Cervical Dysplasia, HPV, and Cervical Cancer
The cervix is the lower part of the uterus that extends down into the top of the vagina. The external os is the opening to the cervix. The internal os is the opening to the uterus, which connects the body of the uterus to the cervix.
Cervical dysplasia is the appearance of abnormal cells in the epithelial layer of cells on the surface of the cervix.
Cervicitis is an inflammation of the cervix. It is natural for the cervix to have inflammation. Chronic cervicitis is an inflammation that lasts more than a couple of months and is so common it is considered natural. With the majority of “abnormal” Pap smears, the abnormality is most often caused by inflammation, not disease.
False-positive and false-negative Pap smears are common. One medical journal reports the error rate of false-positive results (when a Pap smear indicates the cervix has abnormal cells when it does not) is 44.8%. Because of the high error rate, an abnormal Pap smear should be repeated two or three times.
Cervical dysplasia is called squamous intraepithelial lesion (SIL). SILs are divided into two categories: LSIL (low-grade) and HSIL (high-grade).
When dysplasia is discovered through a biopsy of the cervix, it is reported as cervical intraepithelial neoplasia (CIN). CINs are divided into three categories: CIN I (mild dysplasia), CIN II (moderate to marked dysplasia), and CIN III (severe dysplasia to carcinoma in situ).
The most common cause of cervical dysplasia is a vaginal or cervical infection or Human Papillomavirus (HPV). If dysplasia persists, particularly if it progresses from mild CIN I to moderate CIN II, it warrants being tested for HPV. The type of HPV can help determine if it has a high malignant potential of progressing to cervical cancer.
There is no known effective treatment for HPV. There are contradictory opinions regarding the causes of HPV and whether or not it can go away spontaneously. There is a lack of consensus about whether HPV can be effectively treated and whether some treatment causes it to spread. The contradictory opinions and lack of consensus are an indication that little is known about this common, easily transmitted virus.
Some doctors recommend treatment of dysplasia before HPV or the precursor to HPV, koilocytosis (a discoloration of cells that may be identified with a Pap smear or biopsy), has been diagnosed. Before any treatment, tests should be performed to first determine if the dysplasia is inflammation or HPV. If it is HPV, it is important to test what type of HPV it is.
The most common test for HPV is DNA testing, or the polymerase chain reaction test (PCR). PCR enables the identification of bacteria and viruses and the early detection of cancer.
Cervical cancer is rare-about 11,000 cases of cervical cancer are detected each year in the U.S., which is less than 1/100th of 1% of the female population. Cervical cancer is only slightly more prevalent than testicular and penile cancer in men, which are not routinely tested for.
There are over 100 types of HPV. The vast majority of them are benign, garden-variety types, but 14 of them are associated with a high malignant potential-they are HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, and 82, with HPV-16 and 18 being the most prevalent of the high-risk types. HPV types with a high malignant potential may, but do not always, progress to cancer.
PCR will show what general group the specific type of HPV falls into-no risk, low risk, or high risk. It will not provide the specific number of the type of HPV. HPV-16 and 18 comprise Group 1, a high risk of malignant potential. Group 2A (HPV-31 and HPV-33) is also considered to be of a high malignant potential, but it is not considered to be as high a risk as Group 1.
Most HPV falls in the low risk or no risk groups. But if the HPV is confirmed to be one of the numbers that has a high malignant potential, it is likely that a doctor will recommend a punch biopsy and/or a cone biopsy.
A punch biopsy is similar to a paper punch. A small piece of tissue containing the abnormal cells is removed and sent to a laboratory for microscopic examination. Punch biopsies are performed and reported as if looking at a clock, with the tissue removed at 12, 3, 6, or 9 o’clock. If the punch biopsy demonstrates a high-grade HPV, then a cone biopsy is likely to be recommended.
When a cone biopsy (conization) is properly performed, a shallow, ice-cream cone shaped portion of the cervix is removed. The apex of the cone, which is the margin, is in the cervical canal. The transformation zone refers to the lower, thicker part of the cone at the opening of the cervix.
