The cervix is a muscular tube in the female reproductive tract that connects the uterus to the vagina allowing fluids to enter and leave the uterus, and serves as a passageway for natural childbirth. However, it is also at risk of cellular changes called Cervical dysplasia that may lead to cervical cancer. An abnormal growth of precancerous cells on the surface of the cervix, cervical dysplasia is of two grades:
While the risk of cancer is lower for mild dysplasia, 30 to 50% of cases of severe cervical dysplasia progress to invasive cervical cancer if not diagnosed and treated in time. According to the American Cancer Society, cervical cancer used to be the leading cause of death among American women. But as long as it is detected early and managed effectively, it is one of the most preventable and treatable forms of cancer. Hence, the importance of cervical health care cannot be highlighted enough. You may take the following measures to maintain your cervical health:
Since cervical dysplasia is caused by the Human Papillomavirus (HPV), a sexually transmitted virus, practicing safe sex can help you avoid cervical dysplasia and cervical cancer in turn. Having multiple sexual partners, being sexually active at an age younger than 18 years old, giving birth before age 16, or having a partner whose former partner had cervical cancer can greatly increase your chances of having the disease. Hence, condoms and barrier contraceptives may offer protection to a certain extent.
Since, low levels of folate/ vitamin B9 in red blood cells, dietary deficiencies in beta-carotene, selenium, vitamin A, vitamin E, and vitamin C are known to increase the risk, eating a diet rich in beta-carotene, vitamin C, and folate /vitamin B9 present in fruits and vegetables may decrease your risk. Cruciferous vegetables, such as cauliflower, cabbage, and broccoli, calcium-rich foods, including almonds, beans, and dark, leafy greens, such as spinach and kale, antioxidant-rich foods, including fruits, such as cherries, blueberries, and tomatoes, and vegetables, such as squash and bell pepper, lean meats, cold-water fish, healthy oils, such as olive oil are especially important in preventing cervical cancer.
Avoid refined foods, such as white pieces of bread, sugar, pasta, caffeine, alcohol, and tobacco. Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, French fries, cakes, donuts, onion rings, processed foods, and margarine, drinking 6 to 8 glasses of filtered water daily and exercising moderately, for 30 minutes daily, 5 days a week are other lifestyle factors you may adopt to lower your risk of getting the disease.
Exposure to air pollutants and smoking are also known to be risk factors for cervical cancer, so avoiding these can also decrease your risk of getting the disease.
Though the exact cause of cervical dysplasia is not known, there is a strong association between cervical dysplasia and HPV infection, according to studies. A vaccine is available to protect against HPV, so getting vaccinated in time is also a good idea. An HPV vaccine (Gardasil, Cervarix) protects against HPV, the most common cause of cervical cancer is recommended for females starting from young girls aged 9, to women aged 26, but you can still get protection if vaccinated later since it is approved for all people through age 45. Although the vaccine can prevent up to 70% of cervical cancer cases, it is not effective against every cervical cancer-causing virus. So, the importance of routine Pap tests cannot be undermined.
Though there is no sure way to prevent cervical dysplasia, identifying it in its early stages through regular Pap smears is the most effective way to prevent it from progressing to cervical cancer. Pap smears can detect precancerous lesions, and early stages of cervical cancer as well and have saved many lives. It involves the collection of cells from your cervix and sending the sample to the pathology lab for testing. Detecting and treating cervical cancer in its early stages can greatly improve your chances of a full recovery.
Annual Pap smears should be done by women, as soon as they become sexually active, or turn 21, whichever comes first. If their mother took DES during pregnancy then they should begin regular Pap smears at age 14, at the onset of their first menstrual period, or as soon as they become sexually active. They should continue to get regular Pap smears done every three years, until the age of 65.
Cervical dysplasia often has no symptoms and is usually found during a Pap test. However, some signs and symptoms to watch out for are genital warts, spotting after intercourse, abnormal bleeding, vaginal discharge, and lower back pain. But remember to consult your gynecologist for an accurate diagnosis. Any of the above symptoms should be reported immediately to your doctor who will perform a physical examination, including that of the back, abdomen, and pelvis.
In case of symptoms, a Pap test is mandatory to detect any precancerous or cancerous cells in the cervix. As a precaution, you may also do a Pap test annually for screening purposes, even in the absence of cervical dysplasia symptoms.
Depending on your history, such as that of one or more sexually transmitted diseases, such as genital herpes or HIV, systemic inflammatory disease, such as lupus, rheumatoid arthritis, and inflammatory bowel disease, a suppressed immune system, such as from HIV or chemotherapy to treat cancer or using birth control pills for longer than 5 years, or having a biological mother administered Diethylstilbestrol (DES) to conceive, or to sustain pregnancy, the frequency of Pap smear test may be decided.
In case the results from the Pap smear are doubtful, a gynecologist will prescribe the following tests:
In this procedure, the doctor uses a viewing tube with a magnifying lens to examine the abnormal cell growth in the cervix.
During biopsy, a small sample of tissue is removed from the cervix, and examined under a microscope for any signs of cancer.
Early identification, treatment, and consistent follow-up can cure nearly all cases of cervical dysplasia which if left untreated, progresses to cancer. Though women treated for cervical dysplasia have a lifetime risk for recurrence and malignancy, despite the rise in cervical dysplasia numbers, the numbers of cervical cancer have declined due to better screening techniques, and early diagnosis and treatment of cervical dysplasia.
Though medications are not used to treat cervical dysplasia, preliminary studies suggest that a topical medication called Imiquimod may enhance the immune response to HPV-induced genital warts. According to certain studies, the application of Tretinoin, a topical form of vitamin A, to the cervix may help the regression of cervical dysplasia.
Also, certain nutritional deficiencies, including folate, beta-carotene, and vitamin C may be related to the development and progression of cervical dysplasia, and nutritional supplements may be taken under consultation with doctors to compensate for these. However, the preferred treatment for cervical dysplasia is still the surgical removal of abnormal tissue.
Surgical removal of abnormal tissue by following methods, is commonly done to treat cervical dysplasia. About 90% of these procedures can be done in an outpatient setting by doctors. These procedures include:
Cryocauterization uses extreme cold to destroy abnormal cervical tissue which usually destroys 99% of the abnormal tissue and can be done without anesthesia.
Lasers destroy abnormal cervical tissue effectively. They scar less than cryocauterization, are costlier, are performed with local anesthesia, and have a 90% cure rate.
In this procedure, a thin loop wire excises visible patches of abnormal cervical tissue under local anesthesia and has a 90% cure rate.
During this procedure, doctors remove a small cone-shaped sample of abnormal tissue surgically from the cervix under general anaesthesia. Cervical Conization has a 70 to 98% cure rate, depending on whether cancer cells have spread beyond the cervix.
Thus, the importance of cervical health care cannot be highlighted enough. Though your cervix is only a small part of your reproductive system, it may influence your health now and later. Regular cervical health care can prevent future problems and may make the critical difference between life and death.
Thank you John Francis for contributing this article.