Cin 1 due to cervical deformation. Cervical dysplasia: first signs, symptoms and treatment. There are three possible options for the development of the disease

Cervical dysplasia grades 1, 2, 3 is a common diagnosis in women. This pathology can occur for years without symptoms and then develop into cancer. Therefore, it is so important to undergo regular examinations by a gynecologist and begin treatment in a timely manner.

What is the difference between erosion and cervical dysplasia?

Cervical dysplasia differs from erosion (ectopia) in that pathological changes affect the cellular structures of the cervical tissues, that is, disturbances in the structure of cells occur; dysplasia most often develops against the background of infection with oncogenic human papillomaviruses (HPV). Erosion of the cervix most often occurs due to mechanical trauma to tissue and hormonal disorders; cells in ectopia are not atypical.

Cervical dysplasia is a precancerous condition, and erosion over time can become dysplasia.

What is cervical dysplasia

Cervical dysplasia is a pathology associated with atypical changes in the epithelium of the cervix (vaginal part). This condition is precancerous. At first it is reversible, so early diagnosis and adequate timely treatment are of particular importance. This helps prevent the development of a malignant process. The term has synonyms: CIN (cervical intraepithelial neoplasia) and PIP (squamous intraepithelial lesions).

Young women are primarily prone to the disease. Most cases of dysplasia are observed among patients aged 25 to 35 years. The incidence reaches 1.5 per 1000 female population.

In order to clearly understand what pathological changes occur with this disease, a good knowledge of the anatomical features of the cervix is ​​necessary.

Structure of the cervix

The cervix is ​​the lower part of the uterus. It is narrow and cylindrical in shape. Partially located in the abdominal cavity and protruding into the vaginal area (i.e., it consists of supravaginal and vaginal areas).

In order to examine the vaginal part, gynecologists use special mirrors. Inside the neck there is a rather narrow canal, which is called the cervical (cervical). Its length ranges from 1 to 1.5 cm. The internal pharynx of this canal leads into the uterine cavity, and the external pharynx is open into the vagina. That is, this canal connects the uterine cavity with the vagina.

The cervical canal is lined with columnar epithelial cells, which have a bright red hue. It contains glands whose function is to secrete mucus. These secretions serve as barriers to the entry of microorganisms into the uterus.

In the area of ​​the external uterine pharynx, there is a transition from columnar epithelium to flat epithelium, which lines the vagina and the vaginal part of the cervix. There are no glands in this area. The color of squamous epithelium differs from cylindrical epithelium - it has a paler, pink tint. It has a complex structure, including the following layers:

Basal-parabasal. This lowest layer consists of two types of cells: basal and parabasal. Under the basal layer there are muscle tissues, blood vessels, and nerve endings. It contains young cells that have the ability to divide.

Intermediate.

Superficial (functional).

Healthy basal cells are round. Each cell has one large nucleus. They gradually mature and rise to the upper layers. Their shape becomes flat and the core size shrinks. When the cells reach the surface layer, they are completely flattened and have very small nuclei.

In patients with dysplasia, the structure of cells and epithelial layers is disrupted. Atypical cells appear in the epithelium. They do not have a specific shape, reach large sizes, and have more than one nucleus. The division of the epithelium into layers is lost.

Different layers of the epithelium are involved in the pathological process. Characteristic features of the disease are hyperkeratosis, parakeratosis, acanthosis, and intense mitotic activity. Changes occur in the structure of cells: disruption of the cytoplasmic ratio, pathological mitosis, vacuolization, nuclear polymorphism. Cells actively proliferate, and signs of atypia (primarily nuclear) appear. The surface epithelium is not captured in this process.

Classification of cervical dysplasia

In Russia they use the classification of Yakovleva, B.G. Cucuté from 1977. According to which precancerous conditions of the cervix are divided into:

Dysplasia that occurs in an unchanged area of ​​the cervix or in the area of ​​background processes

Weakly expressed;

Moderately expressed;

Expressed.

Leukoplakia with signs of atypia.

