Cervical Pre-Cancer

CONDYLOMA AND DYSPLASIA

Viruses can cause wartlike growths (condyloma) or cell changes (dysplasia) of the cervix and the skin of the genital organs.

IT’S NOT CANCER

These lesions are called “dysplasia”: low-grade (LSIL) or high-grade (HSIL) lesions. They can be detected by a screening smear, which is one reason why it is important to have regular follow-ups (Pap test). Sometimes, their significance is not entirely clear. They are then known as “ASC-US. Condyloma and dysplasia now affect a growing number of women.

They are caused by a family of viruses, and are cousins of the viruses found on your skin. They are known overall as the “human papilloma virus” (HPV) and are transmitted through skin and genital contact, from the very start of sexual relations (40% of women aged under 20 carry the viruses and 80% of women have been in contact with them during their lifetime).

The viruses only affect the genital area, the vagina and uterus and do not pass inside the body. Usually, our natural defence system (immune system) eliminates the viruses. Passing them on to a baby during pregnancy is rare.

The viruses can infect the skin throughout this region and can remain dormant for many years. Condoms are effective against sexual diseases transmitted by the sperm (HIV, hepatitis B and C, etc.), but provide only partial protection against these viruses or the transmission of those outside the vagina, uterine cervix and penis (vulvar infection, for example). The male partner is the carrier, but rarely suffers from dysplasia.

Active or passive smoking is a very definite factor in the development of these lesions.

The viruses sometimes cause minor lesions (LSIL, low-grade) which often heal by themselves (immune system). Some lesions can be more serious (HSIL, high-grade) and require localized treatment. Therapy is effective, but does not eliminate all viruses; there is a 5-10% chance of recurrence following treatment.

A biopsy is required prior to treatment. Lesions of uncertain origin (ASC-US) generally only need careful examination (colposcopy).

Low-grade lesions (LSIL) can be monitored because they often heal by themselves and are only treated if they last more than two years or develop into a high-grade infection.

High-grade lesions (HSIL) are often treated under local anesthetic and removed using a sort of electric scalpel (electrosurgical loop or needle), laser, freezing (cryotherapy) or conventional surgery. The treatment is usually well-tolerated and represents a moderate risk to fertility or a future pregnancy.

There is no medication that acts directly on HPV viruses at present, but numerous studies are under way with regard to developing vaccines.