Cervical dysplasia

Introduction

Cervical dysplasia is the abnormal growth of precancerous cells on the surface of the cervix. 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 often gets better on its own. High-grade cervical dysplasia can lead to cervical cancer. Without treatment, 30 - 50% of cases of severe cervical dysplasia progress to invasive cancer. The risk of cancer is lower for mild dysplasia.

Cervical dysplasia is associated with the human papillomavirus (HPV), a sexually transmitted virus. A vaccine is available to protect against HPV, and regular Pap tests can usually find cervical dysplasia and treat it in its earl stage. Currently, 11% of U.S. women report that they do not have regular Pap tests.

Signs and Symptoms

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

Occasional signs and symptoms of the condition can include:

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

These symptoms can also be caused by other conditions. It's 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 infection with HPV.

Risk Factors

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

  • Human papillomavirus (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
  • History of one or more sexually transmitted diseases, such as genital herpes or HIV
  • Having suppressed immune system, such as from HIV or chemotherapy to treat cancer
  • 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 entirely conclusive at this time; see section on Nutrition and Dietary Supplements)

Diagnosis

If you have any of the symptoms mentioned earlier, 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 when no symptoms are present. 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 preventing 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 - 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:

  • 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. 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 -- 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. Cryocauterization is frequently performed 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, a small cone-shaped sample of abnormal tissue is removed from the cervix. Cervical conization requires general anesthesia and has a 70 - 98% cure rate, depending on whether cancer cells have spread beyond the cervix.

Nutrition and Dietary Supplements

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 any supplements. Some nutrients can interfere with certain medications and procedures.

  • Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables, 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 - 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

Some controversial clinical studies suggest that people who are deficient in beta-carotene may be more likely to develop cancerous or precancerous cervical lesions, but the research isn't clear. Other studies suggest that taking a beta-carotene supplement may help reduce the signs of cervical dysplasia. Despite these promising results, there is no proof that using beta-carotene supplements to prevent cervical dysplasia is effective.

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 folate, also known as vitamin B9, deficiencies 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. There is no clear proof, however, that eating more folate in your diet can help prevent or treat cervical dysplasia.

Ask your doctor if you would benefit from these supplements:

  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease 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, but more research is needed. Taking this compound as a supplement may interact with other medications, so ask your doctor before taking it to be safe. It is safe to eat vegetables that contain this compound.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, 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 the human papilloma virus (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, 300 mg 3 times a day, for inflammation. Turmeric may increase the risk of bleeding, especially if you also take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Pregnant women and people with gallstones or gallbladder disease should not take turmeric.

Other Considerations

Pregnancy

  • Cervical dysplasia may get worse during pregnancy, but treatment can generally be put off until after delivery.
  • It's safe to do a biopsy to diagnose cervical dysplasia during pregnancy.
  • Treatment with cervical conization may affect fertility.

Prognosis and Complications

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 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.

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

References

Ahn WS, Yoo J, Huh SW, et al. Protective effects of green tea extracts (polyphenon E and EGCG) on human cervical lesions. Eur J Cancer Prev. 2003;12:383-90.

Bell MC, Crowley-Nowick P, Bradlow HL, et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol. 2000;78:123-9.

Gingelmaier A, Grubert T, Kaestner R, et al., High recurrence rate of cervical dysplasia and persistence of HPV infection in HIV-1-infected women. Anticancer Res. 2007;27(4A):1795-8.

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.

Hernandez BY, McDuffie K, Franke AA, Killeen J, Goodman MT. Reports: plasma and dietary phytoestrogens and risk of premalignant lesions of the cervix. Nutr Cancer. 2004;49(2):109-24.

Hernandez BY, McDuffie K, Wilkens LR, Kamemoto L, Goodman MT. Diet and premalignant lesions of the cervix: evidence of a protective role for folate, riboflavin, thiamin, and vitamin B12. Cancer Causes Control. 2003;14(9):859-70.Kim YT, Kim JW, Choi JS, Kim SH, Choi EK, Cho NH. Relation between deranged antioxidant system and cervical neoplasia. Int J Gynecol Cancer. 2004;14(5):889-95.

Liao SY, Stanbridge EJ. Expression of MN/CA9 protein in Papanicolaou smears containing atypical glandular cells of undetermined significance is a diagnostic biomarker of cervical dysplasia and neoplasia. Cancer. 2000;88(5):1108-1121.

Paavonen J, Jenkins D, Bosch FX, et al.; HPV PATRICIA study group. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet. 2007;369(9580):2161-70.

Piyathilake CJ, Henao OL, Macaluso M, Cornwell PE, Meleth S, Heimburger DC, Partridge EE. Folate is associated with the natural history of high-risk human papillomaviruses. Cancer Res. 2004;64(23):8788-93.

Qi M, Anderson AE, Chen DZ, Sun S, Auborn KJ. Indole-3-carbinol prevents PTEN loss in cervical cancer in vivo. Mol Med. 2005;11(1-12):59-63.

Hudspeth, R. Ratcliffe: Family Medicine Obstetrics, 3rd ed. Mosby Elsevier: Philadelphia, PA. 2008.

Rock CL, Michael CW, Reynolds RK, Ruffin MT. Prevention of cervix cancer. Crit Rev Oncol Hematol. 2000;33(3):169-185.

Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin. 2002;52(6):342-362.

Sedjo RL, Inserra P, Abrahamsen M, et al. Human papillomavirus persistence and nutrients involved in the methylation pathway among a cohort of young women. Cancer Epidemiol Biomarkers Prev. 2002;11(4):353-359.

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Thomson SW, Heimburger DC, Cornwell PE, et al. Correlates of total plasma homocysteine: folic acid, copper, and cervical dysplasia. Nutrition. 2000;16(6):411-416.

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Alternative Names

Cancer - cervical; Cervical cancer; Pap smear - abnormal

Version Info

  • Last Reviewed on 09/29/2011
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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This page was last updated: May 7, 2013

         
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