Erythroplakia.

Adenomatosis.

Degrees of cervical dysplasia

Based on the depth of pathological changes, three degrees of dysplasia are distinguished. In severe cases of the disease, damage to several layers of the epithelium occurs.
Cervical dysplasia is classified taking into account the intensity of cell proliferation processes and the degree of atypia. According to the international classification, cervical dysplasia has 3 degrees.

Cervical dysplasia grade 1

CIN I. This is the mildest degree of dysplasia. The pathological process is observed in the lower third of the squamous epithelium. Changes in cellular structures are little expressed. Polymorphism of cells and nuclei is noted, mitotic activity is disrupted. Hyperplasia of the basal and parabasal layers - up to U3 thickness of the epithelium.

Cervical dysplasia grade 2

CIN II. This is an average degree of pathology. Changes in cellular structure affect the lower and middle third of the thickness of the epithelial layer. In its affected part, the epithelium consists of cells that have an oval or elongated shape. Such cells fit very tightly to each other. Mitoses are observed, including pathological ones. There is a slight nuclear-cytoplasmic shift (large nuclei, rough chromatin structure).

Cervical dysplasia grade 3

CIN III. The most severe degree of dysplasia. It is considered a non-invasive cancer. Abnormal changes cover the entire thickness of the epithelium. But unlike invasive cancer, the pathological process does not yet affect other tissues (muscles, blood vessels, nerves).

In patients with severe dysplasia, hyperplastic cells account for more than 2/3 of the epithelial layer. The nuclei of such cells are large in size, have an elongated or oval shape, and there are mitoses. There are the following features: strong nuclear polymorphism, binuclearity, cytoplasmic shift. Occasionally, gigantic cells with large nuclei are observed. Cell boundaries remain clear.

Why is cervical dysplasia dangerous?

There are three possible options for the development of the disease:

An increase in pathological changes - in the lower layers there is an increase in atypical cells and degeneration into cancer.

Stabilization.

Regression of the disease when abnormal cells are replaced by the growth of healthy tissue.

Causes of development of cervical dysplasia

The occurrence of this cervical pathology is associated with exposure to oncogenic human papillomaviruses (HPV-16 and HPV-18). They are detected in the vast majority of patients – up to 98%. If the virus stays in the female body for a long time (more than a year), changes in cellular structures begin and cervical dysplasia develops. Read more about the treatment of human papillomavirus infection on our website. There are also several aggravating background factors.

Risk factors

Weakened immunity (due to chronic diseases, stress, poor nutrition, taking certain medications).

Tobacco smoking – the risk of dysplasia in women who smoke is several times higher.

Chronic gynecological diseases of an inflammatory nature.

Hormonal problems caused by menopause and taking hormonal medications.

Hormonal processes associated with pregnancy.

Early onset of sexual activity.

Early birth.

Cervical trauma.

Symptoms of cervical dysplasia

This pathology most often does not have an independent clinical picture; the symptoms are nonspecific. In one out of ten patients, the disease proceeds latently without any symptoms. But usually there is an infection, and associated symptoms appear. The patient experiences itching or burning in the intimate area. Abnormal vaginal discharge appears that has changed in color, smell or consistency. There may be blood in the discharge, especially after sexual intercourse or the use of tampons. There is usually no pain. Cervical dysplasia can last a very long time, and after adequate therapy it can regress. However, more often there is an increase in pathological changes and transition from 1st degree to the second and third.

Cervical dysplasia is often combined with sexually transmitted diseases such as gonorrhea, chlamydia, trichomoniasis, ureaplasmosis, gardnerellosis, mycoplasmosis, candidiasis, condyloma of the anus, vulva, and vagina.

Since there are no pronounced symptoms, laboratory, clinical, and instrumental diagnostic methods are of particular importance.

Diagnosis of cervical dysplasia

If dysplasia is suspected, the examination is carried out according to the following scheme:

1. Examine the cervix using vaginal speculum. Examination helps to identify clinically pronounced forms of dysplasia. The following signs of pathology can be determined by eye: changes in shade, the appearance of shine around the external pharynx, epithelial growths, and the presence of spots.

