Dyskaryosis is the appearance of abnormal cells on the surface of the cervix. These changes are usually detected during a Pap smear, also known as a cervical screening test. A Pap smear is used to screen for cervical cancer.
Most women who have a Pap smear will receive a normal result. However, around 1 in 20 smear test results will come back as abnormal. Abnormal results often indicate infection with Human Papilloma Virus (HPV). Receiving an abnormal result does not mean that you have cervical cancer, but rather that changes have been seen in the cervical cells which require further investigation.
Abnormal cells found on the surface of a woman’s cervix are graded into 3 categories based on the severity of observed abnormal cells. Mild (CIN 1), moderate (CIN 2) or severe (CIN 3) changes might be noted. These changes do not necessarily mean that you have cancer. Rather, they indicate that you may have pre-cancerous cells in or around your cervix that require further investigation and/or treatment.
What Causes Dyskaryosis?
Dyskaryosis is normally caused by infection with the human papillomavirus (HPV). Genital HPV is easily passed on through skin-on-skin contact as well as genital contact and oral sex. Around 20 strains of HPV are linked to cancer, with high-risk HPV strains 16 and 18 being responsible for around 70% of cervical cancer cases.
Because the HPV virus can remain dormant for a very long time and produce no symptoms, many women are unaware that they have the virus. Dyskaryosis (CIN1, 2 and 3) seldom causes any symptoms, such as pain, discharge, or bleeding. This highlights the importance of attending regular cervical screening appointments, where early diagnosis and treatment are possible.
Practising safe sex, using condoms, and getting vaccinated against HPV are both good measures to minimise the risk of developing cervical cancer.
What Are CIN Grades?
Abnormal cells observed on the cervix’s surface are referred to as Cervical Intra-epithelial Neoplasia (CIN). Based on the extent of these abnormal cells, a grading system has been developed to help classify cervical cell changes. Your Pap smear results may indicate that you have CIN 1 (mild changes), CIN 2 (moderate changes), or CIN 3 (severe changes).
CIN 1 Grade (Mild Dyskaryosis)
The CIN 1 grade describes mild dyskaryosis, where only one-third of the cervical surface area contains abnormal cells. CIN1 usually corresponds to infection with Human Papilloma Virus (HPV) and often resolves by itself within six months.
Women with CIN 1 usually do not need treatment, although a repeat Pap smear after six months is required to monitor changes. It is not uncommon for younger women to have low-grade abnormal cells. These do not necessarily require treatment as they often revert to normal over time. Your doctor or nurse may recommend a “watch and wait” (surveillance) approach.
CIN 2 grade (Moderate Dyskaryosis)
A CIN 2 grade indicates moderate changes affecting two-thirds of the thickness of the surface layer of the cervix. This grade does not necessarily mean that you have cancer.
A colposcopy may be carried out and following this, treatment may be required to remove the abnormal cells. The colposcope is a type of microscope which magnifies the cervix’s surface. It allows for detailed inspection and investigation of the cervix and helps to identify cervical abnormalities which may become more serious if left untreated. A small biopsy (tissue sample) may be taken from the cervix for further examination. The examination usually takes around 10-20 minutes.
CIN 3 Grade (Severe Dyskaryosis)
CIN 3 indicates more severe changes affecting the full thickness of the surface layer of the cervix. High-grade smears include moderate and severe pre-cancerous cell changes to the cervix. Although this grade does not mean you have cancer, it is likely that pre-cancerous cells have already started to develop.
A colposcopy examination should be performed to determine if treatment is needed. It is very important to treat severe dyskaryosis as soon as changes are detected by removing abnormal cells which could develop into cancer in the future.
Abnormal Pap smears with grade CIN 2 or CIN 3 abnormal changes, do not necessarily indicate that you have cervical cancer, but these abnormal cells will probably not be able to return to normal without further treatment. If left untreated these pre-cancerous cervical cells could develop into cancer. It is, therefore, extremely important that women with moderate or severe dyskaryosis seek treatment.
A colposcopy examination is an important next step in determining if treatment is needed. If it becomes evident during a colposcopy examination that abnormal cells need to be removed, the doctor who is carrying out the colposcopy will often be able to remove them at the same time. However, if biopsy results are necessary to determine if cells need removal, a separate surgery date will be needed.
A cervical screening test will show if abnormal cells are present. It cannot, however, show how deeply the abnormal cells go into the cervix. To determine the grade of dyskaryosis (CIN), a biopsy from the abnormal areas of the cervix may be done. This tissue sample is looked at under a microscope to determine the grade of the CIN. With this information, your doctor can decide on the most appropriate type of treatment.
A vaccination is now available to protect against high-risk HPV strains. In the UK, it is available through the NHS. However, it will not be of any benefit if the infection is already present and abnormal cell changes have already taken place.