, as seen through a colposcope, appear as small, reddish lesions within the opening. Abnormal cells, in contrast, can present as yellow, blue, or white lesions, especially after applying acetic acid. These can involve redness, growths, and sometimes bleeding upon touch, indicating potential cervical changes.
- Cervical lesions can be categorized as benign (non-malignant) or neoplastic. Common benign lesions include inflammatory, reactive, and reparative lesions like chronic cervicitis, papillary endocervicitis, and coilocytic changes. Hyperplasia, such as nabothian cysts and tunnel clusters, as well as metaplasia like squamous metaplasia, and benign polyps are also considered benign conditions.
- Cervical erosion, or ectropion, is characterized by the eversion of the endocervix, exposing columnar epithelium to the vaginal environment. It is often associated with high estrogen levels, as seen in adolescence, pregnancy, and during ovulation. Symptoms can include vaginal discharge, potential bleeding, and can be managed with reassurance, infection treatment, or ablation.
- HPV (Human Papilloma Virus) infection, along with CIN (Cervical Intraepithelial Neoplasia) grades 1, 2, and 3, are key factors in cervical cancer development. Risks include smoking, high parity, early intercourse, low immunity, socioeconomic status, and multiple partners. Specific HPV strains, like 16, 18, 31, and 33, are particularly linked to cancer risk.
- HPV testing via genotyping identifies specific HPV DNA and can be combined with Pap smears for more comprehensive screening. Women over 30 may benefit from HPV testing in conjunction with Pap smears. The Pap smear test, ideally started at age 21, involves collecting cells from the cervix and evaluating them for abnormalities.
- HPV vaccines, including quadrivalent, bivalent, and 9-valent options, are recommended for both males and females, typically from ages 9 to 26 (up to 45 in India). These vaccines help prevent infection with the HPV strains most commonly associated with cervical cancer.
- CIN represents precancerous changes in cervical cells, classified as CIN1 (mild dysplasia), CIN2 (moderate dysplasia), and CIN3 (severe dysplasia/carcinoma in situ). These classifications reflect the extent of abnormal cell involvement in the cervical epithelium. Progression from CIN1 to invasive carcinoma can take several years.
- Diagnosis of CIN involves Pap smears to identify abnormalities, followed by colposcopy to visualize and biopsy suspicious areas. Colposcopy allows for a magnified view of the cervix after application of saline and acetic acid, aiding in targeted biopsies of abnormal lesions.
- Treatment for CIN ranges from tissue destruction methods like electrocautery, cryosurgery, and laser surgery, to surgical removal methods like LEEP (loop electrosurgical excision procedure) or hysterectomy. The choice of treatment depends on factors such as the patient's age, desire for future pregnancies, the extent of the lesion, and patient preference.
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