2. Perform an examination using a colposcope. This optical device makes it possible to obtain a tenfold magnification, thanks to which you can accurately assess the nature of the pathology. At the same time, a diagnostic test is carried out. To do this, solutions of acetic acid and Lugol are applied to the neck.

Dysplasia fields when tested with Lugol's solution

3. A cytological analysis of the Pap smear is performed. Studying material taken from various areas under a microscope makes it possible to determine the presence of atypical cells. In addition, the method allows you to identify cells that are markers of the papilloma virus. Cells in which the virus is present have wrinkled nuclei and rims.

4. Histological examination of tissue samples that were taken from the cervix in suspicious areas is performed. This is the most effective way to diagnose dysplasia.

5. PCR methods are also used to detect HPV. These studies help determine the strain and viral load (concentration of HPV in the body). Depending on the results (presence or absence of oncogenic types), the patient’s treatment tactics are determined.

Treatment of cervical dysplasia

The treatment regimen for cervical dysplasia is selected taking into account the degree of pathology, the woman’s age, the size of the affected area, and the presence of other diseases. It is also necessary to take into account the patient’s desire to maintain reproductive function.

Drug therapy

For dysplasia, the following drug treatments are indicated:

Etiotropic anti-inflammatory therapy (if cervical dysplasia is combined with inflammatory signs). The course is conducted according to standard schemes.

Normalization of hormonal levels.

Improving immune function with courses of immunomodulators and interferons. Such treatment is necessary if there is a large area of ​​damage, and with recurrent CIN.

Restoration of normal vaginal microbiocenosis and treatment of bacterial vaginosis.

Surgical treatment of cervical dysplasia

Dysplasia is treated with the following surgical methods:

Destruction of the affected area using cryodestruction (liquid nitrogen).

Radio wave therapy.

Electrocoagulation.

Exposure to laser (argon or carbon dioxide).

Conization (surgical removal of an area with dysplasia).

Removal of the cervix completely (amputation).

These methods are used in the days after menstruation. In preparation for the procedures, vaginal sanitation is performed, and according to special indications, immunocorrection is performed.

Treatment of dysplasia 1, 2 and 3 degrees

For some patients, watchful waiting is preferable. This applies to cases where there is a possibility of regression of pathological changes. This can happen in young women with grade 1 or 2 cervical dysplasia in a small area of ​​the lesion.
Based on repeated studies (with an interval of 3-4 months), which gave two positive results, a decision is made on surgical intervention. If a patient is diagnosed with severe cervical dysplasia (grade 3), she must be sent to the gynecological oncology department, where she will undergo surgical treatment (including removal of the cervix).

In grade 1, management of the patient depends on the results of HPV typing and how affected the ectocervix is. If oncogenic types of the virus are present, and the lesion occupies a large area, it is advisable to resort to destructive methods. If the affected area is small and there are no oncogenic types, the patient can simply be observed. After two years of dynamic observation, further tactics are determined. If there is no regression of the disease, destruction of the affected tissue is performed.

For patients under 40 years of age diagnosed with CIN II, destructive procedures are recommended. But the cryodestruction method for CIN II and III is not desirable, since the depth of necrotic changes in such cases is very difficult to predict. Women over 40 years old with cervical deformity undergo excision or conization. Stepwise sections of removed tissue must be examined. If another gynecological disease is detected (severe uterine prolapse, pathology of the appendages, MM, cervical elongation), a decision may be made on panhysterectomy.

Before any surgical intervention, anti-inflammatory treatment is carried out, the purpose of which is to sanitize the source of infection. In some cases, this allows not only to reduce the affected area, but also to achieve complete regression of dysplasia.

Indications for surgery for cervical dysplasia

Indications for excision or conization are:

Incomplete visualization of the affected area due to the spread of the process along the cervical canal.

According to the results of cytology and biopsy - cervical dysplasia of grade II, III or CIS.

