Dysplasia of the cervix, what is it? - Treatment for the degree of dysplasia

Often in women undergoing gynecological examination, including taking vaginal tests, doctors diagnose cervical dysplasia.

The knowledge of most women is reduced to the precancerous nature of the observed deviation. It is not always necessary to associate dysplasia with oncology, but to ignore such a state is fraught with serious consequences.

Cervical dysplasia: what is it?

Cervical dysplasia( neoplasia) is the appearance in the cervical integument, consisting of multilayered flat epithelium, atypical cells. Atypicality consists in changing the shape of the cell, its structure( the appearance of multiple nuclei or an increase in the size of a single nucleus), the loss of the layered structure of the epithelium covering the neck.

Atypical for the structure of this body cells begin to reproduce their own, thereby replacing the healthy epithelium. All these changes also occur with cancer degeneration. However, dysplasia from oncology is distinguished by a single sign - the altered cells do not spread deeper than the basal layer of the epithelium.

Pathological cell mutation occurs at the junction of the cervical mucosa, lined with a cylindrical epithelium, and the vaginal part of the uterine neck, covered with multilayered flat epithelium. Initially, atypical inclusions are formed in the basal layer of the epithelium, then they capture more and more superficial layers.

In this case, not only the correct form of typical cells disappears, but the boundary between the epithelial layers also blurs. Depending on the layered localization of mutated cells, several stages of the development of the disease are distinguished.

Cervical dysplasia 1 degree( CIN 1)

Light dysplasia of the cervix involves the detection of altered epithelium only in the deepest layers. Atypical cells are located in the lower third of the epithelium, the basal layer.

Moderate dysplasia( CIN 2)

Moderate dysplasia is the spread of the replacement process of normal epithelium by altered cells in the thickness of the cervical cover. The defeat of the thickness of the epithelial layers varies in the region 1/3 - 2/3.

Class 3 Dysplasia( CIN 3)

Severe dysplasia of the cervix - called non-invasive cancer, captures all epithelial layers, but does not exceed the boundaries of the basal membrane.

This classification demonstrates different stages in the formation of atypical foci on the cervix of the uterus, which without full treatment ultimately leads to oncology. However, the process does not always progress.

Causes of cervical dysplasia

Cell mutation is far from a spontaneous process. In order for cells to change their structure and begin to chaotically share, it is necessary to break the protective barrier, which is a complex mechanism for controlling the process of cell division and the destruction of abnormal elements.

For such a failure, as a rule, several of the following factors are necessary: ​​

• infection with the oncogenic type of the papilloma virus( HPV) is the most common cause of the appearance of atypical cells in the cervical epithelium; the most dangerous types 16 and 18 have a high risk of oncogenicity;
• long( more than 5 years) contraception with combined hormonal tablets;
• weighed heredity - oncology of genital organs in blood relatives;
• mucosal trauma - abortions, multiple births;
• immunodeficiency - stress, malnutrition, chronic infections in the body, prolonged treatment with antibiotics and corticosteroids;
• frequent or untreated infections of the reproductive system;
• alcohol, active / passive smoking - increase the risk of forming dysplasia by 4 times.

Women at risk for precancerous neoplasia:

• who have started sexual intercourse from the age of 14-15;
• is indiscriminate in the choice of partners;
• large families;
• with a large number of abortions in the history;
• leading antisocial life;
• neglecting basic hygiene and condoms.

The probability of dysplastic pathology does not increase in women in the post-menopausal period and who have undergone removal of the ovaries with a prescribed doctor replacement with hormonal drugs.

Symptoms of cervical dysplasia

Cervical dysplasia does not give specific signs. Women often present complaints related to concomitant inflammation:

• unusual discharge;
• itching and burning sensation in the perineum;
• bloody spotting during sexual intercourse;
• pain, as a rule, is absent and can occur when traumatizing the tender mucous cervix during sexual intercourse.

