Gynecological disease cervical dysplasia. Cervical dysplasia. The degree of dysplasia, modern diagnostics (colposcopy, curettage, cervical biopsy), causes, effective treatment. Causes of moderate cervical dysplasia

One of the most serious diseases of the reproductive system in women is cervical dysplasia - changes in epithelial cells and the appearance of atypical cells that can degenerate into cancer. However, with timely diagnosis and timely treatment, dysplasia is treatable.

In this article, we will analyze in detail the third, most severe degree of cervical dysplasia, the causes of its occurrence and methods of treatment.

Causes of cervical dysplasia

With this disease, cells are most often affected in the area where the squamous epithelium turns into columnar epithelium (the so-called transformation zone). This disease does not occur suddenly; it develops over many years, growing from one stage to another. There are three stages of dysplasia:

• Stage 1 - the epithelium is affected in depth by 1/3;
• Stage 2 - the epithelium is affected in depth by 2/3;
• Stage 3 - the entire thickness of the cervical epithelium is affected by atypical cells, but the disease does not spread to other tissues, blood vessels, nerve endings, etc.

The third stage is precancerous. If left untreated, dysplasia will transform into an oncological disease, and a malignant tumor will develop in the woman’s body.

The most common causes of the appearance and development of dysplasia in the female body are:

• inflammatory processes of the organs of the reproductive system (in particular, inflammation of the cervical canal itself);
• sexually transmitted diseases (STDs in women);
• long-term exposure to certain types of papillomavirus on the body (6, 11, 16, 18, 31, 33, 35).

In addition, there are risk factors that contribute to cell changes: smoking (both active and passive), hereditary predisposition to cancer, early onset of sexual activity and frequent change of sexual partners, long-term use of oral contraceptives, unhealthy diet, etc.) .

This disease does not have any characteristic symptoms and is diagnosed accidentally during a regular gynecological examination. Having suspected dysplasia, the doctor usually prescribes additional examinations, which include tests to detect sexually transmitted infections (PCR), colposcopy, a cytological Papanicolaou smear and, if there is a suspicion of severe cervical dysplasia, a biopsy of a fragment of altered epithelial tissue.

How to treat cervical dysplasia?

There is a standard treatment regimen for cervical dysplasia. Patients with grade 3 dysplasia are usually treated by a gynecologist-oncologist.

Treatment of the disease is based on the following.

1. Recovery therapy (it is carried out for dysplasia of any degree and is desirable for any woman as a preventive measure). It involves changing the diet and additional intake of vitamins and microelements, such as folic acid, bioflavonoids, selenium, vitamins A, C, B6 and B12, E, etc.
2. Removing the area with changed cells. It is carried out using the following methods:

The doctor chooses the method of surgical treatment based on data about the general health of his patient, her medical history, the presence of chronic diseases, the desire to have children in the future, etc., since this is always associated with the risk of complications. Sometimes he may choose a wait-and-see approach, since after restorative therapy the dynamics of dysplasia may improve, which happens quite rarely at stage 3. In advanced cases, as well as in the first stages of cervical cancer, surgical amputation of the cervix is ​​usually performed.

Cervical dysplasia: symptoms, treatment, complications, causes | ABC of health

This pathology is a serious gynecological disease, as it is the “first bell” indicating that the cervix is ​​ready to face cancer. Therefore, dysplasia is rightfully considered a precancerous disease and requires timely and high-quality treatment. It is known that this disease is most often diagnosed in young women (about 25 - 35 years old), and the incidence of pathology reaches 1.5 cases per 1000 representatives of the fairer sex.

The term "cervical dysplasia"

Cervical dysplasia is the process of changes in the structure of the epithelial cells covering the vaginal part of the cervix. Such cells are called atypical, and the disease itself is included in the list of precancerous processes.

The vaginal part of the cervix is ​​lined with stratified squamous epithelium, which is pink in color and consists of several layers:

• basal-parabasal is a deep layer consisting of basal and parabasal cells and bordering the underlying tissues (muscle, nerve endings and vascular walls); it is in this layer that there are young cells that renew the epithelium;
• intermediate;
• functional or superficial - the epithelial cells of this layer die and slough off, being replaced by new ones.

The cells of the basal layer are round and have a single large round nucleus. As they mature and move into the intermediate and functional layers, epithelial cells become flattened and their nuclei become smaller. With cervical dysplasia, structural disturbances occur in the cell, they become shapeless and large, have many nuclei, and the division into layers disappears. When such modified cells are detected, they speak of atypia.

Classification

Depending on the thickness of the epithelial lesion and the spread of atypia to different layers, cervical dysplasia is divided into degrees:

• mild dysplasia - the process affected only the lower 1/3 of the stratified squamous epithelium;
• moderate dysplasia - cell atypia is found in the lower and middle third of the entire epithelium;
• severe dysplasia or dysplasia III - atypical cell changes are present in all layers of the stratified epithelium, but have not yet spread to adjacent tissues (this degree of dysplasia is also called non-invasive, that is, non-penetrating cancer).

Causes

The most important cause of dysplasia is infection of a woman with the human papillomavirus (HPV). The most dangerous are oncogenic types (16 and 18, as well as types 6, 11, 31, 35, 39, 59, 33, 45, 52, 58, 67). And the longer HPV persists in the body, the higher the likelihood of developing atypia of cervical epithelial cells - dysplasia. It is known that in more than 95% of cases of detected cervical dysplasia, HPV is detected. But HPV infection does not necessarily lead to the development of the disease; this requires some predisposing factors:

• parity (numerous births);
• lack of ascorbic acid, vitamin A and carotene;
• taking oral contraceptives (using pills for 5 or more years increases the risk of developing pathology by 2 times);
• active or passive smoking (“the chances” increase by 2 times);
• sexual partners of patients suffering from cancer of the head of the penis;
• weakened immunity (HIV infection, taking certain medications, stress, malnutrition, unfavorable living conditions, etc.);
• early sexual life;
• first pregnancy and childbirth in girls under 18 years of age;
• heredity (predisposition to malignant processes of the genital organs);
• sexually transmitted infections (herpes simplex virus, cytomegalovirus, gardnerella, fungi, mycoplasma and chlamydia);
• promiscuous sex life;
• hormonal disruptions and surges (pregnancy, menopause, taking hormonal medications);
• chronic gynecological pathology;
• cervical injuries during childbirth, artificial abortions and gynecological procedures.