Also, surgical methods are resorted to in case of severe deformation of the neck without taking into account the degree of dysplasia. In addition, they are indicated after there is no result from destruction.
Invasive cancer must be ruled out before deciding to excise. To do this, a thorough clinical examination, colposcopy, cytological and morphological studies are carried out.

Post-operative care

In order for healing to proceed safely and no complications arise, a woman after surgery must adhere to a number of rules. You cannot douche, use tampons, or lift weights. It is necessary to maintain sexual rest. In addition, you must strictly follow all doctor's recommendations.

The first follow-up examination is performed approximately 3-4 months after the surgical procedure. To do this, smears are taken and a cytological examination is performed. This is done every quarter throughout the year. If the examination results are negative, then the patient can be examined routinely during annual examinations.

Complications after surgery

The recovery period after surgery for dysplasia usually lasts about a month. During this time, the following phenomena may be observed:

Aching pain in the lower abdomen. They usually bother a woman in the first few days after the procedure. Pain lasts the longest after laser exposure.

Copious discharge, which may have a distinct odor. This usually lasts about three or even four weeks, especially long after cryodestruction.

Severe bleeding with sharp pain in the lower abdomen and fever. In such a situation, the patient needs immediate medical examination.

Prognosis for cervical dysplasia grades 1, 2, 3

Modern medicine has effective methods for examining and treating dysplasia. This makes it possible to prevent the transition of pathology into a malignant process.
With timely diagnosis, correctly selected therapy and the patient’s compliance with all doctor’s prescriptions, dysplasia of any degree can be cured.

After surgery, the cure rate can reach 95%. Relapses of the disease after the use of surgical methods are observed in 5-10% of patients. This is due to the presence of the papilloma virus or insufficient excision of the area of ​​dysplasia. If treatment is not carried out, cervical dysplasia turns into invasive cancer in 30–50% of cases.

Prevention of cervical dysplasia

The main methods of prevention include:

Vaccination against oncogenic types of the virus (for women at risk).

Barrier contraception.

Timely detection of cervical pathologies and their treatment.

Consultative work with women at risk.

Proper varied nutrition. It is especially important to consume enough vitamins A, B and selenium.

Quitting cigarettes.

Sanitation of infectious foci.

Regular visits to the gynecologist (at least 1-2 times a year), with smear examination.

Experts from organizations (WHO, ACOG, AGS) involved in the fight against cervical cancer recommend early screening. It must be taken at the age of 18 or at the beginning of sexual activity. Gynecological examinations should be performed every year, and Pap tests are required. If they give three negative results, then screening can be done less frequently (every three years).

The feasibility of papillomavirus identification and typing as part of cervical cancer screening has not yet been confirmed. PCR diagnosis of virus types 16 and 18 is a more economical method than cytology.

HPV testing acquires greater prognostic value as the patient ages, but cytological testing loses its value. The detection of oncogenic types of human papillomavirus in patients over 35 years of age indicates a high risk of developing grade 3 dysplasia.

What is cervical dysplasia?

Cervical dysplasia (cervical dysplasia) is a condition of the epithelium covering the cervix, which is characterized by a change in the number of layers and the structure of the cells that form it. In this case, the basal membrane and the uppermost cellular layers are not involved in the process. Dysplasia refers to diseases that, under a combination of circumstances, can cause the development of a malignant tumor of the cervix.

Cervical dysplasia is an extremely dangerous pathology and the most common precancerous form that changes the structure of the mucous membrane of the cervix and vagina. Dysplasia can have different origins, but it is always accompanied by a violation of the cellular structure of the epithelium. It affects not only the upper layers, but can penetrate much deeper.

Cervical dysplasia is often called erosion, but this term does not fully convey the essence of the phenomenon. The main difference between these two processes is that erosion occurs due to mechanical damage to tissue, and dysplasia is characterized by a violation of the cellular structure of tissue.

