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Table of Contents > Conditions > Cervical Dysplasia
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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Batieha AM, Armenian HK, Norkus EP, Morris JS, Spate VE, Comstock GW. Serum micronutrients and the subsequent risk of cervical cancer in a population-based nested case-control study. Cancer Epidemiol Biomarkers Prev. 1993;2(4):335-339.

Behrman RE, ed. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, Pa: W.B. Saunders; 1996.

Brown AD, Garber AM. Cost-effectiveness of 3 methods to enhance the sensitivity of Papanicolaou testing. JAMA. 1999;281(4):347-353.

Butterworth CE Jr, Hatch KD, Macaluso M, et al. Folate deficiency and cervical dysplasia. JAMA. 1992(a);267(4):528-533.

Butterworth CE Jr, Hatch KD, Soong SJ, et al. Oral folic acid supplementation for cervical dysplasia: a clinical intervention trial. Am J Obstet Gynecol. 1992(b);166(3):803-809.

Canale ST. Campbell's Operative Orthopaedics. 9th ed. St. Louis, Mo: Mosby, Inc.; 1998.

Childers JM, Chu J, Voigt LF, et al. Chemoprevention of cervical cancer with folic acid: a phase III Southwest Oncology Group Intergroup study. Cancer Epidemiol Biomarkers Prev. 1995;4(2):155-159.

Comerci JT Jr, Runowicz CD, Fields AL, et al. Induction of transforming growth factor-beta1 in cervical intraepithelial neoplasia in vivo after treatment with beta-carotene. Clin Cancer Res. 1997;3(2):157-160.

Cox JT. Evaluating the role of HPV testing for women with equivocal Papanicolaou test findings. JAMA. 1999;281(17):1645-1647.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

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De Vita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 5th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1997.

Fairley CK, Tabrizi SN, Chen S, et al. A randomised clinical trial of beta-carotene vs placebo for the treatment of cervical HPV infection. Int J Gynecol Cancer. 1996;6:225-230.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:609-610.

Giuliano AR, Gapstur S. Can cervical dysplasia and cancer be prevented with nutrients? Nutr Rev. 1998;56(1):9-16.

Goodman MT, McDuffie K, Hernandez B, Wilkens LR, Selhub J. Case-control study of plasma folate, homocysteine, vitamin B12, and cysteine as markers of cervical dysplasia. Cancer. 2000;89(2):376-382.

Hudson T. Cervical atypia, dysplasias and carcinoma in situ. Townsend Letter for Doctors and Patients. 1992;No. 102:32-41.

Kuttan G, Menon LG, Kuttan R. Prevention of 20-methylcholanthrene-induced sarcoma by a mistletoe extract, Iscador. Carcinogenesis. 1996;17(5):1107-1109.

Kwasniewska A, Tukendorf A, Semczuk M. Folate deficiency and cervical intraepithelial neoplasia. Eur J Gynaecol Oncol. 1997;18(6):526-530.

Lee KE, Koh CF, Watt WF. Comparison of the grade of CIN in colposcopically directed biopsies with that in outpatient loop electrosurgical excision procedure (LEEP) specimens—a retrospective review. Singapore Med J 1999;40(11):694-696.

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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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