Clinical picture

Most often, dysplasia does not manifest itself in any way, and in 10% it is generally an accidental finding during examination. There are no characteristic signs of the disease, complaints appear only when a secondary infection is connected (bacteria, fungi or viruses), in which case the patient begins to worry about increased vaginal discharge, sometimes with an unpleasant odor, a feeling of itching and discomfort, spotting or bloody discharge after sexual intercourse, use tampons.

In severe cases of the disease, nagging painful sensations in the lower abdomen may appear. Since dysplasia is often combined with sexually transmitted infections, genital warts of the vulva and vagina, anus, erased gonorrhea or chlamydia are often diagnosed.

Diagnostics

Due to the fact that dysplasia does not have characteristic clinical signs, the diagnosis is established on the basis of a physical examination in combination with laboratory tests and instrumental methods:

Examination of the cervix in gynecological mirrors

A routine examination often does not allow one to suspect this pathology, since there are no changes visible to the eye on the neck. But in the case of moderate or severe dysplasia, you can detect a change in the color of the mucous membrane (bright red or whitish), proliferation of the epithelium in the form of whitish plaques, and a shiny surface around the external pharynx.

Colposcopy

Colposcopy is recommended for all women once a year, especially with existing chronic gynecological diseases. The method involves examining the cervix with a device (colposcope) under 10x or more magnification. Carrying out diagnostic tests (with dilute acetic acid and iodine) followed by examination of the cervix is ​​called extended colposcopy. When the mucous membrane of the cervix is ​​lubricated with an acetic solution, vasoconstriction of the epithelium and coagulation of mucus occurs, which facilitates examination of the cervix. Dysplasia may be indicated by signs such as:

• the appearance of areas of acetowhite epithelium (elements of leukoplakia);
• the appearance of coarse or fine punctuation;
• the appearance of polygonal areas (the mucous membrane seems to be lined with lines in different directions - a mosaic).

After the acetic acid test, the cervix is ​​stained with an aqueous solution of iodine, which is called the Schiller test. Atypia of the cervical epithelium can be suspected when areas on the cervix unstained with iodine are detected, which indicates a lack of glycogen in the epithelial cells and indicates a pathological process in the cervix. The Schiller test is considered positive if the entire surface of the cervix becomes a uniform brown color.

Cytological examination of a smear

An equally important study in terms of identifying diseases of the cervix is ​​taking a smear from the cervix for cytology or oncopathology. A smear analysis for cytology is carried out in Russia every year for every woman and consists of a scraping from the cervical surface (and if pathological areas visible to the eye are detected from the most suspicious) and from the depths of the cervical canal (in some cases, precancerous processes begin to develop in it, while the vaginal part of the cervix not changed). The material is taken with a Volkmann spoon or spatula from the surface of the cervix and with a brush or Volkmann spoon from the cervical canal. This is necessary to scrape off the epithelial cells that are needed for cytological analysis, otherwise only cervical mucus with microflora will get into the smear and the analysis will be uninformative. After a cytological examination of the smear, the doctor classifies it according to Papanicolaou:

• Type 1 – the cytological picture is normal;
• Type 2 – there are inflammatory changes in cells;
• Type 3 – there are individual epithelial cells with abnormalities of the cytoplasm and nucleus;
• type 4 - some cells with pronounced malignancy (large and irregularly shaped nuclei, abnormal cytoplasm, chromosomal rearrangements);
• Type 5 – detection of atypical (cancerous) cells.

In case of dysplasia of 1 - 2 degrees, the cytology smear is represented by the second and third types of smear, and in case of severe dysplasia, the smear corresponds to the third and fourth types.

Biopsy of the cervix with future curettage of the cervical canal

A biopsy (tissue collection from a damaged area of ​​the cervix) is performed under the control of colposcopy (therefore the procedure is called a targeted biopsy). Then a histological examination of the material is carried out. Biopsy is the main method for diagnosing this disease, as it allows one to study not only the structure of the cells, but also the architectonics of the epithelial layers (their number, relative position, “depth” of atypia). After a biopsy and confirmation of the diagnosis of dysplasia, patients are required to undergo diagnostic curettage of the cervical canal so as not to miss the precancerous process in it.

Treatment

Treatment of the described disease is necessarily comprehensive and includes the following points:

• carrying out anti-inflammatory therapy;
• normalization of immunological disorders;
• restoration of vaginal microbiocenosis.

The management of patients depends on the extent of the process, the area of ​​the lesion, the desire to become pregnant and age. If a mild/moderate degree of pathology is detected in young women and small pathological areas, treatment is not prescribed; only dispensary observation is indicated (every quarter), since there is a high chance of spontaneous cure - regression of the disease (about 70 - 90%). But if HPV is detected, especially if it persists for a long time in the body, etiotropic antiviral therapy (acyclovir, groprinosin, isoprinosine, panavir) is prescribed locally and systemically, drugs to normalize immunity (polyoxidonium, roncoleukin, immunal, viferon) and treatment of the pathological area with cauterizing substances mild action (solkovagin). After antiviral therapy, therapeutic measures include probiotics and eubiotics (bificol, bifidumbacterin, lactobacterin) in the form of vaginal tampons, which normalizes the vaginal microflora.

But conservative therapy does not always give a positive effect. Indications for surgical treatment are:

• 3 degree of dysplasia;
• cervical cancer in the first stage;
• unsatisfactory results of cytological smears and colposcopy during six-month follow-up.

Surgical methods for treating cervical dysplasia include:

Diathermocoagulation or DTC

The essence of the technique is the destruction (destruction) of the pathological focus with high-frequency electric current, which is supplied to the electrode (loop) in contact with the neck. As a result, necrosis (death) of atypical epithelial cells occurs, and a scab forms at the site of cauterization. The method has lost its relevance in recent years due to low efficiency (about 70%) and a high risk of complications (bleeding, pain, cicatricial deformation of the neck, long healing period).

Cryodestruction

This method involves treating the pathological lesion with cold (liquid nitrogen at a very low temperature), as a result of which atypical cells are destroyed and rejected. This method of treatment is suitable for nulliparous women, but also has a number of disadvantages: long healing time and a high risk of developing inflammatory processes in the treated lesion.