Depending on the depth of damage to the mucous membrane of the cervix, there are:

mild (mild) form of dysplasia (up to a third of the thickness of the layers of squamous epithelium is affected; the cells of the intermediate layer may swell);

moderately expressed (average) form of dysplasia (from one third to two thirds of the thickness is affected; the polarity of the epithelium is disturbed);

pronounced (severe) form of dysplasia (all layers of the epithelium are affected).

Every year, about 40 million women around the world are diagnosed with cervical dysplasia for the first time or confirmed. This disease accounts for approximately 15-18% of cases of identified cervical pathologies. Typical for women of reproductive age 34-35 years. The average rate of transition of severe forms of cervical dysplasia to cancer is approximately 10-30% according to various studies.

Most patients, not understanding the essence of the pathological mechanisms, confuse cervical dysplasia with erosion or cancer. Neither statement is correct. To understand what the difference is, you need to look at anatomy.

The cervix is ​​the boundary between the vagina and the uterus itself. It consists of 3 types of fabrics:

epithelial;

muscular;

connecting.

A peculiarity of its epithelium is that it is heterogeneous in its structure. The cervix is ​​the meeting place of 2 types of integumentary epithelium: cylindrical, the cells of which are arranged in one layer, have a rectangular shape and line the uterine cavity and the cervical canal, and multilayered squamous, characteristic of the vagina and represented by several rows of flattened cells. Both epithelium is located on a thin basement membrane, consisting of collagen fibers and playing the role of a strong base and limiter.

It is precisely because of this complex structure of the cervix that various pathological processes associated with changes in cell characteristics often occur in this area.

The most basic of them are:

Erosion is a displacement of the cylindrical epithelium towards the vagina. The structure, functions, and growth characteristics of cells are not affected. Due to the difference in conditions in the cervical canal and in the vagina, cylindrical cells are damaged by an acidic environment, waste products of the normal microflora of the female genital tract, trauma during sexual intercourse, forming poorly healing wounds - erosion. During a gynecological examination on a chair, it looks like a rich red area on a pale pink background.

Cervical cancer is a process of changes in the structure and functions of epithelial cells that have acquired the ability for unlimited growth. If the overgrown cells have not gone beyond the basement membrane, then they speak of “cancer in situ” (CIS carcinoma in situ); it is the initial stage of the development of malignant neoplasms of any internal organs. If a cancerous tumor has grown through the basement membrane, then from a medical point of view, we are talking about invasive cancer (this is cancer in the layman’s understanding).

Dysplasia is a change in the structure of the multilayered squamous epithelium that covers the cervix, while cells with an “abnormal” nuclear shape appear in it, multinuclear, irregularly shaped, and the anatomical division into layers is lost. However, the altered cells do not have the ability to grow unlimitedly and do not penetrate beyond the basement membrane. The columnar epithelium in the transition zone on the cervix remains unchanged.

Modern medicine has not used the term “dysplasia” for a long time; instead, both in the diagnosis and in the scientific literature one can find the following definition: cervical intraepithelial neoplasia (CIN, or CIN), which means the formation of new cellular elements of the cervical epithelium that are not characteristic of this tissue.

The appearance of cervical dysplasia, like any other precancerous disease, does not occur under the influence of any one factor. This is always a complex combination of many provoking components.

The main reasons for the formation of foci of dysplasia are:

infection with certain types of human papillomavirus (HPV);

hormonal contraceptive pills for long-term use (from 5 years);

early sexual activity (14-15 years);

a large number of sexual partners;

bad habits (smoking).

The following may also play a role in the development of dysplastic processes:

monotonous diet with a lack of vitamin C, A;

immunity disorders;

genetic predisposition to any cancer;

sexual infections;

low level of education, life, antisocial behavior;

a large number of births.

The discovery of the dominant role of the HPV virus in the development of dysplasia and malignant tumors of the cervix was a breakthrough in the development of effective methods to combat cancer of the female reproductive system.

Viral factor

Cervical dysplasia most often develops due to human papillomavirus (HPV). This disease is most often asymptomatic; it usually takes about 10 years from the onset of dysplasia to the appearance of cervical cancer.

