Cervical dysplasia

Signs and Symptoms

Cervical dysplasia often has no symptoms. It is usually discovered during an annual Pap test.

Occasional signs and symptoms of the condition include:

• Genital warts
• Abnormal bleeding
• Spotting after intercourse
• Vaginal discharge
• Low back pain

These symptoms can also be caused by other conditions. It is important to see your doctor for an accurate diagnosis.

Causes

The precise cause of cervical dysplasia is not known. Studies have found a strong association between cervical dysplasia and HPV infection.

Risk Factors

The following may increase a person's risk for developing cervical dysplasia:

• HPV infection
• Genital warts
• Smoking
• Being sexually active at a younger age (younger than 18 years old)
• Giving birth before age 16
• Having multiple sexual partners
• Having a partner whose former partner had cervical cancer
• Having a systemic inflammatory disease, such as lupus, rheumatoid arthritis, and inflammatory bowel disease
• History of one or more sexually transmitted diseases, such as genital herpes or HIV
• Having a suppressed immune system, such as from HIV or chemotherapy to treat cancer
• Lack of prior Pap smear screening
• Using birth control pills for longer than 5 years
• 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 is not conclusive)
• Exposure to air pollutants

Diagnosis

If you have any symptoms of cervical dysplasia, your doctor will perform a physical, including an abdominal, back, and pelvic examination. The doctor will also do a Pap test to detect precancerous or cancerous cells in the cervix. A Pap test is also done annually for screening purposes, even in the absence of cervical dysplasia symptoms. Depending on your history, a Pap test may be done more or less often. If there are any questionable or unclear results from the Pap smear, a gynecologist will do one of the following tests:

• Colposcopy. A procedure where the doctor 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 sure way to prevent cervical dysplasia, regular Pap smears are the most effective way to identify it in its early stages and prevent it from progressing to cervical cancer. Women should begin getting 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.

Girls as young as 9, and women as old as 26, can get the HPV vaccine (Cervarix, Gardasil) that protects against HPV, the most common cause of cervical cancer. The vaccine is also approved for boys and young men, ages 9 to 26. Although the vaccine could prevent up to 70% of cervical cancer cases, it cannot prevent infection with every virus that causes cervical cancer. Routine Pap tests to screen for cervical cancer remain very important.

Some lifestyle modifications may also help prevent the development of cervical dysplasia, including:

• Practicing safe sex
• Not smoking
• Eating a diet rich in beta-carotene, vitamin C, and folate (vitamin B9) from fruits and vegetables. Cruciferous vegetables, such as cabbage, cauliflower, and broccoli, are especially important in preventing cancers such as cervical cancer.

Treatment Approach

An important consideration in deciding whether or not to treat cervical dysplasia is how the treatment may affect future fertility. There are no good studies investigating infertility after treatment for cervical dysplasia, but there is some evidence of increased risk of preterm delivery among pregnant women.

Surgical removal of abnormal tissue is still 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. However, several studies indicate that the development and progression of cervical dysplasia may be related to certain nutritional deficiencies, including folate, beta-carotene, and vitamin C.

Medications are not used to treat cervical dysplasia. But preliminary studies suggest that a topical medication called Imiquimod may enhance the immune response to HPV-induced genital warts. Preliminary studies also suggest that tretinoin, a topical form of vitamin A, applied to the cervix may help the regression rate of cervical dysplasia.

Surgical removal of abnormal tissue is the most common method of treating cervical dysplasia. Doctors can perform about 90% of these procedures in an outpatient setting. These procedures include:

• Cryocauterization. Cryocauterization uses extreme cold to destroy abnormal cervical tissue. This is the simplest and safest procedure, and it usually destroys 99% of the abnormal tissue. Doctors frequently perform dysplasia cryocauterization without anesthesia.
• Laser therapy. Lasers destroy abnormal cervical tissue with less scarring than cryocauterization. Lasers are more costly than cryocauterization, are performed with local anesthesia, and have a 90% cure rate.
• Loop electrosurgical excision (LEEP). During a LEEP, a thin loop wire excises visible patches of abnormal cervical tissue. LEEP is performed with local anesthesia and has a 90% cure rate.
• Cervical conization. During a cervical conization, doctors remove a small cone-shaped sample of abnormal tissue from the cervix. Cervical conization requires general anesthesia and has a 70 to 98% cure rate, depending on whether cancer cells have spread beyond the cervix.