Laser vaporization

The essence of the technique is the action of laser beams on the affected area (non-contact method), while the liquid evaporates from the affected cells and they are destroyed. Laser treatment is a fairly effective method and has only two drawbacks: high price and expensive equipment, which is not available in all medical institutions.

Treatment with radio waves (using the Surgitron device)

The method is similar in action to laser vaporization, only radio waves are used instead of laser beams (the method is also non-contact).

Surgery

In some situations, surgery on the cervix is ​​indicated, either knife conization or excision (excision of a pathological focus within the boundaries of healthy tissue) or amputation of the cervix (removal). Indications for this type of intervention are:

• spread of the process along the cervical canal;
• moderate and severe dysplasia, first degree cervical cancer, confirmed by biopsy results;
• severe deformation of the neck, regardless of the degree of pathology;
• re-treatment in case of a negative effect from destruction methods.

After surgical treatment

After destruction of the pathological focus on the cervix, the patient is recommended:

• limit physical activity and heavy lifting for 1.5 – 2 months;
• sexual rest by 1 – 3 (depending on the treatment method);
• prohibition of douching and the use of tampons for the entire healing period;
• control examination of the cervix after one and a half months.

In case of pain, non-steroidal anti-inflammatory drugs (Nise, ibuprofen) can be taken. In the first 3 to 4 weeks after surgical treatment, vaginal leucorrhoea may increase, both with and without odor. If the temperature rises to 38 or higher or bleeding occurs, you should immediately seek medical help.

Complications

Cervical dysplasia is fraught with the following complications, which usually occur after surgical treatment:

• bleeding during or after destruction (associated with vascular damage and scab rejection if recommendations are not followed);
• development of anomalies of labor forces, which is caused by deformation of the cervix by scars and stenosis of the cervical canal;
• infertility due to obstruction of the cervical canal (stenosis) or as a result of an ascending infection (chronic salpingitis and endometritis);
• menstrual irregularities (hormonal problems);
• transition to cervical cancer.

Question answer

Is relapse of the disease possible, and what causes it?

Unfortunately, no methods of treating dysplasia, even surgery, provide a 100% guarantee of getting rid of the disease. Resumption of dysplasia occurs when treatment is inadequate, for example, destruction of the pathological focus was carried out, but previous antiviral therapy was not. Dysplasia recurs especially often when HPV persists for a long time in the body. In addition, before surgical treatment, it is necessary not only to get rid of HPV, but also from other sexually transmitted infections, as well as to correct hormonal disorders.

Is pregnancy complicated after surgical treatment of dysplasia?

A complicated course of both pregnancy and childbirth occurs after cauterization of the cervix (DTC), which is facilitated by cicatricial deformation of the cervix, causing both difficulties with conception due to stenosis of the cervical canal, and abnormalities during childbirth (discoordination of labor forces, cervical ruptures).

Is it permissible to treat dysplasia using traditional methods?

No and no again. Firstly, there are no traditional medicine methods for treating this pathology (how could our great-great-grandmothers know about such a disease?). And, secondly, all so-called “folk” methods of therapy (tampons with sea buckthorn oil, aloe juice or douching) will not only not have a positive effect, but will also accelerate the transition of dysplasia to a more severe degree, as they will provoke proliferation (growth) of atypical cells. The only thing that can help from traditional medicine is taking vitamin and immunostimulating teas, decoctions and infusions, and only under the supervision of a gynecologist and at a certain stage of treatment.

Are cervical erosion and dysplasia the same disease?

Cervical erosion is a background disease, the essence of which boils down to the growth of the columnar epithelium covering the endocervix onto the vaginal part of the cervix, which is normally lined with stratified epithelium. That is, one type of epithelium is replaced by another. Dysplasia, roughly speaking, is a precancer and its essence lies in a change in the structure of the cells themselves, which, in the absence of proper treatment, very quickly turns into cervical cancer.

Is dysplasia not considered a contraindication to having sex?

No, the disease itself does not prohibit sexual activity, but it is recommended to use barrier contraceptive methods (condoms) to avoid infecting a partner with HPV or other sexually transmitted infections. But with a severe degree of the disease, contact bleeding may appear during or after coitus. And, of course, it is necessary to maintain sexual rest (up to 2 months) after surgical treatment of the pathology in order to avoid complications during the healing period.

Can dysplasia disappear without treatment?

Yes, there is a very high percentage of self-reduction of the process with mild dysplasia (reaches 90%) and slightly less (about 70%) with moderate dysplasia, but provided that there is no HPV in the woman’s body.

How does childbirth proceed in a woman with dysplasia discovered during pregnancy?

If mild or moderate dysplasia is detected, the patient is “allowed” to go into spontaneous labor, that is, she gives birth through the vaginal canal, and surgical delivery is carried out only for obstetric indications. Pregnancy is not affected by the course of the disease (self-healing of the disease is observed in 60-70% of cases after childbirth in grades 2 and 3 dysplasia, and only less than 1% of cases develop minimally invasive cervical cancer), nor does dysplasia itself have a negative effect on the fetus. Treatment of pathology is postponed until the postpartum period, since all methods of destruction adversely affect the development of the fetus. But if it is necessary to carry out conization of the cervix (for example, in case of severe dysplasia), it is carried out during gestation, followed by suturing the cervix (prevention of premature birth), and delivery is carried out depending on the obstetric situation, either independently or operatively.

Should you follow a diet if you have dysplasia?

One of the risk factors for the development of the described disease is poor nutrition and a lack of certain vitamins (group B, folic acid, vitamin E and C). The diet should be dominated by green vegetables rich in folic acid and B vitamins (lettuce, dill and parsley, broccoli, soybeans, cabbage, green peas, beans), ascorbic acid (citrus fruits, bell peppers, currants, sea buckthorn and others), vegetable oils (lots of vitamin E).

Is sunbathing allowed?

No, you cannot sunbathe if you have any precancerous processes, and, of course, if you have dysplasia. Ultraviolet rays cause mutation of genes in cells, which aggravates the disease. Therefore, both sunbathing and sunbathing in a solarium is prohibited.