Anyone can become infected with the human papillomavirus, but women who are sexually active and have multiple sexual partners are at risk. Neglect of contraception and untreated inflammation of the reproductive system also increase the likelihood of becoming infected with HPV. Trauma to the cervix can also occur due to abortion or frequent childbirth.

There are a large number of types of the HPV virus, each of which can cause characteristic lesions. For example: common warts on the hands and feet, genital warts in the genital area; dysplasia and cancer of the cervix.

According to the degree of cancer “danger”, all types of HPV can be divided into 3 categories:

Non-oncogenic and low oncogenic risk types are found in warts and genital warts, these are types 1, 2, 3, 5, 6, 11, 42, 43, 44.

Low oncogenic risk. Viruses belonging to highly oncogenic serotypes are found in 90% of all cases of dysplasia and malignant neoplasms of the cervix. These are 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 types.

High oncogenic risk. Particularly aggressive of them are 16 and 18, which are more common than others and in half of the cases lead to the development of cervical cancer.

How does HPV cause cellular changes?

In a healthy body, any damaged cell is immediately destroyed by the immune system and internal antitumor mechanisms, which prevent it from entering the process of division and reproducing similar defective cells. In addition, the number of divisions of each cell type is strictly limited by the genetic program. This determines the aging process in the body; with all the desire, a person cannot live forever.

When the HPV virus, which has high oncogenic activity, enters the body, it is carried by the blood to the genitals and is embedded in the cells of the squamous cervical epithelium. Viral particles produce special proteins that block the “security system” of the epithelial cell and damage DNA. As a result, atypical cells are formed that do not die, are not removed by the immune system, they are capable of dividing and reproducing similar “abnormal” specimens. Thus, a change in the structure of the layers of the epithelium of the cervix occurs, which, when analyzed, is defined as cervical intraepithelial neoplasia (CIN, or CIN). However, with dysplasia, unlike cancer, atypical cells do not have the property of unlimited uncontrolled growth.

Use of contraceptives

The effect of long-term use of hormonal combined oral contraceptives (COCs) on the occurrence of dysplastic processes in the cervix has been well studied.

In this case, there are 2 separate effects (COC):

indirect;

The indirect effect is that women who constantly take COCs, usually young, 20-40 years old, are sexually active, often change sexual partners, they are more likely than others in the population to suffer from sexually transmitted diseases, and smoke. The combination of these factors increases the risk of developing dysplastic processes in the cervix.

The mechanism of the direct effect has not been fully studied, however, based on statistical data, it was concluded that long-term use of COCs (5 years or more) increases the risk of developing cervical dysplasia by almost 2 times.

Women who use progestin preparations (contraceptive pills for pregnant women) for protection do not fall into the risk category, since this type of contraceptive does not affect the epithelium of the cervix. The same applies to women in menopause or with removed ovaries who receive hormone replacement therapy; their risk of developing dysplastic processes does not increase.

Other reasons

The causes of cervical dysplasia can be an unhealthy lifestyle and bad habits (especially smoking), since reduced immunity and hypoxia increase the likelihood of microtrauma to the cervical epithelium.

Other reasons, such as early sexual activity, a large number of sexual partners, low social level - all of them are directly related to the frequent infection of this category of women with various types of HPV.

Lack of vitamins A and C, immunodeficiency states, and genetic predisposition lead to disruption of the body's defense system and disruptions in the program for destroying damaged cellular elements, which also contributes to the development of dysplastic processes.

In general, the development of cervical dysplasia can be explained using the “weed” theory, which was proposed in 1995 by University of California gynecologist Michael Policar. In his opinion, the cervical epithelium is the soil where the “seeds” of cellular changes in the form of HPV fall, but in order for them to germinate, “water, light, heat” are necessary, the role of which is played by other factors in the development of dysplastic processes - smoking, decreased immunity , vitamin deficiency, genetic predisposition. Without them, even in the presence of HPV, the development of cervical dysplasia does not occur.

