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 SymptomsCervical 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
CausesThe 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.
The following may increase your risk for cervical dysplasia:
- Having sex before age 18
- Having a baby at very young age
- Having had multiple sexual partners
- Having other illnesses, such as tuberculosis or HIV
- Using medicines that suppress your immune system
Risk FactorsThe following may increase an individual's risk for developing cervical dysplasia:
- Human papilloma virus (HPV) infection
- Genital warts
- 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)
DiagnosisIf 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 CareWhile 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 ApproachSurgical 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.
MedicationsMedications are not used to treat cervical dysplasia.
Surgery and Other ProceduresSurgical 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 SupplementsSeveral 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:
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
- Vitamin E
- Vitamin A
- Vitamin B12
- Vitamin B6
- 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 ComplicationsPap 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.
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