Understanding Dysplasia: Precancerous Changes You Should Know

Dysplasia means abnormal growth or development, which can happen either at the cellular (microscopic) level or in organs (macroscopic). These changes affect the normal structure or function of tissues and organs.

Dysplasia is seen as different from other growth changes like hyperplasia (increased cells), metaplasia (cell type change), and neoplasia (new, often uncontrolled growth). Most dysplasias are not cancer, but some can be precancerous. For example, myelodysplastic syndromes can range from harmless to cancerous. This shows that dysplasia covers a wide range of abnormal tissue changes.

Causes of Dysplasia

Dysplasia occurs when normal cells are exposed to repeated damage or stress, leading them to grow and develop abnormally. Several factors can contribute to this condition, including:

• Chronic irritation: Long-term friction or pressure, such as from poorly fitting dentures or joint stress.
• Chronic inflammation: Persistent inflammation from conditions like gastritis or gum disease can damage cells.
• Infections: Certain viruses and bacteria, like HPV or H. pylori, can trigger abnormal cell growth.
• Mutagenic exposures: Tobacco, alcohol, radiation, and harmful chemicals can alter DNA and cause dysplasia.
• Genetic predisposition: Some people may naturally be more prone to abnormal cell changes.
• Immune system problems: A weakened or suppressed immune system increases the risk of dysplasia by failing to clear infections or damaged cells.

Types of Dysplasia

Microscopic dysplasia (Cell and Tissue Level)

Microscopic dysplasia is a diagnosis made by a pathologist looking at tissue under the microscope. It describes disordered cellular growth and architecture at the tissue/cell scale (for example, epithelial dysplasia, or fibrous dysplasia of bone). Pathologists often call these lesions intraepithelial neoplasia because the abnormal cells are confined above the basement membrane.

Examples of Microscopic Dysplasia

1. Epithelial Dysplasia:

Epithelial dysplasia is when the cells on the surface layer of the skin or an organ start to grow abnormally. These cells look different under a microscope and may be a warning sign that cancer could develop later if not treated.

2. Cervical Dysplasia:

Cervical dysplasia happens when cells on the cervix (the lower part of the uterus) grow abnormally. It is usually caused by certain types of human papillomavirus (HPV) and can sometimes lead to cervical cancer if not monitored or treated.

3. Oral Epithelial Dysplasia:

Oral epithelial dysplasia refers to abnormal changes in the cells lining the mouth. These changes may look like white or red patches and can sometimes develop into oral cancer if not checked or treated in time.

4. Fibrous Dysplasia of Bone:

Fibrous dysplasia of bone is a condition where normal bone is replaced by soft, fibrous tissue. This makes the bone weaker, misshapen, or prone to fractures. It can affect one bone or multiple bones in the body.

5. Tubular Adenoma of the Colon:

A tubular adenoma is a type of polyp found in the colon that shows dysplastic changes under the microscope. While usually benign, it is considered a precancerous lesion because it can progress to colorectal cancer if not removed. Colonoscopies often detect and remove these adenomas early to prevent cancer.

Tubular adenoma can be classified as low-grade dysplasia, showing mild cellular changes, or high-grade dysplasia, which carries a greater risk of progressing to colorectal cancer.

Macroscopic dysplasia (Organ Level)

Macroscopic dysplasia refers to abnormal development or structure of an entire organ or anatomical unit, usually visible on gross inspection, imaging, or at surgery. These are typically congenital or developmental anomalies in which normal organ architecture is replaced or grossly malformed.

Examples of Macroplastic Dysplasia

1. Hip Dysplasia:

Hip dysplasia is a condition where the hip joint does not form properly. The ball of the thigh bone doesn’t fit snugly into the hip socket, which can cause pain, limping, or arthritis later in life. It’s often present from birth.

2. Myelodysplastic Syndrome (MDS):

Myelodysplastic syndrome is a blood disorder where the bone marrow doesn’t make healthy blood cells. Instead, it produces abnormal or immature cells, leading to problems like anemia, infections, or easy bleeding. It is sometimes called a “pre-leukemia” condition.

3. Multicystic Dysplastic Kidney (MCDK):

Multicystic dysplastic kidney is a condition present at birth where one of the kidneys is replaced by many cysts (fluid-filled sacs) instead of normal kidney tissue. The affected kidney usually doesn’t work, but most people stay healthy if the other kidney functions normally.

How is Dysplasia Diagnosed?

Dysplasia is diagnosed differently depending on the organ or tissue involved, but here are the common methods doctors use:

Medical history & physical exam: Checking symptoms, risk factors, and visible abnormalities.

Imaging tests: X-rays, ultrasounds, CT scans, or MRIs help detect structural problems (e.g., hip dysplasia, kidney dysplasia).

Screening tests:

• Pap smear (for cervical dysplasia – looks at cervix cells under a microscope).
• Oral examination (for oral epithelial dysplasia – dentist/doctor checks mouth patches).

Biopsy: Taking a small tissue sample and examining it under a microscope to see abnormal cell growth (common for epithelial dysplasias).

Blood tests & bone marrow biopsy: Used for myelodysplastic syndrome to check if blood cells are formed normally.

Treatment Options for Dysplasia

Treatment depends on the type, severity, and location of dysplasia. The goal is to remove or control abnormal cells and prevent progression to cancer or other complications. Common options include:

1. Watchful waiting/Monitoring: In mild cases, doctors may closely monitor the condition with regular check-ups, Pap smears, imaging, or blood tests.
2. Medications: Antiviral, antibiotic, or anti-inflammatory medicines may be used if an infection or inflammation is the cause. In myelodysplastic syndrome, drugs to boost blood cell production may be prescribed.
3. Lifestyle changes: Stopping smoking, improving oral hygiene, or reducing irritants can help slow or stop dysplasia in some cases.
4. Minimally invasive procedures:
   • Cryotherapy (freezing abnormal cells)
   • Laser therapy (burning away abnormal tissue).
   • LEEP (Loop Electrosurgical Excision Procedure) for cervical dysplasiaThese treatments remove or destroy abnormal cells with little damage to surrounding healthy tissue.
5. Surgery: Removal of affected tissue or bone (in severe dysplasia or when precancerous changes are advanced). In kidney dysplasia, the non-functioning kidney may sometimes be removed.
6. Bone marrow transplant: A treatment option for severe myelodysplastic syndrome (MDS) when other therapies do not work.

Clinical Trials Leading the Fight Against Cancer

Advances in cancer treatment are made possible through oncology clinical trials, which test new therapies, drugs, and approaches to improve patient outcomes. These trials provide hope by giving patients access to innovative treatments while helping researchers find better ways to fight cancer.

One area of progress is Solid Tumor Clinical Trials in Nebraska, where researchers are testing potential new therapies. These studies aim to improve survival rates and quality of life by testing targeted and personalized treatment options.

Conclusion:

Dysplasia represents abnormal cell or tissue growth that can range from harmless to precancerous. While mild cases may reverse if triggers are removed, higher-grade dysplasia carries significant cancer risk. Early diagnosis, monitoring, and treatment are essential to prevent progression, making awareness and timely medical care vital for better outcomes.