Neoplasia does not provoke infertility and does not adversely affect the developing fetus. In addition, hormonal restructuring during pregnancy causes a physiological change in the cervix, often taken for dysplastic processes.

The cylindrical epithelium moving from the cervical canal emerges from the external pharynx of the cervix in the form of a red corolla( ectropion or pseudo-erosion).

Diagnosis

Pathological changes are detected in the following studies:

• gynecological examination of the uterine neck in the mirrors - whitish plaques that do not change color slightly when stained with Lugol solution( Schiller test);
• colposcopy - pale coloration of the dysplastic focus, strengthening of the blood picture;
• cytology( PAP test) - detection of atypical cells( sensitivity increases with severe degree of neoplasia) and HPV markers
  targeted biopsy and histology of the material taken;
• PCR analysis is an immunological study that detects HPV infection.

The methods and means of treating cervical dysplasia are selected depending on the results of the diagnostic examination.

Treatment of dysplasia of the cervix of the 1st degree

Since in most cases a slight degeneration of the epithelial layer and the papilloma virus that caused it are eliminated in 1-2 years, in the treatment of grade 1 cervical dysplasia, it is recommended:

• regular observation in the gynecologist, including annual cytology and colposcopy;
• high-grade treatment of inflammation of the vagina;
• replacement of combined oral contraceptives with alternative agents;
• elimination of endocrine disorders and strengthening of immunity;
• lifestyle correction - nutrition, rejection of cigarettes, adequate hygiene.

In case of ineffectiveness of these recommendations and fixation of grade 1 dysplasia after 2 years, treatment of the altered focus by chemical agents - Vagotide, Solkogin - is possible.

Treatment of cervical dysplasia of 2 and 3 degree

Developing neoplasia requires a more radical approach, correction of lifestyle and inflammation removal in the treatment of cervical dysplasia of 2 and 3 degrees is indispensable, surgery is required.

• Electrocoagulation - removal of abnormal cells by cauterization with electric current. Available financial method does not allow you to regulate the depth of impact. In the healing stage, it often forms rough scars that prevent the opening of the cervix in subsequent births.
• Cryodestruction - freezing of the altered section with liquid nitrogen. Does not leave scars( shown for the treatment of nulliparous patients), is fraught with prolonged( up to 1 month or more) flow of fluid.
• Laser coagulation - evaporation of the altered epithelium by means of a laser. To prevent damage to healthy cells, the woman should not move / tremble during the procedure. High efficiency is due to the ability to regulate the depth of impact.
• Radio wave treatment - removal of cervical dysplasia of 2, 3 degrees due to heating by high-frequency radio waves. Rapid recovery, absence of scars and high accuracy of treatment cause the absence of relapses and complications. It is used in nulliparous women. Quite expensive method of treatment.
• Conization of the cervix in dysplasia - surgical excision of pathological education. The most traumatic intervention is not recommended for women of childbearing age. If there are special equipment in the clinic, the removal of neoplasia with a scalpel is replaced by laser excision. Thus, the probability of postoperative bleeding and infection decreases, and healing takes place more quickly.

Mini-traumatic operations for cervical dysplasia of the 2nd degree are performed in an outpatient mode, immediately after the end of menstrual bleeding and in most cases do not require general anesthesia.

With any form of surgical treatment, you must give up sex, take a bath and visit the sauna / pool, visit the beaches and solarium. At the end of menstruation after surgery, a gynecological examination is necessary.

Forecast

Prognosis for cervical dysplasia is clearly dependent on the degree of pathology:

• When diagnosing mild neoplasia, only a 1% of cases show a transition to a moderate and severe degree.
• In patients with CIN 2, a severe precancerous form develops only in 16% of cases in 2 years and in 25% in 5 years.
• Severe form of neoplasia( grade 3) passes into invasive cancer( spread of altered cells beyond the basal membrane) in only 12-32% of patients.

These figures indicate the need for timely detection( preventive examinations) and treatment of the revealed pathology. Only a complete lack of attention on the part of the woman herself threatens her with serious consequences.