DEFINITION

Cervical Dysplasia is also known as Cervical Intraepithelial Neoplasia (CIN) or pre-cancerous cells. It refers to abnormal changes in the cells of the cervix that are not yet cancerous, but may develop into Cervical Cancer if untreated.

DESCRIPTION

Cervical Dysplasia is present for many years before developing into cancer. It does not cause any symptoms, and can only be detected by examining cervical cells under a microscope following a Pap smear. Most abnormal Pap smears are not cancer, but Cervical Dysplasia. There are three grades of Dysplasia: mild, moderate and severe.
Mild Dysplasia or CIN I - this is characterised by a few abnormally immature cells, which extend through one-third of the thickness of the epithelial or cervical skin. This level of dysplasia can sometimes resolve without treatment. Usually the doctor will repeat the smear in a few months, and no other action is required until then.
Moderate Dysplasia or CIN II - this is characterised by increasing numbers of immature cells, taking up to two-thirds the thickness of the epithelium or cervical skin. This level of dysplasia requires further examination by a Gynaecologist.
Severe Dysplasia or CIN III - this is characterised by a large number of immature cells, with only a thin layer of normal cells remaining. If the entire layer of cervical skin is abnormal, the term carcinoma in situ or CIS is used. While CIS does not have the capacity to invade blood and lymph vessels or spread, urgent and immediate investigation and treatment is required.

In all levels of Cervical Dysplasia, the base membrane of the cervical epithelia remains intact. That is, the abnormal cells remain within the cervix itself. Once the cells have crossed the membrane and entered areas other than the cervix, Cervical Cancer is diagnosed.

PREVENTION

Gardasil is the name given to the vaccine that immunises females and males against the sexually transmitted disease, human papillomavirus (HPV) Types 6, 11, 16 and 18. These strains of HPV are known to cause 7 out of 10 cervical cancers in women and 9 out of 10 cases of genital warts in both men and women.

CAUSE

Cervical Dysplasia is directly related to female/male sexual activity. It is not seen in virgins, nuns, celibate or homosexual women. The risk factors for Cervical Dysplasia include:
- Age at first intercourse. The younger the woman, the greater the risk.
- Multiple sexual partners.
- Sexual relations with a man who has had multiple partners.
- Infection with the human papilloma virus, which causes genital warts. About 80% of sexually active women will contract the virus during their lives, but not all of these will develop cervical changes.
- Smoking.
- The oral contraceptive pill may be associated with a higher risk of human papilloma virus.

DIAGNOSIS

It is important to remember that a Pap smear does NOT diagnose Dysplasia or cancer. It is only detects the possibility of abnormal cells. Depending on the exact results of your Pap smear, your Doctor may choose to repeat the smear in a few months, or may refer you to a Gynaecologist for a colposcopy or cone biopsy.
Colposcopy - A Colposcope is an instrument that allows a direct microscopic examination of the cervix and vagina. It is used to visualise parts of the cervix that are too small to be seen with the naked eye. A Colposcopy can be performed in your Gynaecologist's office, and is no more complex than a normal pelvic examination.
1) The woman lies on her back with her knees drawn up and parted.
2) An instrument called a speculum is inserted into the vagina to hold apart the vaginal walls and allow the Doctor to see the cervix.
3) The colposcope is positioned with its light source shining onto the cervix.
4) The Doctor looks through the colposcope to see the cervix and surrounding tissues.
5) Acetic acid (vinegar) is applied to the cervix. Abnormal areas will appear as white patches.
6) Small snips of tissue may be taken for testing (biopsy). The cervix has few pain receptors, so this usually cannot be felt. Some Doctors may choose to use a little local anaesthetic.
Cone Biopsy - A cone biopsy may be performed if the colposcopy shows moderate to severe Dysplasia. It is usually done under mild anaesthetic as a day patient. A cone-shaped wedge of the cervix is removed and tested, to see the extent of the abnormal cells. The biopsy does not interfere with a woman's ability to conceive or have children.

TREATMENT OPTIONS

- All women who have ever had sex should have a Pap smear every 2 years, more often if you have had a previous abnormal smear.
- Always report any unusual vaginal bleeding, discharge or pain to your Doctor immediately.
- If you have an abnormal Pap smear, DO NOT PANIC. Most abnormal smears are NOT cancer.
- The aim of the treatment of Dysplasia is to destroy any abnormal cells with as little harm to the cervix as possible.
- Several different methods may be used to treat Cervical Dysplasia. These include heat (diathermy), wire loop excision, laser treatment or freezing (cryosurgery). Your Gynaecologist will discuss these options with you.

PHARMACIST'S ADVICE

1) Condoms can help reduce the risk of human papilloma virus and other STDs. Ask your Pharmacist for advice.
2) Anti-smoking products can help reduce cravings when quitting smoking. Ask your Pharmacist for the available range.
3) Panty liners may be used following minor procedures to manage any discharge.
4) Paracetamol or mild pain relief may be required following some procedures.

VITAMINS/MINERALS/HERBS

Nutritional supplements are only to be used if the dietary vitamin intake is inadequate.
- Zinc and selenium help stimulate the body's immune system.
- Folic acid and vitamin C play an important role in the prevention of unhealthy cell changes that can lead to cancer.
- Vitamin A deficiency may increase the risk of Cervical Dysplasia progressing to more serious cell changes..
- Multi B vitamins, taken daily, will help to support the nervous system during times of stress. There may be a link between Cervical Dysplasia and stress.
- Echinacea helps stimulate the body's immune system and improves resistance to infection. Taking this herb may be especially beneficial in cases where HPV is increasing the risk of Cervical Dysplasia.

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