Is it possible to do IVF with dysplasia?

This pathology is not an absolute (when they say: categorically impossible) contraindication to in vitro fertilization. However, the doctor will recommend examination and treatment, if necessary, before this procedure, since the presence of HPV in the body of the expectant mother can adversely affect the development of the fetus or lead to its infection during childbirth.

What is photodynamic therapy and is it possible to cure dysplasia with it?

Photodynamic therapy is considered the most promising and high-tech method for treating cervical dysplasia. However, this method of treatment is effective only in the presence of mild to moderate dysplasia. The essence of the method is the action of a low-energy laser beam of a certain wavelength on the pathological area, which has been pre-treated with a photosensitizer gel. This gel absorbs laser light and “turns on” a number of chemical reactions. That is, the gel “transmits a laser pulse” to intracellular oxygen, which, when activated (“foaming”), destroys cells. The method has a number of advantages: painlessness, bloodlessness, rapid healing, and no scars on the neck.

Obstetrician-gynecologist Anna Sozinova

Cervical dysplasia grades 1, 2, 3: symptoms, treatment, photos

What is it - the main cause of cervical dysplasia is infection with the human papillomavirus. It promotes the transformation of tissues of the human body from benign to malignant. Timely testing for papillomavirus allows you to assess the likelihood of developing cervical cancer. It is very relevant, since according to statistics, about 90% of the planet's population is infected with this virus. The beginning of such tissue degeneration is considered to be the presence of dysplasia, which is a prestage of the oncological process. Its essence lies in the pathological change in epithelial cells and the relationships between them. In modern medicine, the term “Dysplasia” has been replaced by “cervical intraepithelial neoplasia.”

Causes of cervical dysplasia

Cervical dysplasia in most cases develops due to human papillomavirus infection. The latter takes on a more aggressive course if combined with the presence of the herpes virus in the body (especially the second type). It acts as a concomitant factor that triggers the processes of carcinogenesis, which leads to the development of persistent dysplasia. As a rule, it does not regress on its own. Papillomavirus has many variations in structure, on the basis of which strains of this virus are isolated (currently there are approximately 70 of them). Moreover, some may cause certain clinical manifestations, while others may not. The virus is characterized by tropism for epithelial cells of the skin and mucous membranes. The degree of oncogenic risk will depend on the strain that caused the infection. Therefore, strains with low risk, medium and high oncogenic risk are distinguished.

Cervical dysplasia grades 1, 2, 3

There are three main types of cervical epithelial dysplasia, which determine the risk of malignant degeneration. The first degree of dysplasia, or mild dysplasia, is characterized by the fact that cells that do not have differentiation are determined in an area of ​​1/3 of the entire thickness of the epithelial layer from the basement membrane to the surface. If this is moderate dysplasia, then they are found in an area of ​​2/3 of the entire thickness of the epithelium. In severe dysplasia, they penetrate more than 2/3 of the thickness of the epithelial layer. Pre-invasive cancer is also included in this category. It is not possible to differentiate between them. But due to the same high danger for women, treatment tactics should be the same.

Symptoms of cervical dysplasia

Cervical intraepithelial neoplasia, or dysplasia, can be combined with condylomas and papillomas. They can be localized on the genitals, soles, mucous membrane of the respiratory tract, etc. This combination of symptoms should prompt the doctor to think about searching for a precancerous process. In general, cervical dysplasia is asymptomatic. During examination, areas of erosion or keratinization may be detected in the mirrors. In this case, a more targeted diagnostic search is necessary.

Diagnosis of dysplasia

Depending on the severity of changes in the epithelium, cervical dysplasia is classified into three degrees:

• light
• average
• heavy.

However, the diagnosis of this process is quite difficult, since its clinical manifestations are absent for a long time. The main recommended diagnostic tests are:

• colposcopy with detailed examination of the pathologically changed area
• cytological examination of smears taken
• histological examination, which puts an end to establishing the correct diagnosis.

A cytological sign that indicates infection with papillomaviruses is the detection of cells in smears such as koilocytes. Their peculiarity is the presence of a large light zone around the core. It appears as a result of the death of part of the cytoplasm and cytoplasmic organelles. In addition to koilocytes, the following can also be detected:

• keratinized and keratinizing epithelial cells
• cells with two nuclei
• acanthosis

It should be remembered that on the basis of cytological examination one can only suspect cervical intraepithelial neoplasia. So, in 30% of cases, false negative results can be obtained, that is, if dysplasia is present, it is not diagnosed. Therefore, when pathological changes are detected in a cytological smear, a histological examination is indicated, which allows one to assess the degree of dysplasia. It includes a biopsy from pathologically changed areas of the cervix and/or separate diagnostic curettage of the cervical canal. The main histological signs of dysplasia are considered to be the following:

• the cell nucleus becomes larger
• its shape becomes irregular
• different nuclear structure options in one material
• a large number of mitotically dividing cells
• irregular mitoses
• cell maturation is impaired or absent.

In addition, it is necessary to assess the infection of the body with papillomaviruses. For this purpose, various research methods can be used:

1. 1) Polymerase chain reaction, which allows us to evaluate a specific strain and the degree of its oncogenic risk.
2. 2) Serological study, which determines antibodies to these viruses.

Treatment of cervical dysplasia

Surgical and destructive treatment of cervical dysplasia is mainly used. Let's take a closer look at which method is best to use.

1. 1) Destructive, in which the pathological cervical epithelium is destroyed (use of laser, cryodestruction, diathermocoagulation)
2. 2) Surgical, which involves the removal of this tissue. This includes all types of excisions.

Each of these types has its own indications and contraindications, and also has different effectiveness. Therefore, each of them will be considered separately. Diathermocoagulation involves “cauterization” of a dysplastic area of ​​the cervical epithelium using an electric current. The effectiveness of the method ranges from 70 to 97% in the treatment of ectocervical epithelial dysplasia. A significant disadvantage of this type of treatment is the inability to control the depth of exposure to tissue. In addition, complications can often develop:

• bleeding
• formation of scars, including those that deform the cervical canal (this may further affect the process of opening the cervix during childbirth, therefore diathermocoagulation is not recommended for nulliparous women)
• constant pain throughout the healing period

MyMedicalPortal.net

Hello. Please tell me how to cure grade 2 cervical dysplasia... without a doctor? folk remedies?

