N512- Low-grade Cervical Dysplasia Discussion

A Pap smear removes cervical cells to assess for pre-cancerous and cancerous cells. The pap test results will be classified as low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or atypical glandular or squamous cells. The squamous cells of the cervix are found on the lining of the outer portion of the cervix. The inner portion of the cervix are where columnar cells are found. Both sites are considered the outer surface lining of the cervix.

Tissue cells in LSIL mean there are changes in the appearance of normal cells. Although the cells still appear somewhat normal, there may be some with odd shapes, some cells that are larger and more frequent in number across the surface lining of the cervix. These cells are involved in the lower one-third of the squamous epithelium.

In HSIL, the abnormal cells are well observed in abnormal size and shape and are increased in number from the normal cells. These cells also only involve the surface of the outer lining of the cervix. HSIL can be moderate involving the lower two-thirds of the squamous epithelium, and the severe dysplasia involves the entire layer of the squamous epithelium (American Academay of Family Physicians, 2018; Rogel Center Center Michigan Medicine, n.d.; The John Hopkins University, n.d.; Zheng & Pruett, 2020).

Research has found that cervical dysplasia is commonly caused by a viral infection, specifically, the human papillovirus (HPV), which is also the most common cause of cervical cancer around the world. HPV is a DNA virus with many genotypes that cause skin infections and introduce infection into mucosal cells which help to explain the cell changes seen (World Health Organization, 2020). HPV is also associated with oropharynx, vaginal, and anus cancers. The oncogenic HPV type is not genetically inherited. The viral gene causes genes in the host cells to change (mutate) from the way they normally function by causing abnormal cell protein instructions to take over the way the normal healthy cells generate and grow giving rise to abnormal tissue growth (dysplasia) that can progress to tumors and cancer. In particular, the oncogenes of HPV will encode certain normal proteins in the host changing them to oncoproteins. Because these oncoproteins have been isolated, antibodies have been found to target these oncoproteins in which vaccines have been developed to help prevent HPV infection. For example, two HPV oncoproteins (E6 and E7) are found to disrupt normal cell function. E6 will adhere to and deactivate the p53 tumor suppressor gene, and the E7 will adhere to and deactivate the Rb tumor suppressor gene in the human body. These two genes are significant because out of the many strains of HPV, the HPV strain variations with E6 and E7 oncoproteins variations are related to a low risk or a high risk of developing cancer. The low risk types are associated with benign neoplastic growths whereas the high-risk types cause pre-cancerous changes in mucosal tissues. (Abcore, Inc., 2020; Hammer & McPhee, 2019).

Ms. Van’s prognosis at this time is good since most mild cases of cervical dysplasia resolve on their own. Given Ms. Van’s age and knowing that HPV is a common cause of cervical dysplasia, it would be important to obtain a biopsy to assess for depth of the involvement and whether there is HPV influence. Even though an HPV related dysplasia progression to cervical cancer usually takes many years, knowing the type of HPV would provide a more definitive diagnosis, treatment plan, and prognosis for her. At this point, her prognosis is good. Due to her age, she may or may not clear the HPV on her own which can take up to two years in younger adults. If she were positive for HPV, close continued surveillance would be important. The American College of Obstetricians and Gynecologist (ACOG) recommend to repeat the Pap test in one year for LSIL (American College of Obstetricians and Gynecologist, 2020).

 

References:

 

Abcore, Inc. (2020). Oncoproteins. Retrieved from https://www.abcore.com/oncoproteins

American Academay of Family Physicians. (2018, November 13). Cervical Dysplasia. Retrieved from https://familydoctor.org/condition/cervical-dysplasia/

American College of Obstetricians and Gynecologist. (2020). Abnormal Cervical Cancer Screening Test Results. Retrieved from https://www.acog.org/patient-resources/faqs/gynecologic-problems/abnormal-cervical-cancer-screening-test-results

Hammer, G. D., & McPhee, S. (2019). Pathophysiology of Disease: An Introduction to Clinical Medicine (8 ed.). New Youk: McGraw-Hill Education Medical.