Following these nutritional tips may help reduce the chances of developing cervical dysplasia. However, if you have cervical dysplasia, you should ask your doctor before making any changes to your diet or taking supplements. Some nutrients can interfere with certain medications and procedures.

• Eat calcium-rich foods, including beans, almonds, and dark, leafy greens, such as spinach and kale.
• Eat more cruciferous vegetables, such as cabbage, broccoli, and cauliflower.
• Eat antioxidant-rich foods, including fruits, such as blueberries, cherries, and tomatoes, and vegetables, such as squash and bell pepper.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat more lean meats, cold-water fish, or beans for protein.
• Use healthy oils, such as olive oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise moderately, for 30 minutes daily, 5 days a week.

Several population-based studies suggest that eating a diet rich in the following nutrients from fruits and vegetables may protect against the development of cervical cancer:

Beta-carotene

Studies suggest that people who are deficient in beta-carotene may be more likely to develop cancerous or precancerous cervical lesions, but the research is inconclusive. Other studies suggest that taking a beta-carotene supplement may help reduce the signs of cervical dysplasia. Despite these results, there is no proof that taking beta-carotene supplements is effective for preventing cervical dysplasia.

Some researchers think that supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this risk. Beta-carotene can interfere with some statin drugs.

Folate (Vitamin B9)

Like beta-carotene, some evidence suggests that deficiencies of folate, also known as vitamin B9, may contribute to the development of cancerous or precancerous lesions in the cervix. Some researchers also think that eating foods with folate may improve the cellular changes seen in cervical dysplasia by lowering homocysteine levels. Homocysteine is a substance believed to contribute to the severity of cervical dysplasia, however, there is no clear proof that adding more folate in your diet can help prevent or treat cervical dysplasia. DO NOT take more than 400 mcg of folate per day, unless instructed to do so by your physician. Some clinicians have expressed concern that taking very high doses of folate (800 to 1,200 mcg per day) over a long period of time may increase the risk of certain diseases. Speak with your physician.

Ask your doctor if you would benefit from these supplements:

• Omega-3 fatty acids, such as fish oil, to help reduce inflammation and improve general health. Omega-3 fatty acids may increase the risk of bleeding, especially if you take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins including folic acid, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Indole-3-carbinol, a compound derived from cruciferous vegetables, such as broccoli, Brussels sprouts, and cabbage. One study found that taking 200 mg or 400 mg of indole-3-carbinol helped treat cervical dysplasia. More research is needed. Taking this compound as a supplement may interact with other medications, especially hormone-related medications, so ask your doctor if it is safe to eat vegetables that contain this compound or take as a supplement.

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and can interact with other herbs, supplements, or medications. DO NOT self treat cervical dysplasia. Cervical dysplasia should be treated by a gynecologist. If you wish to use natural therapies in conjunction with conventional gynecological care, make sure you work with a knowledgeable proficer and tell your doctor about any and all natural therapies you are considering. You should take herbs with care, under the supervision of a health care practitioner.

If you have cervical dysplasia, ask your doctor before taking any herb.

• Green tea (Camelia sinensis) extracts as an ointment or pill. In one human study, an extract of green tea reduced cervical dysplasia caused by infection with HPV. More research is needed. Green tea may interact with a number of medications, especially if the tea contains caffeine. To be safe, ask your doctor before taking green tea as a supplement. People with diabetes and liver disease should also ask their doctors before taking green tea.
• Turmeric (Curcuma longa) standardized extract, for inflammation. Turmeric may increase the risk of bleeding, especially if you also take blood-thinning medications, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Pregnant women and people with gallstones or gallbladder disease should not take turmeric.

Other Considerations

Cervical dysplasia may get worse during pregnancy.

• Treatment can usually be postponed until after delivery.
• It is safe to do a biopsy to diagnose cervical dysplasia during pregnancy.
• Treatment with cervical conization may affect fertility.

Pap smears are essential to detecting precancerous lesions, as well as early stages of cervical cancer. 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 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 way to detect cervical dysplasia.

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 numbers of cervical dysplasia have been on the rise, the numbers of cervical cancer have declined. This may be due to better screening techniques, which identify cases of cervical dysplasia in the early stages.