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Cervical Dysplasia
Also Listed As: Cancer, Cervical; Cervical
Cancer; Pap Smear, Abnormal
Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Medications
Surgery and Other Procedures
Nutrition and Dietary Supplements
Other Considerations
Prognosis and Complications
Supporting Research
Cervical dysplasia is a condition characterized
by the presence of abnormal cells in the cervix, indicating
either precancerous or cancerous cells. The condition is
classified as low-grade or high-grade, depending on the
extent of the abnormal cell growth. Low-grade cervical dysplasia
progresses very slowly and typically resolves on its own.
High-grade cervical dysplasia, however, tends to progress
quickly and usually leads to cervical cancer. An estimated
66% of cervical dysplasia cases are estimated to progress
to cancer within 10 years.
Signs and Symptoms
Cervical dysplasia often produces no symptoms and
is usually discovered during an annual Pap smear.
Occasional signs and symptoms of the condition can include:
Genital warts
Abnormal bleeding
Spotting after intercourse
Vaginal discharge
Low back pain
It is important to note that these symptoms are not unique
to cervical dysplasia and they may indicate a different
problem. If you are experiencing any of these signs or symptoms,
you should see your physician for an accurate diagnosis.
Causes
The precise cause of cervical dysplasia is not
known. Studies have found a strong association between cervical
dysplasia and infection with human papilloma virus (HPV),
but additional factors (still unknown) must also be at play
in order for cervical cells to change and become precancerous.
Risk Factors
The following may increase an individual's risk
for developing cervical dysplasia:
Human papilloma virus (HPV) infection
Genital warts
Smoking
Early onset of sexual activity (younger than 18 years
old)
Multiple sexual partners
Having a partner whose former partner had cervical cancer
History of one or more sexually transmitted diseases,
such as genital herpes or HIV
Having suppressed immune function from, for example, HIV
or the use of chemotherapeutic medications to treat cancer
Long-term use (5 or more years) of birth control pills
Being born to a mother who took diethylstilbestrol (DES)
to become pregnant or to sustain pregnancy (this drug was
used many years ago to promote pregnancy but it is no longer
used for these purposes)
Low levels of folate (vitamin B9) in red blood cells
Dietary deficiencies in vitamin A, beta-carotene, selenium,
vitamin E, and vitamin C (scientific data are not entirely
conclusive at this time, see section on Nutrition and Dietary
Supplements)
Diagnosis
If any of the symptoms mentioned earlier are present,
the physician will perform a physical including an abdominal,
back, and pelvic examination. As part of the pelvic exam,
a Pap smear will be performed to detect precancerous or
cancerous cells in the cervix. A Pap smear is also performed
annually for screening purposes even when no symptoms are
present. This test may be performed more or less often than
once a year, depending on your individual medical history
and risk factors for cervical cancer. For example, an individual
who has had abnormal Pap smears in the past may require
more tests than an individual who has always had normal
Pap smears. But, if you have had normal pap smears 3 years
in a row and you are over age 30, your doctor may perform
a pap smear test only every 2 to 3 years. If there are any
questionable or unclear results from the Pap smear, one
of the following tests will be performed by a gynecologist:
Colposcopy a procedure in which the physician uses a
viewing tube with a magnifying lens to examine the abnormal
cell growth in the cervix
Biopsy a small sample of tissue is removed from the
cervix and examined under a microscope for any signs of
cancer
Preventive Care
While there is no established strategy for preventing
cervical dysplasia, regular Pap smears are the most effective
and reliable method of identifying the condition in its
early stages. Such early detection is key to preventing
the condition from progressing to cervical cancer. Women
should begin receiving annual Pap smears as soon as they
become sexually active or no later than age 21. Women whose
mothers took DES during pregnancy are advised to begin regular
Pap smears at age 14, at the onset of their first menstrual
period, or as soon as they become sexually active, whichever
comes first.
Barrier contraceptives, such as condoms, may offer some
degree of protection from cervical dysplasia.
Some lifestyle modifications may also help prevent the development
of cervical dysplasia:
Practicing safe sex
Not smoking
Eating a diet rich in beta-carotene, vitamin C, and folate
(vitamin B9)
from fruits and vegetables
Treatment Approach
Surgical removal of abnormal tissue is
the treatment of choice for cervical dysplasia. Medications
are not used to treat cervical dysplasia, and few complementary
or alternative therapies have been evaluated for their effectiveness
in treating the condition. Several studies indicate, however,
that the development and progression of cervical dysplasia
may be related to certain nutritional deficiencies, including
folate, beta-carotene, and vitamin C.
Medications
Medications are not used to treat cervical dysplasia.
Surgery and Other Procedures
Surgical removal of abnormal tissue is the most
common method of treating cervical dysplasia. Ninety percent
of these procedures can be done in an outpatient setting.
