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- Cervical Dysplasia
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A small percentage of women diagnosed with cervical dysplasia will go on to develop cervical cancer, which is one of the most preventable cancers.
In this protocol you will learn about factors that increase risk of cervical dysplasia and how cervical dysplasia is classified. The benefits and risks of currently available treatments will also be reviewed, and evidence concerning integrative interventions such as B vitamins and diindolylmethane DIMwhich have been studied in the context of cervical dysplasia, will be presented.
Women who opt for watchful waiting after a diagnosis of low-grade cervical dysplasia should sk ii men anti aging the healthy lifestyle choices and sk ii men anti aging reduction measures presented in this protocol.
If the condition persists or worsens, active treatment can be instituted. Cervical dysplasia is the abnormal growth of the cells that line the surface of the cervix.
It is usually caused by the human papillomavirus HPV. Integrative interventions like folate and green tea extract can help reduce the risk of cervical dysplasia and cervical cancer. Vitamin E: Alpha-tocopherol levels were found to be lower in women with cervical abnormalities or cancer, and supplementation with vitamin E promoted reversal of cervical dysplasia in a randomized controlled trial.
Green Tea Extract: Women with cervical dysplasia who supplemented with green tea extract had nearly a 7 times higher response rate than women receiving no treatment. The cervix is the lower part of the uterus womb and is situated at the upper end of the vagina ACOG Dysplastic cells can vary in their degree of abnormality from mild to severe, plante anti-imbatranire dysplasia has several possible sk ii men anti aging it may disappear entirely, remain stable over time, or progress to cancer Ho ; ACOG a; Moore However, only a small percentage of women diagnosed with dysplasia will go on to develop cervical cancer, which is one of the most preventable cancers ACOG a; ACOG a.
Cervical cancer used to be a common cause of death from cancer among American women.
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This screening test can detect changes in the cervix before cancer develops or while cancer is still in its early stages, when treatment is generally most effective ACS a. Most cases of cervical dysplasia and cervical cancer are associated with human papillomavirus HPV infectionwhich infects nearly all sexually active men and women at some point in their lives CDC However, at present, many women and girls are not vaccinated, possibly as a result of misperceptions about the vaccines or a lack of awareness because these vaccines are relatively new Fiks ; Delere ; Etter Low intake of several vitamins may increase risk of cervical cancer.
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Studies have shown that women with lower intakes of vitamins A, C, and E are at increased risk of cervical cancer Kim ; Peng Also, women with low concentrations of B vitamins, especially folate, may have an increased risk of cervical dysplasia or cervical cancer Butterworth ; Piyathilake ; Liu ; Butterworth ; Butterworth, Hatch ; Kwasniewska ; VanEenwyk ; Kwanbunjan The benefits and risks of currently available treatments will also be reviewed, and evidence on integrative interventions such as B vitamins and diindolylmethane DIMwhich have been studied in the context of cervical dysplasia, will be presented.
Novel and emerging therapies including new types of HPV vaccines will be discussed as well. There are numerous strains of HPV.
Cervical cancer rarely develops in women younger than age 20; most cases occur in midlife and in women under age Most cases in women over 65 occur in those who did not undergo regular screening with Pap tests before age 65 ACS a.
Cervical cancer usually develops over a period of several years ACOG During this time, the cells on or around the cervix become abnormal. The cellular abnormalities that occur before cancer is present are usually called cervical intraepithelial neoplasia CIN. Cervical dysplasia and cervical cancer are classified along a spectrum of increasing cervical cell abnormality. The goal of classification is to determine the degree to which the cervical cells have become abnormal, and whether treatment is needed, since lower degrees of dysplasia may resolve on their own without treatment.
Risk factors interact and may be additive, so it is usually difficult to say that a given factor is responsible for any one case of cervical dysplasia or cancer La Vecchia ; Arnheim Dahlstrom ; ACS b.
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Each virus in the group is given a number, which is called an HPV type or strain Kumar Eight other high-risk HPV strains types 31, 33, 35, 45, 51, 52, 56, and 58 are associated with the great majority of other cases of cervical cancer Wheeler ; de Sanjose Prevalence of HPV infection increases from age 14 to 24 but then gradually declines through age 59 Dunne Young women, especially those 21 or younger, usually clear the infection by means of their immune response in an average of ziaja lotiune autobronzanta months ACOG a.
Most associated cervical abnormalities will also spontaneously resolve among these women Moore ; Fuchs Other Risk Factors Immunosuppression. Women receiving immunosuppressive therapy for autoimmune disease sk ii men anti aging cancer, or because of an organ transplant, are at increased risk of cervical dysplasia progressing to cervical cancer Dugué ; ACOG Smoking increases the risk of many cancers, including cervical cancer Silva Diethylstilbestrol exposure.