Rogel Center Center Michigan Medicine. (n.d.). Squamous Intraepithelial Lesion (SIL). Retrieved from https://www.rogelcancercenter.org/gynecologic-cancers/prevention/pre-cancerous-conditions/squamous-intraepithelial-lesion

The John Hopkins University. (n.d.). Cervical Dysplasia. Retrieved from https://www.hopkinsmedicine.org/kimmel_cancer_center/cancers_we_treat/cervical_dysplasia/diagnosis_and_treatment/abnormal_pap_test.html

World Health Organization . (2020). Biologicals . Retrieved from https://www.who.int/biologicals/areas/human_papillomavirus/en/#:~:text=Human%20papillomavirus%20(HPV)%20is%20a,approximately%208%2Dkb%20in%20length.

Zheng, A. K., & Pruett, D. (2020). Abnormal Pap and Cervical Dysplasia. Retrieved from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116920/all/Abnormal_Pap_and_Cervical_Dysplasia

Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Low Grade Cervical Dysplasia

            Pap smear is a test that is usually recommended during health exams for females especially when they become sexually active. If the result shows an abnormal growth on the surface lining of the cervix, implies you have cervical dysplasia. This disease ranges from mild to severe. To prevent the disease from progressing to a more severe form like invasive cervical carcinoma, early detection and treatment after proper screening is necessary (Hammer, G.D., & McPhee, S.J., 2019. P.57).

See Van in our case study was diagnosed with low-grade cervical dysplasia which is the mild form of the disease. This means that the abnormal cells are found on the surface of the cervix (epithelium). Human papillomavirus (HPV) infection is generally the cause for Cervical dysplasia (Stoppler, 2016). Cervical dysplasia is generally cause by HPV. Therefore, it is important to take the necessary precautions to prevent the infection from the virus. HPV vaccine is usually given between the ages of 9 to 26 and according to the Center of disease prevention and control recommendation it should be given between the ages of 11 and 12 (Blackburn, K.B., 2018).

Low-grade cervical dysplasia usually goes away by itself and it does not mean you have cancer, or you’ll get cancer in the future (Nathan-Garner, L., 2017). The fact that See Van’s was diagnosed early and with the right treatments, she has very low chances for the disease to progress and develop into cancer. See Van is 35 years old and if she was not vaccinated, she should discuss about the benefit of the HPV vaccine with her Certified Midwife’s practice. This will prevent her from having the disease again after treatment.

Five years ago, my cousin when for her yearly physical and her pap smear came back abnormal. Her doctor referred her to a gynecologist who did a biopsy of her cervices. She was diagnosed with moderate grade cervical dysplasia. The doctor discussed different treatment options with her. She was so scared that the disease may affect her chances of having a baby because she just got married and they had plans of having their own baby. The doctor told her to try to conceive as soon as possible and will be closely monitored. She got pregnant two months later and she had frequent pap smears. She carried her pregnancy to term without issues and immediately after birth, she had a partial hysterectomy. Her gynecologist still scheduled her for a pap smear after a year and the result was normal.

Having an abnormal result after a regular yearly test can be very scary. Early detection of cervical dysplasia is important because the damage is still on the epithelia cell of the cervix. At this stage the disease has a very good prognosis. It is necessary to get HPV vaccine when recommended by your doctor because HPV infection is the main cause of the disease.

 

References:

Hammer, G.D. & McPhee, S.J., (2019). Pathophysiology of disease: An introduction to

clinical medicine (8th ed.). New York, NY: McGraw-Hill Education/Medical.

Blackburn, K.B., (2018). HPV vaccine: What age is too late? MD Anderson Center.

The University of Texas. Retrieved from https://www.mdanderson.org/publication/focus-on-health/focus-on-health-june-2018/hpv-vaccine-when-is-it-too-late.htm.

Nathan-Garner, L., (2017). Abnormal Pap test? What to know about cervical dysplasia? MD

Anderson Center. The University of Texas. Retrieved from https://www.mdanderson.org/cancerwise/abnormal-pap-test–what-to-know-about-cervical-dysplasia.html

Stoppler, M.C., (2016). Cervical Cancer Symptoms, Stages, and Treatment. Retrieved from

https://medicinenet.com/cervical_dysplasia/article.htm.

 

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