Evgenia Sheveleva

Without a doctor... also 2nd degree... with “home” remedies... girl, aren’t you scared AT ALL?...

Denis Taratorovsky

Don't play around, your risk of cancer is much higher. Better see a doctor.

Do you really believe that grandmothers could diagnose this disease and come up with some means for treatment..?

Andrey Enyutin

look for infection with or without a doctor. Just don’t say that it doesn’t exist, you just didn’t look hard enough.

Svetlana Marachkovskaya

Only cauterization will help here, or wait until it turns into cancer, it won’t be long

As a result of histological examination of pathologically altered cervical epithelium, severe cervical dysplasia can be diagnosed, which according to the international classification is called cervical intraepithelial dysplasia of the third degree (out of the existing four).

The disease is considered a precancerous condition of cervical tissue and has not one code according to ICD 10, but two: class XIV (diseases of the genitourinary system), N87 – Dysplasia of cervix uteri, as well as class II (neoplasms), D06 – Carcinoma in situ of cervix uteri .

ICD-10 code

N87.2 Severe cervical dysplasia, not elsewhere classified

Causes of severe cervical dysplasia

In oncology, precancerous is a term used to describe changes in the condition of the cervix that make it more sensitive to the action of the human papillomavirus (HPV or HPV). This may be somewhat inconsistent with the definition of carcinoma as a cancer of epithelial tissue.

To date, according to numerous epidemiological studies, the causes of severe cervical dysplasia in 62% of diagnosed cases are caused by this persistent viral infection. Although most genital HPV infections do not cause cancer.

Pathological changes in the form of atypical cells of the cervical epithelium are noted in the so-called transformation zone - where one type of mucosa, consisting of glandular and cylindrical cells, constantly (in connection with the menstrual cycle) changes into another type of squamous epithelium.

The pathogenesis of any, including severe cervical dysplasia, is associated with the fact that HPV damages the cells that line the cervix (enlargement and chromatosis of nuclei, changes in cell shape, etc. are noted). Sometimes the virus damages the gene of healthy cells (introsomal type of damage), which causes not only abnormalities in the morphology of cells in almost the entire layer of squamous epithelium, but also their intensive proliferation.

Gynecologists note that factors that increase the risk of developing severe dysplasia include unprotected sexual contact; decreased immune reactivity of the body (including due to a deficiency of immune-supporting vitamins - ascorbic acid and retinol); disruption of homeostasis (in particular, increased acidity of the internal environments of the body, which is largely facilitated by smoking); history of multiple pregnancies; hereditary predisposition to the appearance of gynecological malignant neoplasms, as well as long-term contraception using hormone-containing tablets taken orally.

Symptoms of severe cervical dysplasia

Precancerous changes in the cervix often occur without obvious manifestations. And the first signs of the disease are an abnormal result of a cervical smear (Pap test, Pap test or Papanicolaou smear).

Obvious symptoms of severe cervical dysplasia may appear as:

• discomfort and pain during coitus;
• bloody vaginal discharge or bleeding after coitus;
• pruritis (itching) in the genital area;
• the appearance of other atypical vaginal discharge;
• aching and pulling pain in the lower part of the abdominal cavity and pelvic area.

Cervical neoplasia of the third degree (CIN III) or severe cervical dysplasia affects only the squamous epithelium and has complications in the presence of concomitant infections (chlamydia, vaginosis, vulvitis, colpitis). The consequences of severe dysplasia are its further development with all the signs of oncology. Or spontaneous disappearance (50 to 50), but it is extremely difficult to predict the “behavior” of the disease.

Diagnosis of severe cervical dysplasia

A standard scheme has been developed for diagnosing severe cervical dysplasia.

After examining the cervix in a chair, the doctor prescribes tests:

• cytological smear of the cervical mucosa (Pap test using the Papanicolaou method);
• smear for the presence/absence of human papillomavirus (HPV) to determine its serotype;
• taking a sample of cervical tissue (by scraping) for papillomavirus DNA.

Instrumental diagnostics are also used: colposcopy (vaginal endoscopy), which allows visualization of cervical tissue at multiple magnification using a special endoscopic device (colcoscope).

Differential diagnosis of severe cervical dysplasia (from ectopia, cervicitis, retational cystosis, etc.) is carried out on the basis of a biopsy, which is often performed during colcoscopy, and histological examination of the resulting sample of modified tissue.

Treatment of severe cervical dysplasia

Currently, medicines are not used in the treatment of this pathologist (by chemical destruction of atypical cells): their ineffectiveness is recognized by all.

Therefore, surgical treatment of severe cervical dysplasia is considered more effective using excision methods such as:

• diathermy or loop electrical excision procedure – LEEP (Loop Electrosurgical Excision Procedure);
• cryocoagulation (freezing with liquefied nitrogen);
• laser ablation (used on clearly localized pathological areas of cervical tissue or when an entire layer of tissue on its surface is affected);
• resection of the pathological area using a scalpel;
• ectomy or removal of the entire cervix (used when abnormal cells are found in the cervical canal).

To restore healthy cells, vitamin therapy (vitamins A, C, group B), zinc and selenium supplements are used.

Traditional treatment with turmeric, pineapple juice, and green tea is intended to stimulate the body's defenses against HPV. Herbal treatment uses ingested decoctions of plants with an immunostimulating effect - Echinacea purpurea and especially astragalus, which activates the synthesis of interleukin-2, which can destroy the papilloma virus and mutant cells.

Homeopathy in its preparations to combat HPV uses aloe juice and thuja occidentalis extract, as well as a topical remedy based on the essential oil of Melaleuca alternifolia - tea tree.

Prevention and prognosis

Prevention of this pathology is possible if all women, after turning 18 years old, undergo an annual smear test and undergo screening Pap testing. If a negative result is detected twice within 6-12 months, then it is enough to be examined every three years.

In the absence of treatment, doctors give a prognosis for this pathology based on statistics: according to some data, in 20-30% of cases, according to others in 30-50%, according to others -12%, severe cervical dysplasia progresses to squamous cell carcinoma.

- This is a form of uterine precancer, which is especially common nowadays. Dysplasia means the presence of changes in the mucous membrane of the cervix, as well as the vagina, of various origins.

