Cervical dysplasia natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural history
- Cervical dysplasia arises from squamous-columnar junction.
- The earliest microscopic change corresponding to cervical intraepithelial neoplasia(CIN) is dysplasia of the epithelial or surface lining of the cervix,are associated with HPV infection, such as koilocytes, are also commonly seen in Cervical intraepithelial neoplasia (CIN).
- However most CIN spontaneously regress. Left untreated, about 70% of CIN-1 will regress within one year, and 90% will regress within two years. About 50% of CIN 2 will regress within 2 years without treatment.
- Progression to cervical cancer in situ (CIS) occurs in approximately 11% of cervical intraepithelial neoplasia(CIN1) and 22% of cervical intraepithelial neoplasia(CIN2). Progression to invasive cancer occurs in approximately 1% of cervical intraepithelial neoplasia (CIN1), 5% in cervical intraepithelial neoplasia (CIN2) and at least 12% in cervical intraepithelial neoplasia (CIN3).
- This process can be quite slow. Longitudinal studies have shown that in patients with untreated in situ cervical cancer, 30% to 70% will develop invasive carcinoma over a period of 10 to 12 years. However, in about 10% of patients, lesions can progress from in situ to invasive in a period of less than 1 year. As it becomes invasive, the tumor breaks through the basement membrane and invades the cervical stroma.[1]
Prognosis
Early diagnosis and prompt treatment cure nearly all cases of cervical dysplasia. Sometimes, the condition returns.
Without treatment, severe cervical dysplasia may develop invasive cancer. It can take 10 or more years for cervical dysplasia to develop into cancer. The risk of cancer is lower for mild dysplasia.