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Cervical Dysplasia
 

Cervical Dysplasia Introduction

:cervical_20dysplasia.jpg Cervical dysplasia refers to the development of abnormal cells on the surface of the cervix. Alternate terms for this condition include squamous intraepithelial lesion (SIL) and cervical intraepithelial neoplasm (CIN). SIL is subdivided into low (L-)or high grade (H-)categories. CIL is subdivided numerically, and the categorization of numbers is paralleled to the severity of abnormality upon the cervix - CIN I (mild); CIN II (moderate); or CIN III (severe). Cervical dysplasia is diagnosed by the PAP smear test. [1]

For some medical authorities, cervical dysplasia is considered a sexually transmitted disease. It is estimated that 90% of dysplasia cases result from the infection of the Human Papilloma Virus (HPV), which also causes genital warts. [2] Several strains of HPV including, 16,18,31,33,35 and 39, are more highly correlated with severe cervical dysplasia and its progression into cervical cancer. Other risk factors for developing cervical dysplasia include; cigarette smoking, multiple sexual partners, unprotected sexual intercourse, and sexual intercourse at an early age. [3]

Women of any age can develop cervical dysplasia. The most common age for development of low grade SIL or CIN I is 25-35. The most common age for development of high grade SIL or CIN II and CIN III is 30-40. [4] Lesions or abnormalities of the cervix are pre-cancerous.

Cervical cancer is the third leading cause of cancer deaths for women in the United States.[5] Although the mean age of detection is 50 years old, cervical cancer may affect women as early as 20 years of age. [6] 90% of low grade or mild cervical dysplasia are detected by an abnormal PAP smear test. This early detection is critical, as cervical dysplasia is 100% treatable. [7, 8] Most cases of cervical dysplasia will take 10-15 years to develop into cancer, but severe forms of dysplasia can develop into cancer in as quickly as one year.

Cervical Dysplasia Signs and Symptoms

Cervical dysplasia usually has no physical symptoms and is discovered from an abnormal PAP smear test. Early signs of cervical cancer may manifest themselves as, abnormal bleeding that occurs between periods, bleeding after sexual intercourse, or increased bleeding during menstruation. An increase in discharge from the vagina, that may or may not be foul smelling, is also a symptom of early cervical cancer. [9] If a woman is experiencing any of these symptoms, she should seek the care of a physician to rule out the possibility of cervical cancer. Many other diseases can cause these same symptoms.

Cervical Dysplasia Treatment

Conventional treatments of cervical dysplasia usually involve the removal of the abnormal/precancerous cells. There are several methods for removal of the cells; cryotherapy, which involves freezing the abnormal cells with liquid nitrogen, a LEEP, which is an excision of the abnormal cells using an electric current, and laser or cold knife removal. [10]

Supplements helpful for Cervical Dysplasia

Folic Acid

Folic acid or folate is a key nutrient involved in the production of cellular DNA. A deficiency in folic acid causes abnormalities in the structure of new DNA. These abnormalities in the DNA can increase the cells susceptibility to viruses and carcinogens (cancer causing agents). Folic acid deficiency also causes specific cervical cell changes, termed megaloblastic changes, that make the cells larger and ‘puffier’ than they should be. This growth causes a fragile cell membrane and increased susceptibility to viruses and carcinogens. [11] Folic acid deficiency is more significant in women who smoke, who are pregnant, and who take oral contraceptives (birth control pills). [12] Although cervical cell changes may still occur when the blood levels of folic acid or folate are measured to be in the normal range, there is a far greater risk for change when a deficiency is present.

One study found that supplementation with folic acid for 3 months caused the regression of cervical dysplasia in women who were taking oral contraceptives. [13] Another study found that folic acid supplementation was correlated with a decreased risk of developing cervical cancer from low grade SIL (LSIL). [14] Other studies have found that low folate in blood serum and red blood cell to be associated with an increase risk for developing cervical cancer. [15] The overall treatment with supplementary folic acid causes a regression rate between 20-100%, depending on the grade of dysplasia. This statistic is compared with a regression rate of 1.3% with no treatment for mild dysplasia only.[16]

Beta-carotene and Vitamin A

Beta-carotene is a well-known anti-oxidant, which harnesses certain immune stimulating properties. It is equally vital for the integrity of certain cellular structures, most notably, epithelial cells. Vitamin A also exhibits certain anti-viral properties. Interestingly, women with cervical dysplasia were found to have a 4.5 times lower serum concentration of retinoids (Vitamin A), than women not suffering from this condition. Studies have also found that there is an increased risk for developing cervical dysplasia when plasma carotenoids are low. [17]

Topical application of all-trans-retinoic acid (Vitamin A) was shown to induce regression of CIN II. [18] Though most studies using beta-carotene as a treatment have not had significant results, supplementation is recommended, because low serum beta carotene has been linked to a 3-fold increase of risk for developing severe dysplasia. 38% of cervical dysplasia patients have low serum beta-carotene, which directly correlates with the severity of disease. [19]