A doctor can perform either a shallow or deep conization. A shallow conization is preferable because it leaves enough of the cervix to perform a second conization if there is a recurrence. After a deep conization the tissue is too thin and the cervix often becomes stenotic-the cervix no longer stays open, the cervix closes. If the cervix becomes stenotic, it can often be kept open with a seaweed pack called a luminaria. The luminaria must be kept in the cervix to keep it open until it heals.
The surgeon performing the conization should orient the tissue for the pathologist, who will study the tissue sample, by placing a suture in both the apex and the transformation zone. Orienting the tissue will enable the pathologist to identify whether the margin and transformation zone are normal. If a conization reveals dysplasia that does not extend to the margin at the apex or the transformation zone, removal of the tissue may cure the dysplasia. The cervix can be tested yearly for a possible recurrence with a Pap smear and a colposcopy.
A conflict exists in medical literature regarding the most effective method of performing a conization-with a laser, a loop electrosurgical excision procedure (LEEP) or cold knife. Some research reports that laser conization can spread HPV. LEEP and cold knife conization seem to cause the least amount of damage to the surrounding tissue. The pathologist is better able to distinguish the margins and the transformation zone when damage to the tissue is minimized. Most cone biopsies are performed using the cold knife or LEEP procedure.
Cone biopsies are generally followed up with a Pap smear and colposcopy. A colposcope is a long endoscope that allows the doctor to see into the cervical canal.
Although a consensus does not exist, a majority of the medical literature reports that most, if not all, dysplasia is caused by HPV. HPV is highly contagious. It can be transmitted sexually or in hot tubs and pools. HPV can also be transmitted by trying on underwear or bathing suits in a store. At least 50% of the population have HPV. Although men are usually not aware that they have HPV, they can transmit it. Men can be evaluated by a urologist for penile HPV.
HPV is the most common sexually transmitted disease. In response to this, the pharmaceutical industry has created two vaccines, which they say protect women from cervical cancer. Studies funded by the manufacturers of Gardasil and Cervarix indicate that the vaccines may prevent HPV-16 and 18. Gardasil is also said to prevent HPV-6 and 11, which are thought to cause genital warts.
Women who are vaccinated against HPV are told they need to have a Pap smear each year nonetheless, and the side effects and severe adverse effects of HPV vaccines are numerous. According to The Centers for Disease Control and Prevention, “As of February 14, 2011, there have been 61 VAERS reports of death among females who have received Gardasil.” The CDC also reports, “There are two reports of death among males who were given Gardasil “since recent approval of Gardasil for males.” Gardasil was approved for women on June 8, 2006 and for men on October 16, 2009. These reports only cover deaths reported in the US, not on the many women and men who have been given Gardasil in other countries. Many drug and device experiments and clinical trials are carried out on people in third world countries.
The District of Columbia passed a law, with an opt out option, requiring girls to receive Gardasil prior to entering the sixth grade. Just four years later, those same legislators voted to reject the vaccine after a public hearing. The mother of one of the girls who died after being given Gardasil said in her testimony at the hearing, “The risk of having an adverse event in relation to the vaccine…is greater than your risk of dying of cervical cancer.” Even in states where the vaccine has been mandated, the opt-out rate for parents who do not want their daughters to be vaccinated is very high.
Although cervical cancer is rare, it is not uncommon for hysterectomy to be performed because of abnormal cervical cells. If HPV is of a high malignant potential with glandular involvement (that is, the cancer has spread to glands in the cervix, which means it is not localized in surface tissue and may continue to spread), a hysterectomy may be lifesaving. Most HPV types are benign, though, and are not a cause for alarm. Even high risk HPV can be monitored. Removal of the female organs for HPV is rarely warranted.
Hysterectomy, removal of the uterus, causes many well documented, permanent, irreversible, and life-altering problems. The most consistent problems women experience after hysterectomy (surgical removal of the uterus), whether the cervix or ovaries are retained or not, include a 25-pound average weight gain in the first year following the surgery, a loss of sexual feeling, a loss of vitality, joint pain, back pain, profound fatigue, and personality change.