These procedures include:
Cryocauterization extreme cold destroys abnormal cervical
tissue; this is the simplest and safest procedure and it
usually destroys 99% of the abnormal tissue; frequently
performed without anesthesia
Laser therapy lasers destroy abnormal cervical tissue
with less scarring than cryocauterization; more costly than
cryocauterization; performed with local anesthesia; 90%
cure rate
Loop electrosurgical excision (LEEP) thin loop wire
excises visible patches of abnormal cervical tissue; performed
with local anesthesia; 90% cure rate
Cervical conization small cone-shaped sample of abnormal
tissue is removed from the cervix; requires general anesthesia;
70% to 98% cure rate, depending on whether cancer cells
have spread beyond the cervix
Nutrition and Dietary Supplements
Several population-based studies have suggested
that eating a diet rich in the following nutrients from
fruits and vegetables may protect against the development
of cervical cancer:
Beta-carotene
Some research suggests that individuals deficient in beta-carotene
may be more likely to develop cancerous or precancerous
cervical lesions, but this relationship remains inconclusive.
Other studies indicate that oral supplementation with beta-carotene
may promote a regression, or decline in the signs of cervical
dysplasia. Despite these promising results, the benefit
of using beta-carotene supplements to prevent the development
of cervical dysplasia or cervical cancer has not been proven.
Folate (Vitamin B9)
Like beta-carotene, some evidence suggests that folate (also
known as vitamin B9) deficiencies may contribute to the
development of cancerous or precancerous lesions in the
cervix. Researchers also theorize that folate consumed in
the diet may improve the cellular changes seen in cervical
dysplasia by lowering homocysteine (a substance believed
to contribute to the severity of cervical dysplasia) levels.
The benefit of using dietary folate to prevent or treat
cervical dysplasia has not been sufficiently proven.
Other dietary nutrients that may protect against the development
of cervical cancer include:
Vitamin C
Selenium
Vitamin E
Vitamin A
Vitamin B12
Vitamin B6
In addition, some of the risk factors for cervical dysplasia
may cause certain nutritional deficiencies. For example,
smoking may contribute to a deficiency in vitamin C and
long-term use of birth control pills may diminish folate
levels. Research has yet to prove whether taking vitamin
C and folate supplements can help prevent or treat cervical
dysplasia or cervical cancer. At the same time, it seems
prudent to eat a diet rich in fruits and vegetables which
contain vitamin C, folate, and beta-carotene, as these nutrients
have been shown to have many health benefits.
Other Considerations
Pregnancy
Cases of cervical dysplasia may advance during pregnancy,
but treatment can generally be deferred until after delivery
A biopsy to diagnose cervical dysplasia is safe to perform
during pregnancy
Treatment with cervical conization may adversely affect
fertility
Prognosis and Complications
Pap smears are essential to detecting
precancerous lesions as well as early stages of cervical
cancer. The regular use of Pap smears as a screening test
has prevented millions of cases of cervical cancer and has
saved a similar number of lives. Despite their value, they
are not always 100% accurate. Up to 2% of women with normal
Pap smear results actually have high-grade cervical dysplasia
at the time of evaluation. In some rare cases, Pap smears
may produce "false positive" results, meaning
that a healthy woman may be falsely diagnosed with cervical
dysplasia. Despite these errors, Pap smears are the most
effective and reliable method of identifying cervical dysplasia.
Cervical cancer, a major complication of cervical dysplasia,
is the leading cause of death in many developing and poorer
countries and accounts for 4,800 deaths in the United States
every year. Most cervical cancer deaths occur in women who
have not had a Pap smear. Cervical cancer constitutes more
than 10% of cancers worldwide and it is the second leading
cause of death in women between the ages of 15 and 34.
With early identification, treatment, and consistent follow-up,
nearly all cases of cervical dysplasia can be cured. Without
treatment, many cervical dysplasia cases progress to cancer.
Women who have been treated for cervical dysplasia have
a lifetime risk for recurrence and malignancy. Fortunately,
while the incidence of cervical dysplasia has been on the
rise, the incidence of cervical cancer has declined dramatically.
This may be due to improved screening techniques, which
identify cases of cervical dysplasia in the early stages,
before they have progressed to cancer.
Supporting Research
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Review Date: June 2003
Reviewed By: Participants in the review process include:
Constance Grauds, RPh, President, Association of Natural
Medicine Pharmacists, San Rafael, CA; Jacqueline A. Hart,
MD, Department of Internal Medicine, Newton-Wellesley Hospital,
Harvard University and Senior Medical Editor Integrative
Medicine, Boston, MA; Peter Hinderberger, MD, PhD, Ruscombe
Mansion Community Health Center, Baltimore, MD.
Copyright © 2004 A.D.A.M., Inc
The publisher does not accept any responsibility for the
accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information
contained herein, including any injury and/or damage to
any person or property as a matter of product liability,
negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims
or endorsements are made for any drugs or compounds currently
marketed or in investigative use. This material is not intended
as a guide to self-medication. The reader is advised to
discuss the information provided here with a doctor, pharmacist,
nurse, or other authorized healthcare practitioner and to
check product information (including package inserts) regarding
dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed
herein.
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