Indole-3-carbinol

Indole-3-carbinol is a nutrient found in foods, specifically vegetables such as cabbage, kale, broccoli, and brussel sprouts. It has the potential to prevent and treat cancer, especially those that may be related to estrogen. Its primary mechanism is to improve estrogen metabolism via the liver. Women with moderate and severe dysplasia have been found to have an abnormality in the metabolic pathway for estrogen. [20]

In a particular double-blind study, supplementation with indole-3-carbinol for 12 weeks induced a complete regression in nearly 50% of cervical dysplasia cases, as compared to 0% in the placebo group. [21]



Anti-oxidants

Low anti-oxidant status has been linked to the development of precancerous and cancerous cells. It has not always been fully understood which came first; the deficiency of anti-oxidants causing susceptibility, or the abnormality that uses up the available anti-oxidants in an attempt to decrease severity of disease. Anti-oxidants are key in the fight against reactive oxygen species (ROS) and free radical damage. If anti-oxidants are low, then the DNA is at risk for damage by free radicals as is the outer membrane of the cell.

In one study, patients with confirmed dysplasia were found to have lower levels of serum CoQ10 and Vitamin E. [22] Another study found an increased risk of cervical dysplasia to be associated with low levels of Vitamin C, Vitamin E, and beta-carotenes. [23]

References

[1] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml What you need to know about cancer of the cervix. National Cancer Institute. Oct 2004.

[2] Syrjanen K. Spontaneous evolution of intraepithelial lesions according to grade and type of the implicated human papilloma virus (HPV). Eur J Obstet Gyn Reprod Biol. 1996; 65:45.

[3] Beers M and Berkow R. Cervical Cancer. The Merck Manual of Diagnosis and Therapy. 17th Ed.: 1964-1968.

[4] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml What you need to know about cancer of the cervix. National Cancer Institute. Oct 2004.

[5] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml American Cancer Society

[6] Beers M and Berkow R. Cervical Cancer. The Merck Manual of Diagnosis and Therapy. 17th Ed.: 1964-1968.

[7] Beers M and Berkow R. Cervical Cancer. The Merck Manual of Diagnosis and Therapy. 17th Ed.: 1964-1968.

[8] Hudson T. Cervical Dysplasia. Women’s Encyclopedia of Natural Medicine. 1999. Keat’s Publishing, Los Angeles.

[9] Beers M and Berkow R. Cervical Cancer. The Merck Manual of Diagnosis and Therapy. 17th Ed.: 1964-1968.

[10] Beers M and Berkow R. Cervical Cancer. The Merck Manual of Diagnosis and Therapy. 17th Ed.: 1964-1968.

[11] Marshall K. Cervical dysplasia: early intervention. Altern Med Rev. 2003 May; 8(2): 156-170.

[12] Pizzorno J, Murray M, and Joiner-Bey H. Cervical Dysplasia. Clinician’s handbook of Natural Medicine. Churchill Livingstone. New York: 109-113.

[13] Butterworth et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr. 1982 Jan; 35(1): 73-82.

[14] Hernandez BY et al. Diet and premalignant lesions of the cervix: evidence of a protective role for folate, riboflavin, thiamin, and vitamin B12. Cancer Causes Control. 2003 Nov; 14(9): 859-870.

[15] Weinstein SJ et al. Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer in US women. J Nutr. 2001 Jul; 131(7): 2040-2048.

[16] Pizzorno J, Murray M, and Joiner-Bey H. Cervical Dysplasia. Clinician’s Handbook of Natural Medicine. Churchill Livingstone. New York: 109-113.

[17] Marshall K. Cervical dysplasia: early intervention. Altern Med Rev. 2003 May; 8(2): 156-170.

[18] Meyskens FL et al. Enhancement of regression of cervical intraepithelial neoplasia II (moderate dysplasia) with topically applied all-trans-retinoic acid: a randomized trial. J Natl Cancer Inst. 1994; 86: 539-543.

[19] Pizzorno J, Murray M, and Joiner-Bey H. Cervical Dysplasia. Clinician’s Handbook of Natural Medicine. Churchill Livingstone. New York: 109-113.

[20] Marshall K. Cervical dysplasia: early intervention. Altern Med Rev. 2003 May; 8(2): 156-170.

[21] Bell MC et al. Placebo controlled trial of indole-3-carbinol in treatment of CIN. Gynecol Oncol. 2000; 78: 12-129.

[22] Palan PR et al. Plasma concentrations of coenzyme Q10 and tocopherols in cervical intraepithelial neoplasia and cervical cancer. Eur J Cancer Prev. 2003 Aug; 12(4): 321-326.

[23] Goodman MT et al. The association of plasma micronutrients with the risk of cervical dysplasia in Hawaii. Cancer Epidmiol Biomarkers Prev. 1998 June; 7(6): 537-544.