Daughters of women who took the synthetic hormone diethylstilbestrol DES during pregnancy are at increased risk for dysplasia and cervical cancer NCI a. DES has not been prescribed to pregnant women in sk ii men anti aging United States since ; thus, most DES-exposed women are currently beyond their childbearing years Casey In the United States, women of different ethnicities have different degrees of risk of cervical cancer.
Pregnancy-related risk factors.
For reasons not fully understood, three or more full-term pregnancies seem to increase the risk of developing cervical cancer. Additionally, women whose first full-term pregnancy occurred before age 17 are nearly twice as likely to develop cervical cancer later in life compared with women whose first pregnancy occurred at age 25 or older ACS b; Weppner Oral contraceptives birth control pills.
Taking oral contraceptives for prolonged periods of time appears to increase the risk of cervical cancer. One study reported that cervical cancer risk doubled in women on birth control pills for more than five years, but found the risk returned to normal 10 years after they were discontinued ACS b. Sexual history. One study found that condom use significantly promotes regression of cervical dysplasia, even of CIN II or higher Hogewoning Body weight.
Also, overweight and obese women are at greater risk of dying from cervical cancer Wee Family history of cervical cancer.
Women whose mother or sister had cervical cancer are at two to three times the risk of developing the disease themselves ACS b. Chlamydia infection.
Chlamydia is a sexually transmitted disease that often causes no symptoms. Women with a history of chlamydia infection appear to be at increased risk of cervical dysplasia and cervical cancer.
A history of other sexually transmitted disease is also associated with increased risk of cervical dysplasia and cancer ACS b; Jensen Menstrual bleeding can be abnormally heavy, and unusual bleeding may occur at other times, typically after intercourse.
Advanced cervical cancer may cause pelvic pain, difficulty with urination, and leg swelling. Cervical cancer may spread to nearby organs or circulatory vessels, affecting their function ACOG ; Zanotti HPV Vaccination — Prevention of Cervical Dysplasia and Cervical Cancer HPV vaccination confers a high degree of protection against cervical dysplasia and cervical cancer, and is a leading method of prevention.
Males and females up to age 26 can be protected by receiving an HPV vaccination, and girls and boys as young as nine years of age are eligible for these vaccines Xu ; Ferris The vaccinations are given in three injections over the course of six months CDC ; Gardasil a; Gardasil b.
The five additional HPV types against which Gardasil 9 offers protection—31, 33, 45, 52, and 58—are not prevented by previously sk ii men anti aging HPV vaccines. HPV vaccination can also offer protection against anal, oropharyngeal, vulvar, vaginal, and penile cancers NCI b. The vaccines work best when given before there is any contact with the HPV types against which they are meant to protect.
Nevertheless, vaccination has been reported to be effective among women who are already sexually active. Some parents may be opposed to HPV vaccination for their children because they feel the vaccine would encourage risky sexual behavior Soper ; Perkins However, a survey of females aged 15—24 years found that vaccination did not increase the likelihood of risky sexual behavior, and, in fact, vaccinated individuals were more likely to use condoms Liddon A lab then analyzes the sample to determine if there are any abnormal cells ACOG c.
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When results of a Pap test are abnormal, this does not mean that the patient has cancer, but rather that further evaluation is needed.
Mildly abnormal cells sometimes may go away on their own. Additional tests after an abnormal Pap test may include a repeat Pap test, or a more detailed examination called colposcopy, which uses a low-power microscope to examine the cervix, and which is capable of viewing abnormalities that cannot be seen by the naked eye Weppner During colposcopy, the doctor may sometimes also perform a biopsy.
If precancerous changes are present, treatment will be based on several factors, such as age, the exact type of abnormal results, or how long abnormal cells have been present ACOG c; Brookner It is important that healthcare practitioners distinguish cervical dysplasia from other conditions that may present similarly, such as hyperkeratosis, metaplasia, warts, glandular epithelial abnormalities, and some types of cancer Weppner Cervical Screening Exams Cervical cancer screening can detect changes in cervical cells that may lead to cancer.
Screening includes the Pap test and, for some women, testing for HPV. The latest routine cervical cancer screening guidelinesreleased by the American Congress of Obstetricians and Gynecologists in sk ii men anti aging, read as follows ACOG b : Cervical cancer screening should start at age 21 years; women and girls younger than this need not be screened. Women aged 21—29 years should have a Pap test every three years.
Women aged 30—65 years should have a Pap test and an HPV test every five years. It is acceptable to have a Pap test alone every three years. Women should no longer have cervical cancer screening after age 65, unless they have a history of moderate or severe dysplasia sk crema cu colagen pareri sk ii men anti aging anti aging cancer.
If they have such history but have had either three negative Pap test results in a row, or two negative HPV and Pap co-test results in a row within the past 10 years, with the most recent test performed within the past five years, they need not resume screening. Once screening is stopped after age 65, it should not be resumed.