To date, it has not been possible to confirm this theory clinically and laboratory. However, the combination of HPV with other risk factors in most women speaks in favor of this scientific hypothesis.

Symptoms of cervical dysplasia

In its initial forms, the disease is often asymptomatic. The disease manifests itself only in advanced conditions: a woman develops pain in the lower abdomen, and there may be light vaginal bleeding. To avoid this and start treatment on time, it is necessary to undergo regular gynecological examinations, which include instrumental, laboratory and clinical examinations.

Signs of dysplasia can only be detected if the symptoms are accompanied by other diseases. According to gynecologists, in most cases, in the presence of cervical dysplasia, there is erosion of the cervix. Therefore, a competent doctor will certainly refer the patient for a PAP test (SMEAR) if she detects erosion.

Symptoms of dysplasia may include:

profuse leucorrhoea without an unpleasant odor, milky white in color;

streaks of blood in vaginal discharge after intimacy;

pain during sexual intercourse.

It must be repeated once again: these symptoms are not specific to cervical dysplasia, cannot be used for diagnosis, but are only a reminder to the woman that her women’s health needs a thorough examination.

Degrees of dysplasia

Depending on how deeply the cervical epithelium is affected, there are 3 degrees of cervical dysplasia:

1 degree (weak);

2 degree (moderate);

3rd degree severe.

If we imagine a section of epithelium in the form of a rectangle, the lower side of which is represented by the basement membrane, and the upper side is the superficial row of cells, then the different degrees of dysplasia will look like this.

Cervical dysplasia grade 1 (weak)

In the medical documentation (analysis results or extract) it is designated as follows: CIN I (cervical intraepithelial neoplasia I). It is placed if only the lower 1/3 of the epithelial layer adjacent to the basement membrane has undergone pathological changes.

Cervical dysplasia grade 2 (moderate)

The diagnosis is designated as CIN II (cervical intraepithelial neoplasia II). It is established when the pathological process spreads to 2/3 of the depth of the epithelium, while the upper 1/3 remains unaffected.

Cervical dysplasia grade 3 (severe)

Referred to as CIN III (cervical intraepithelial neoplasia III). It is the most severe form of cervical dysplasia, when the structure of all layers of the epithelium is disrupted. This grade is a fine line between dysplasia itself and the early stage of cancer (“carcinoma in situ”). In neither case does the basement membrane remain intact. The only difference is in the function of the cells, which acquire the ability to divide indefinitely. Histological examination can help establish the severity of the pathological process.

What a woman can face with cervical dysplasia directly depends on its degree:

1st degree

Cervical dysplasia of the 1st degree in 57% of cases goes away on its own after the virus is removed from the woman’s body. In a healthy person, in 9 out of 10 cases, the virus ceases to be detected in blood tests six months to a year after entering the body. The immune system destroys the viral particles on its own.

2nd degree

Cervical dysplasia of the 2nd degree in 43% of cases also goes away on its own after the body is freed from HPV. In 35%, its long-term stable course is observed. Thus, 70% of women recover within 2 years from the moment of diagnosis.

3rd degree

According to studies conducted among various categories of women, the probability of grade 3 cervical dysplasia turning into cancer is 10-30%. The reason for this scatter of results is the presence of a different number of individual risk factors in different categories of women (by age, cotraception methods, bad habits, lifestyle, number of sexual partners).

Cervical dysplasia is not a contraindication to pregnancy in women who were first diagnosed during pregnancy. The presence of this pathological process does not affect the development of the unborn child and does not inhibit the function of the placenta. At the same time, pregnancy itself does not in any way affect cervical dysplasia, does not worsen its course and does not contribute to the transition to a more severe form.

In addition, under the influence of hormonal changes occurring in a pregnant woman, physiological changes can develop in the cervix, which can be mistaken for cervical dysplasia. We are talking about ectrapion (pseudo-erosion), in which cells characteristic of the cervical canal move towards the vagina. Upon examination, this condition is identified as a red ring on the cervix.

