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Warts and Dysplasia

Genital warts might or might not be "warts" in the conventional sense. Warts are most commonly caused by HPV and usually start out as small, raised bumps that are either white or flesh-colored and will grow if left untreated. Although they are quite a nuisance, genital warts are essentially harmless and will not cause cancer. However, they are very easily transmitted: you can spread them through sex, with or without a condom (since they can grow on areas that a condom doesn't cover), through touching yourself and then your partner " down there " (since you can get the virus on your hands by touching infected areas), and there is also a slight possibility of transmitting the virus through oral sex, though this is much less common. It is rare or unheard of to transmit the virus through toilet seats, public swimming pools, hot tubs etc. or any other everyday contact.

Dysplasia is a fancy term for abnormal (pre-cancerous) cells on the cervix, identified by an abnormal pap smear. The types of HPV that cause dysplasia are usually 16 and 18 (less commonly 31, 33, 35, 39, 45, 51, 52, 56, and 58). In fact, types 16, 18, 31, and 45 alone are responsible for 80% of all cervical cancer. This is not to say that having an abnormal pap smear means that you have, or will get, cancer. Thanks to pap smears, only about 2% of the women with dysplasia ever do develop cancer. All this means is that if your pap smear was abnormal, you have cells on your cervix that could turn into cancer if they were left untreated. It usually takes at least several years without any treatment for the cells to actually become cancerous, although this process can be faster if the immune system is compromised through immunosuppressant drugs or illness, such as AIDS. (It is especially important for HIV-positive women to get regular pap smears and monitor any cellular changes.) There are varying degrees of dysplasia, from the very mild, which doctors usually don't even treat because it goes away on its own, to the severe, which requires immediate surgery. (There are also anal cancerous risks, however much less common). Doctors use several classification systems to categorize them. These classification systems are a special favorite of mine, because they're so confusing (and if your doctor just told you that you have some sixteen-letter word on your cervix, you're probably confused too!). There is the Descriptive System, the CIN system, the Bethesda System, and the Class System.

The Descriptive System is very simple: you have mild dysplasia, moderate dysplasia, or severe dysplasia. Mild, as mentioned earlier, does not usually require any treatment, but may be monitored because it could progress, and further tests may be done. Moderate will definitely lead to some kind of further testing, such as a biopsy/colposcopy (a procedure where they insert a camera to look at the cervix and take a bigger sample of tissue). It may also require surgery, depending on the situation. Severe dysplasia certainly requires surgery, such as a LEEP procedure (where they take a wire loop and scrape the cells off).

The CIN system is still pretty simple: it uses CIN1, 2, 3, and 4. This is where CIN stands for "cervical intraepithelial neoplasia," or bad cells on the cervix, and 1 is mild, while 4 is severe.

The Bethesda system is not as easy to understand, but it's used most commonly and contains a word that keeps haunting our vocabulary: squamous intraepithelial lesion. "Squamous intraepithelial lesion," now what is that?! Do doctors do this just to prove that we don't know anything about the medical profession? In terms that the rest of us can understand, it means a patch of cells that have become abnormal. So now you know. There are four categories within the CIN system:

  1. ASC-US (Atypical squamous cells of undetermined significance): This means your pap smear is borderline, and you may or may not have HPV.
  2. ASC-H (Atypical squamous cells, cannot exclude HSIL): The results are still borderline, but you may very well have HSIL (high-grade lesions).
  3. LSIL (Low-grade squamous intraepithelial lesions) : Low-grade abnormal cells, or low/moderate dysplasia.
  4. HSIL (High-grade squamous intraepithelial lesions) : High-grade abnormal cells, or severe dysplasia.

The Class System just has Class 1 through 4. It is no longer widely used.

Related Page: Keeping Tabs on HPV



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