With the development of dysplasia, disturbances appear in the structure of the cells of the surface layer of the cervix. Depending on the stage of dysplasia, changes occur not only in the superficial layers, but also in the deeper ones. Sometimes dysplasia is referred to as, but most experts are inclined to think that this term cannot fully reveal the essence of the ongoing process. Indeed, with erosion, tissue damage occurs, which is mechanical in nature, and cervical dysplasia implies the presence of damage to the structure of tissue cells. That is, with dysplasia, not only do cells develop that have signs of atypia, but also a pathological change in the tissue complex as a whole occurs.

Types of cervical dysplasia

When making a diagnosis, specialists use the classification of dysplasia, which determines the degree of damage to the stratified squamous epithelium of the cervix.

If the patient is determined 1st degree cervical dysplasia , then in this case a third of the thickness of the epithelium is affected. Therefore, this degree is considered mild. This stage of dysplasia is sometimes combined with edema and vacuolization of the cells of the intermediate layer.

If the patient has affected from 1/3 to 2/3 of the thickness of the epithelium, then in this case it is diagnosed cervical dysplasia 2 degrees . We are talking about the average degree of damage. In this case, the polarity of the epithelium is disrupted.

If the patient has a lesion of the entire thickness of the epithelium, then it is determined cervical dysplasia grade 3 , which is a severe degree of the disease. In this case, there is no division of the squamous multilayer epithelium into layers, and there is pronounced cellular and nuclear atypia.

Causes of cervical dysplasia

In approximately 95% of cases, dysplasia develops at the site of transformation of the cervix. It is in this zone that the transition of columnar epithelium to flat epithelium is noted. Under the influence of a mechanical or physical nature, dysplasia develops in this place.

There are several factors that determine the development of this disease in a woman. In particular, cervical dysplasia develops against the background, vaginosis , . In addition, the cause of the development of dysplasia is often ectopia And cervical erosion , vulva . The disease is also often diagnosed as a consequence in patients sexually transmitted diseases .

Very often, epithelial dysplasia occurs against the background of damage to the mucosal epithelium. Under the influence of the virus, proliferation of cells of the basal and parabasal layer occurs. Cells affected by the virus gradually grow and move to the upper layers of the epithelium, in which the virus multiplies. As a result, a viral attack provokes the occurrence of dysplasia.

Experts also identify other factors influencing the development of dysplasia: early onset of sexual life, as well as early (before the age of 16 years); frequent sexual intercourse with non-regular partners; neglect of contraceptive methods, in particular the use of a condom; numerous or genera. A higher risk of developing dysplasia exists in women who smoke, since hypoxia occurs under the influence of tobacco smoke. As a consequence, the local one significantly deteriorates, and the risk of epithelial microtrauma increases significantly. Long-term use of combined oral contraceptives can also provoke cervical dysplasia.

Also, as factors influencing the occurrence and development of the disease, it should be noted the deficiency of some vitamins (A, C, β-carotene), low quality of life, the presence of a certain genetic predisposition to the disease.

The manifestation of hormonal dysfunctions of any etiology can become another reason for the development of this disease.

Symptoms of cervical dysplasia

As a rule, there are no pronounced clinical signs during the development of cervical dysplasia. However, with severe, advanced dysplasia, a woman may experience periodic pain in the lower abdomen. In addition, small amounts of bloody discharge may sometimes appear.

Approximately 10% of women have a latent course of the disease. But most often microbial infections are associated with dysplasia. In this case, the patient already notices signs characteristic of other diseases: noticeable changes in the consistency and nature of the discharge, pain, burning, itching.

Diagnosis of cervical dysplasia

Due to the absence of pronounced symptoms in the process of diagnosing cervical dysplasia, the use of clinical, instrumental and laboratory research methods that allow assessing the cellular structure of the cervical epithelium is of particular importance. The appropriateness of using a specific method in each individual case is determined by the attending physician.

During the examination, the following methods are used: cervical examination, simple and extended colposcopy, endocervical curettage (the procedure consists of curettage of the mucous membrane of the cervical canal).

In addition, tests with acetic acid, studies for the presence of sexually transmitted infections, and determination of immune status are used.

If during colposcopy areas of the epithelium are detected where dysplasia is likely to develop, a biopsy is performed and subsequent histological examination is performed. It is this method that allows you to accurately determine the severity of the disease.

Treatment of cervical dysplasia

Sometimes treatment for cervical dysplasia is not practiced at all. The need to use specific methods of therapy is determined by the treating specialist, guided by a number of factors. In nulliparous young women, sometimes the disease goes away on its own, provided that we are talking about mild or moderate dysplasia. In this case, the following conditions must be met: the patient’s age does not exceed 20 years, there are only point lesions, the pathological process has not affected the cervical canal, there are no viral infections in the body. But even in the absence of treatment, in this case, constant monitoring by a doctor and research every few months are indicated.

When prescribing treatment for dysplasia, it is imperative to use two directions: removal of the area affected by the disease and subsequent restorative treatment. It is important to take into account the degree of the disease, the woman’s age, a history of childbirth, and other risk factors.

To choose the right method for removing an atypical area, the doctor must take into account all the individual characteristics of the patient’s health condition. The fact is that certain types of surgical intervention can provoke the development of serious complications in the future. It could be the appearance of scars on the cervix , menstrual cycle disorders , pregnancy disorders .

The chemical coagulation technique is most often used if a woman is diagnosed with true erosion, and the lesions are relatively shallow and not extensive. Methods using electricity are also used for the cauterization procedure. This procedure is performed quickly, but after it, scars may remain on the uterus.

Cryodestruction and cryoconization methods, which consist of freezing the affected areas using liquid nitrogen, are also often used in the treatment of dysplasia. However, in the case of severe dysplasia and manifestations of a malignant process, freezing is not used. The disadvantages of this technique are the inability to accurately regulate the depth of freezing, as well as the appearance of discharge for too long after the procedure.

Tissue cauterization is also performed using a laser. Operations using a laser allow you to most accurately influence the affected areas. But at the same time, such an intervention is quite painful, and after a few days it may occur.

