Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Cervical dysplasia refers to the presence of precancerous changes of the
cells that make up the inner lining of the cervix, the opening to the womb (uterus). The term
dysplasia refers to the abnormal appearance of the cells when viewed under the
microscope. The degree and extent of abnormality seen on a tissue sample (such
as a Pap smear) was formerly referred to as mild, moderate,
or severe dysplasia. In recent years, this nomenclature has been replaced by two
newer systems. These systems are based upon changes in the appearance of cells
visualized when smears of individual cells (cytological changes) or tissue
biopsies (histological changes) are reviewed under a microscope.
Squamous intraepithelial lesion is the
pathology terminology for
cervical dysplasia observed in smears of cells taken from the cervix.
Squamous refers to the type of cell that lines the cervix.
intraepithelial refers to the fact that
these cells are present in the lining tissue of the cervix.
Cervical intraepithelial neoplasia iscervical dysplasia
that is observed on a cervical biopsy
or surgically removed cervix.
These classification systems will be
further discussed below.
What causes cervical dysplasia?
Cervical dysplasia is caused by infection of the cervix
with the human papillomavirus (HPV). Although there are over 100 HPV types, a subgroup of HPVs
have been found to infect the lining cells of the genital and reproductive tract
in women. HPV is a very common infection and is transmitted through sexual
contact; over 75% of sexually active women are thought to acquire the
virus at
one point or another. It is believed that over 6 million people become infected
with HPV every year in the US, and approximately 50% of those infected are
between the ages of 15 and 25. Most infections occur in young women, do not
produce symptoms, and resolve spontaneously without any long-term consequences.
The average length of new HPV infections in young women is 8-13 months. However,
it is possible to become re-infected with a different HPV type.
Some HPV infections persist over time rather than resolve,
and the reason why the infection persists in these women is not fully
understood. Factors that may influence persistence of the infection include:
advancing age,
duration of the infection, and
being infected with a "high-risk"
HPV type (see below).
Persistent HPV infection has been shown to play a causal
role in the development of genital warts and precancerous changes (dysplasia) of
the uterine cervix as well as cervical cancer. Even though HPV infection appears
to be necessary for the development of cervical dysplasia and cancer, since not
all women who have HPV infection develop dysplasia or cancer of the cervix. Additional, yet uncharacterized factors must also be important in causing cervical dysplasia and
cancer. Since HPV infections are transmitted primarily by sexual intimacy, the
risk of infection increases as the number of sexual partners increases.
Among the HPVs that infect the genital tract, certain types typically cause
warts or mild dysplasia ("low-risk" types; HPV-6, HPV-11), while other types
(known as "high-risk" HPV types) are more strongly associated with severe
dysplasia and cervical cancer (HPV-16, HPV-18). Cigarette smoking and
suppression of the immune system (such as with concurrent HIV infection) have
been shown to increase the risk for HPV-induced dysplasia and cancer of the
cervix.
The HPV types that cause cervical cancer also have been
linked with both anal and penile
cancer in men as well as a subgroup of head and neck cancers in both
women and men.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
A hysterectomy is a surgical procedure whereby the
uterus (womb) is removed. Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States.
How common is hysterectomy?
Approximately 300 out of every 100,000 women will undergo a hysterectomy.
Why is a hysterectomy performed?
The most common reason
hysterectomy is performed is for uterine fibroids The next most common reasons
are:
abnormal uterine bleeding (vaginal
bleeding),
cervical dysplasia (pre-cancerous conditions of the cervix),
endometriosis, and uterine prolapse (including
pelvic relaxation).
Only 10% of hysterectomy is performed for
cancer. This article will primarily focus on
the use of hysterectomy for non-cancerous, non-emergency reasons, which can involve
even more challenging decisions for women and their do...
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