Introduction:

Cervical dysplasia is a condition characterized by the abnormal growth of cells on the surface of 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 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. Currently, 11% of U.S. women report that they do not have regular cervical cancer screenings.

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 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 human papillomavirus (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 papillomavirus (HPV) infection
• Genital warts
• Smoking
• Early onset of sexual activity (younger than 18 years old)
• Giving birth before age 16
• 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 is 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, a woman who has had abnormal Pap smears in the past may need more tests than a woman 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 - 3 years, and only when your doctor suggests it is safe to wait that long between tests. If there are any questionable or unclear results from the Pap smear, a gynecologist will perform one of the following tests:

• Colposcopy -- Colposcopy is a procedure in which the physician uses a viewing tube with a magnifying lens to examine the abnormal cell growth in the cervix.
• Biopsy -- Biopsy is when 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.

The FDA has approved a vaccine, Gardasil, for human papillomavirus (HPV) for females 9 - 26 years of age to prevent cervical cancer. The Center for Disease Control' s National Immunization Program (NIP) and the federal Advisory Committee on Immunization Practices have recommended the use of the vaccine. 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, any nutritional interventions should be cleared by your doctor. 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 fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present), or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable 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 coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately, for 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following 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.
• A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium. Folic acid is important in preventing cervical dysplasia and should be part of a multivitamin supplement.
• Digestive enzymes, 1 - 2 tablets 3 times daily with meals.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Acidophilus (Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) daily, when needed for maintenance of gastrointestinal and immune health.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily, for antibacterial/antifungal activity, gastrointestinal health and immunity.
• Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help decrease inflammation.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation, immune and antibacterial/antifungal activity.
• Bromelain (Ananus comosus) standardized extract, 40 mg 3 times daily, for pain and inflammation.
• Turmeric (Curcuma longa) standardized extract, 300 mg 3 times a day, for inflammation. May increase bleeding time so if you are using blood thinning medication, talk to your doctor before using turmeric.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day.

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 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 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.

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 effect.

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.

Castor Oil Packs

Dampen a cloth with castor oil and apply to the abdomen. Cover with saran wrap and then apply a heating pad over this pack. Used for 1 - 3 hours, castor oil packs can reduce cramping and pain in some patients.

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 - 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.

Alternative Names:

Cancer - cervical; Cervical cancer; Pap smear - abnormal