Excision by cold knife conization is currently used infrequently, since this method is fraught with a number of complications: high morbidity, severe bleeding. Subject to diagnosis first stage of cancer The woman is scheduled for cervical amputation.

It is important to consider some features of the treatment of dysplasia. It is advisable to perform the operation at the beginning of the menstrual cycle, since it is at this time that tissue restoration occurs most actively. Generally, local anesthesia is used during the operation. General applies only in individual cases.

In the postoperative period, women notice the appearance of discharge for about a month. In the first weeks, there is also pain in the lower abdomen. During the recovery period after surgery, a woman is prohibited from lifting heavy loads, using tampons, douching, or being sexually active. Sedative medications can also be used at this time, but they are prescribed on an individual basis.

Approximately three months after surgery, it is important to take a cytological smear to check the effectiveness of the procedure. As a rule, restoration of the epithelium occurs after 6-10 weeks. During the first year after surgery, the condition of the epithelium should be checked at least once every three to four months.

As a restorative treatment, it is important to take a course of medications containing vitamins A , E , C , AT 6 , AT 12 , bioflavonoids , β-carotene , and other microelements. During the research, a direct connection was noted between the lack of certain vitamins in a woman’s body and the manifestation of cervical dysplasia. Complex multivitamins are also used to prevent the manifestation of dysplasia. During the recovery period, the patient’s diet should also include those foods that contain the maximum of these vitamins and elements. It is also recommended to drink green tea every day, which has a positive effect on the restoration of the epithelium.

When prescribing treatment methods, the doctor must take into account the nature of the diseases accompanying dysplasia. Before surgical treatment, mandatory sanitation occurs in order to eliminate inflammation, if any.

Some traditional methods used to treat cervical dysplasia are also recommended. A course of treatment using tampons with propolis and butter is effective. To prepare them, melt 200 g of butter and add 10 g of pre-crushed propolis. Boil this mixture for 15 minutes over low heat. After this, the liquid is filtered through several layers of gauze. The tampon is soaked in this mixture and inserted into the vagina for about half an hour. The ointment should be stored in a cold place, and procedures with tampons are carried out throughout the month.

You can also prepare tampons with aloe and honey to treat dysplasia. To do this, equal parts of fresh aloe juice and honey are mixed, a tampon is soaked in the mixture, which is inserted into the vagina at night. The course of treatment is two weeks.

For daily douching, which should be done morning and evening, use an infusion of green tea and calendula. To prepare it, you need to take one tablespoon of calendula flowers and dry green tea, pour boiling water over the mixture and leave for several hours. Douching is carried out for one month.

It is very important to always remember that, if not treated on time, they can develop into a malignant form over time. Therefore, you should undergo preventive examinations on time and take all measures to cure the disease.

Today, the use of the correct approach to treating the disease ensures the cure of dysplasia and the prevention of its degeneration into a malignant form.

The doctors

Medicines

Prevention of cervical dysplasia

Cervical dysplasia can occur not only in those women who belong to the risk groups described above. Women who have already begun sexual activity must strictly adhere to the timing of preventive examinations with a gynecologist.

A mandatory preventive measure for every woman should be the correct approach to organizing daily nutrition: in particular, you need to constantly eat dishes enriched with beneficial microelements.

An important preventative measure is complete cessation of smoking, the connection of which with the development of dysplasia has been clearly proven by scientists. It is important to observe the rules of sexual hygiene, use, and ensure timely treatment of all diseases of the genitourinary system.

List of sources

• Kondrikov, N.I. Pathology of the uterus: illustrated. hand / N.I. Kondrikov. - M.: Prakt. Med., 2008;
• Prilepskaya V.N. Cervical pathology and genital infections. M.: MED press-inform, 2008;
• Neishtad E.L., Krulevsky V.A. Differential diagnosis of cervical tumors. - St. Petersburg: KultInformPress, 2012;
• Rogovskaya, S. I. Human papillomavirus infection in women and cervical pathology / S. I. Rogovskaya. - M.: GO-ETAR-Media, 2005.

- a disease based on pathomorphological changes in the epithelial cells of the part of the cervix that extends into the vagina. The process is characterized by disordered growth of atypical cells against the background of squamous metaplasia.

The term “cervical dysplasia” is not entirely correct at the moment; the correct nosological unit is called cervical intraepithelial neoplasia(Cervical Intraepithelial Neoplasia - CIN).

There are 1.5 cases of atypia detected per 1000 women, and the disease occurs mainly in women of childbearing age.

This pathology is interpreted by experts as precancerous. It is dangerous due to degeneration into a malignant tumor, so early detection of neoplasia, timely and competent treatment helps prevent malignancy of the process.

Pathogenesis of cervical neoplasia

The squamous epithelium of the mucosa has a multilayer structure and consists of a basal-parabasal layer - the deepest, an intermediate layer - with maturing cells, and a functional or superficial layer - with mature and not yet keratinized epithelial cells.

The dysplastic process is manifested by abnormal uncontrolled growth of altered epithelial cells. Atypia is characterized by the formation of cells of irregular shape, size, their thickening and structural disturbances: abnormalities of the nuclei, cytoplasm and other components. The most characteristic cytomorphological sign is dyskaryosis - a violation of the morphology of the nuclei.

Classification of cervical neoplasia

Neoplasia can affect either one or several layers of squamous epithelial cells. Regarding the depth of spread of atypia, three degrees of the disease are distinguished:

1. Lightweight or mild neoplasia (mild dysplasia, CIN I) is characterized by minor dysplastic changes in the structure of epithelial cells with moderate proliferation of the basal layer. Changes, starting from the basement membrane, cover no more than 1/3 of the thickness of the epithelial layer.

2. Moderate cervical neoplasia (moderate dysplasia, CIN II) is characterized by more pronounced morphological changes, affecting up to 2/3 of the thickness of the epithelial layer. Atypia is detected in the middle and lower third of the thickness.

3. Severe (pronounced) neoplasia or non-invasive cancer (severe dysplasia, CIN III) is established when a pronounced pathological process has spread to more than 2/3 of the epithelial layer, and there is no longer any division into layers, since most often they are all affected. This stage is characterized by pathological mitoses and acanthosis. The appearance of a thin layer of keratin on the surface of the epithelium suggests the presence of carcinoma in situ.