Women who have a history of cervical cancer, are infected with HIV, have a weakened immune sk ii men anti aging, or were exposed to DES before birth should not follow these routine guidelines. In these cases, women should seek guidance from their healthcare provider. If a woman has an abnormal cervical cancer screening test result, additional testing or treatment may be indicated. Her healthcare provider will recommend when she can return to routine screening.
For women aged 30—65 years, the combination of a Pap test plus an HPV test can help predict whether dysplasia will be diagnosed in the next few years, even if the Pap test results are normal. If the results of both the HPV and Pap tests are normal, the chance that mild or moderate dysplasia will develop in the next four to six years is sk ii men anti aging low.
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If a woman has had a hysterectomy that preserved her cervix, she may still need to undergo cervical cancer screening. Whether a woman needs to continue to have screening tests depends on why the hysterectomy was needed, whether the cervix was removed, and whether she has a history of moderate or severe dysplasia. Women in this situation should consult with their healthcare provider s.
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Mild dysplasia, such as CIN I or LSIL, may go away without treatment, but careful follow-up at regular intervals, generally 6—12 months, is needed, and treatment should be performed if the changes do not go away or worsen over time A. If the condition persists or worsens, then active treatment can be instituted.
Women who opt for watchful waiting after a diagnosis of low-grade cervical dysplasia should adopt the healthy lifestyle choices and risk reduction measures presented in this protocol, and follow ongoing screening recommendations, as advised by their healthcare provider.
Active Treatment Several active treatment options are available. These include ablation cryotherapy or laser ablationexcision including loop electrosurgical excision procedure [LEEP]cold knife conization, laser conizationand rarely, hysterectomy Echelman ; Sauvaget ; Singh Cryotherapy has been used successfully for the past fifty years, but use is declining, with other procedures such as laser ablation and LEEP being used with increasing frequency Sauvaget Cryotherapy is most efficacious when used for smaller and less invasive cervical lesions.
Cryotherapy involves the sk ii men anti aging application of a metal probe to the cervix, without touching the vagina, to administer a compressed gas such as nitrous oxide or carbon oxide to destroy the affected cervical tissue.
It acts by decreasing the temperature locally, and causing crystallization and the breakage of cellular membranes Sauvaget ; Singh Cryotherapy has a very low rate of complications, and adverse effects that may occur, such as vaginal discharge and cramps, are usually temporary and self-limited McClung LEEP, also known as loop excision of the transformation zone LETZ or large loop excision of the transformation zone LLETZuses low current at high frequency and loops made of stainless steel or tungsten to excise the lesions.
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Some complications of LEEP include bleeding, incomplete removal of the lesion, and narrowing of the cervix, but advantages include low cost, high patient acceptance, and the possibility to retrieve samples for further laboratory analyses Mayeaux Laser conization is another approach for excisional treatment. A study that examined the persistence of HPV genetic material after laser conization reported that the viral genome that existed before treatment regularly disappeared after the conization procedure Kjellberg Biospectroscopy is the examination of the wavelength of light reflected from specimens of living tissue or body fluids Kelly This technique has been investigated as a screening tool for cervical cancer.
A review of biospectroscopy as a screening tool for precancerous abnormalities of the cervix noted that it can identify different grades of dysplasia Purandare Another study found that biospectroscopy was superior to the Pap test for identifying cervical abnormalities Gajjar Further research is needed before biospectroscopy is incorporated into cervical screening programs.
DNA methylation testing. This may allow a type of viral testing to predict actual risk for cervical abnormalities Mir One study found that the combination of cervical cell testing Pap test and colposcopy and DNA methylation testing was highly effective for detecting high degrees of cervical dysplasia and cancer. At-home HPV testing.
This tests for HPV strains 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and The test includes laboratory analysis and a physician review, online storage of the test results, and free counseling and support. The manufacturer states that the test is as accurate as those performed at approved clinical laboratories because it uses comparable methodology Everlywell Emerging Interventions HPV immunotherapy. VGX works by eliciting a powerful immune response to specific vulnerable antigens expressed by HPV strains 16 and Carrageenan-based vaginal gel.
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Carrageenan is a compound extracted from edible red seaweeds; it is a complex sugar molecule that is widely used as a food additive. Carrageenan has been found to inhibit HPV infection in laboratory and animal studies Yermak ; Rodríguez A randomized, controlled trial compared Carraguard, a carrageenan-based vaginal gel, plus condoms to placebo gel plus condoms for prevention of high-risk HPV infection. High-Dose Vitamin D Vaginal Suppositories A trial compared vitamin D vaginal suppositories to a lactobacillus probiotic suppository sk ii men anti aging the treatment of cervical dysplasia.
The vitamin D suppositories, which contained 12 IU vitamin D per dose, were used three nights per week for six weeks.