Abnormal cells on the cervix (dysplasia)

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Screening tests for cervical cancer can detect abnormal cells on the cervix. These cells are often not dangerous and usually go back to normal again without treatment. But they might continue to change and eventually turn into cervical cancer.

In Germany, dysplasia is classified into three grades, depending on the outcome of the tissue sample examination (biopsy):

  • low-grade dysplasia (medical term: CIN 1)
  • moderate dysplasia (CIN 2)
  • high-grade dysplasia (CIN 3)

In all of the different grades of dysplasia, the abnormal cells are only found in the uppermost layer of cells. In high-grade dysplasia, the cells have already changed a lot. If cancer cells have developed but haven't yet spread, it is called a “carcinoma in situ” ("in situ" is Latin and means “in its original place”). Cervical cancer is said to be "invasive" if the cancer cells have spread from the uppermost mucous membrane layer to the tissue beneath it.

What happens if abnormal tissue (dysplasia) is found?

Low-grade or moderate dysplasia is usually no cause for concern. A lot of women have this kind of dysplasia at some point in their lives without knowing it. Their body fights the that is causing the cells to change, so the abnormal cells usually return to normal – especially in women between the ages of 20 and 30.

Whether and when to have surgery to remove abnormal tissue is a personal decision. Women who don't have low-grade or moderate dysplasia removed straight away aren't risking anything. You can wait at first, and have check-ups to see what happens to the abnormal cells. This can avoid potentially unnecessary treatment.

But things are different in women who have high-grade dysplasia. Without treatment, an estimated half of these women will go on to develop cervical cancer. For this reason, doctors recommend removing the abnormal tissue using a procedure known as conization.

It's important to know that there's no need to panic if abnormal cells are found. There's enough time to calmly gather information and talk to your doctor about what you would like to do next.

How is cervical dysplasia treated?

In conization, a cone-shaped wedge of tissue about the size of a cherry is removed from the opening of the cervix and from the cervix itself. This is usually enough to get rid of all of the abnormal tissue and prevent cervical cancer. The operation is done through the vagina, under local or general anesthetic.

Women may have mild pain and bleeding immediately afterwards. A reddish discharge and bleeding in the first few days after surgery are possible too. So it's important to take care and rest a lot at first, and to avoid sex in the first few weeks after surgery. Conization usually doesn't cause any severe side effects.

Surgeons should remove as much tissue as necessary, but as little tissue as possible, particularly in women who would still like to have children. Removing tissue weakens the cervix, increasing the risk of preterm birth in women who get pregnant after the procedure. This risk is especially high if a lot of tissue is removed: About 3 out of 100 babies are then born too soon (before 37 completed weeks of pregnancy). Removing less tissue greatly reduces the risk of preterm birth.

If high-grade dysplasia is discovered during pregnancy, doctors normally recommend waiting and operating after the baby is born, to avoid weakening the opening of the cervix.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Invitation and decision aid for cervical cancer screening; Executive report; Commission P15-02. 2017.

Krebsinformationsdienst (KID), Deutsches Krebsforschungszentrum (DKFZ). Gebärmutterhalskrebs: Das Zervixkarzinom. 2016.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on September 7, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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