Causes of cervical neoplasia

The existence of HPV in the female body for more than one or one and a half years inevitably leads to the development of cervical neoplasia of varying severity and squamous cell carcinoma.

Interferon has antitumor and antiviral activity, but HPV encodes specific oncoproteins E6 and E7, after which they neutralize this activity, leading to a decrease in local immunity and promoting the beginning of the degeneration of healthy cells into atypical-precancerous, and then into cancerous ones.

Infection with the virus can occur unnoticed by a woman, but if she has a hereditary predisposition to cancer, and especially if there have been cases of cancer of the reproductive system in her family, then the risk of neoplasia and carcinoma increases many times over. Therefore, genetic predisposition is one of the predisposing factors for the appearance of neoplasia.

Other risk factors include:

Early first births or a large number of them;
sexual activity before age 16;
promiscuous sex life with different sexual partners (frequently changing them);
repeated abortions, during which the cervix is ​​subjected to mechanical trauma;
hormonal imbalance due to long-term use of contraceptives, pregnancy or menopause;
immunodeficiency caused by various reasons: suppression of immune defense by forced use of immunosuppressants or some other drugs, due to stress, unbalanced nutrition, acute or long-term diseases, for example, tuberculosis, diabetes, HIV infection and AIDS;
chronic diseases of the genital organs, accompanied by prolonged inflammation;
genital herpes;
active or passive smoking;
presence of cancer of the glans penis in a sexual partner;
low social level.

Clinical manifestations of cervical neoplasia

In this case, the following symptoms appear:

Itching and burning in the vagina;
bloody discharge after douching, using tampons, or sexual intercourse;
changes in the consistency, color and smell of discharge: the appearance of profuse, thick, unpleasant-smelling leucorrhoea;
discomfort during sexual intercourse.

With severe atypia, moderate nagging pain in the uterine area is possible.

The disease often occurs simultaneously with genital herpes, genital warts of the anus, vulva, vagina, as well as other sexually transmitted diseases.

In the absence of concomitant diseases and accompanying symptoms, cervical neoplasia can only be detected during a gynecological examination.

Diagnosis of cervical neoplasia

Diagnostic methods necessary to detect cell atypia:

Gynecological examination using vaginal speculum. The goal is to detect changes in the mucous membrane visible to the eye.
In no more than 3.4% of women, visual examination does not give any results. In 20–24% of cases, minor changes are detected: retention cysts, focal or diffuse hyperemia of the cervical mucosa. In 64–73% of patients with severe dysplasia, erosions, pseudo-erosions, leukoplakia of varying degrees of keratinization, and exophytic growths of the epithelium are visualized.

Colposcopy is an examination of the cervix through a colposcope - an optical device that has the ability to magnify an object 10 times or more. Colposcopy allows, simultaneously with the examination, to carry out diagnostic tests - treating the cervix with Lugol's solution or acetic acid.

A targeted biopsy is performed during colposcopy. A piece of tissue is excised from the suspicious area of ​​the cervix for subsequent histological examination.

Histology of a biopsy is a histological examination of the material taken during a biopsy. This is the most informative diagnostic method for dysplasia.

Pap smear cytology is a study of scrapings from the mucous membrane of the cervix using a microscope. Helps detect cellular atypia and HPV marker cells.

Ultrasound of the female genital organs.

Additional studies are possible:

PCR study.
Blood test for immune status.

Treatment options for cervical neoplasia

In case of a mild form of the disease, only dynamic observation is sufficient; if a urogenital infection is detected, specific treatment is prescribed.

Moderate dysplasia is usually treated conservatively. This therapy includes immunomodulators, anti-inflammatory drugs, and vitamins. CIN II dysplasia is almost always accompanied by HPV, so antiviral therapy takes a leading place.

Other possible surgical treatment options:

Cryodestruction – removal of a changed area of ​​tissue by exposure to liquid nitrogen (freezing);
electrocoagulation – cauterization of tissue using high-frequency current;
laser therapy - laser exposure to an atypical area for the purpose of its destruction;
radio wave therapy – treatment with radio waves.

Statistics
Only in 16% of patients with CIN II neoplasia, the disease progresses to CIN III after 2 years and in 25% of women after 5 years. In 32% of cases, CIN III develops into cancer.

Conization is an operation to remove a pathological area of ​​the cervix. Recommended for young women planning to maintain childbearing function;
hysterectomy – complete amputation of the uterus. It is performed on elderly postmenopausal patients.

Treatment of cervical neoplasia CIN I and II is carried out by gynecologists, and women with CIN III are supervised by gynecological oncologists.

After treatment, each patient is on D-registration. In the first year after surgery, you are supposed to visit a gynecologist once every 3 months, in the second year – once every 6 months, and subsequently once a year. A visual examination is required, including extended colposcopy and cytological examination of a smear.

Treatment with traditional methods

Herbal infusion recipe:
Take sweet clover (1 teaspoon), yarrow (2 teaspoons), nettle (3 teaspoons), rose hips (3 teaspoons), calendula and meadowsweet flowers (4 teaspoons each). Mix everything, pour 1 teaspoon of the mixture into a glass of boiling water, then leave for half an hour. Douche with the cooled infusion in the morning and evening, and additionally insert tampons moistened with the same solution into the vagina for 30–40 minutes. The course is a month.

Treatment is effective with sea buckthorn oil, which must be soaked into a tampon and inserted overnight. Duration of treatment is from 2 to 3 months. You can use aloe juice for the same purpose, but you need to use tampons 2 times a day for a month. The residence time of each tampon in the vagina is 4–5 hours.

These methods bring positive results for mild to moderate dysplastic processes.

Prevention of cervical neoplasia

Balanced diet.
A diet with a high content of microelements and vitamins, especially vitamins A, group B, selenium, folic acid.
Barrier contraception used for casual sex.
Regular (1-2 times a year) visits to the gynecologist.
Timely treatment of all gynecological diseases and infections.
To give up smoking.
Regular PAP smear cytology.
Diagnosis of infection using PCR.

Complications and possible consequences of cervical neoplasia

Postoperative complications:

Deformation of the cervix with scars;
menstrual irregularities;
infertility;
exacerbation of existing chronic diseases of the reproductive organs;
recurrence of dysplasia.

Forecast