Therefore, if a woman was examined within 1-3 years before pregnancy and has a negative cytological test result, then repeated control is not prescribed.

If a pregnant woman has never been examined for either HPV carriage or atypical cells, then when changes in the cervix are detected for the first time at any stage, a smear is taken for a Papanicolaou test (smear-test).

Further tactics depend on the result. If it is negative, then no further action is taken and control is prescribed 12 months after birth. If the test is positive and a mild degree of dysplasia is detected, then colposcopy and monitoring are performed 12 months after birth.

For moderate cervical dysplasia, colposcopy and re-examination after childbirth are prescribed.

If grade 3 dysplasia is suspected, a targeted biopsy is performed - taking a piece of altered tissue for analysis. If severe dysplasia is confirmed, colposcopy is necessary every 3 months until birth and the first 1.5 months from the moment of delivery.

If cancer is detected, further management of the patient is agreed upon with the oncologist and depends on the specific situation.

Since dysplasia can turn into cancer under a number of conditions, the most important thing in preventing complications is its early diagnosis. All women over 21 years of age who are sexually active must visit a gynecologist once a year for examination and undergo a cytological examination once every 3 years.

The following common methods are used to diagnose this disease:

• cytological examination of a smear (Papanicolaou test, or smear-test);

  colposcopy;

  sampling a piece of tissue (targeted biopsy).

When examined in mirrors, areas of dysplasia look like irregularly shaped areas (plaques) of a whitish color. When performing the Schiller test - staining the cervical epithelium with Lugol's solution - uneven staining is determined. Areas of dysplasia remain lighter than healthy tissue.

Colposcopy is an instrumental method of examining the vaginal part of the cervix using a special magnifying device - a colposcope. Upon examination, incorrectly located branched blood vessels in the zone of dysplasia, mosaic appearance, and pale coloration of the altered epithelium will be visible. When treating the cervix with a solution of acetic acid, the changed areas will be white.

It should be remembered that none of these methods can differentiate severe dysplasia from cancer. This is only possible with the help of histological examination of a piece of epithelium. The method by which this is performed is called targeted biopsy with curettage of the cervical canal. The tissues obtained as a result of the procedure are subjected to careful study. This method is 100% accurate.

Before treating cervical dysplasia, the doctor discovers and eliminates its cause (hormonal disorders, infections or inflammatory processes). This should stop the development of dysplasia in non-advanced forms and promote tissue scarring. In other cases, surgical treatment is recommended for patients.

A common method of treating dysplasia is an electric knife, which is used to excise the affected tissue. Healing after such an operation takes three months, but scarring and bleeding are possible, which creates a risk of unfavorable pregnancy.

Cervical dysplasia is also treated with laser surgery. Depending on the extent of the pathological process, healing can take about two months, but this treatment is safe and occurs with virtually no consequences.

Another method of surgical treatment of dysplasia is cryotherapy. Affected tissues are frozen using liquid nitrogen. In addition, there is also a chemical treatment method, which consists of applying a special chemical preparation to the areas of dysplasia that cauterizes the tissue. After a couple of days they fall off in the form of a thin crust.

Treatment tactics are influenced by the severity of the pathological process:

1st degree

Since there is scientifically proven evidence that in most cases, grade 1 cervical dysplasia goes away on its own after 1-2 years, provided that the body is freed from HPV, modern doctors do not recommend using any treatment at this stage.

Therapeutic tactics are as follows:

dynamic observation for up to 2 years from the date of diagnosis;

cytology analysis and colposcopy every year;

treatment of diseases of the reproductive system (vaginitis, sexually transmitted infections);

fighting bad habits (quitting smoking);

selection of alternative methods of contraception;

correction of endocrine system disorders.

Since antiviral drugs for the treatment of HPV have not yet been created, proper nutrition and vitamin support greatly help the body in the fight against the virus. It is recommended to take multivitamin complexes containing vitamins E, B12, B6, A, C, folic acid, and selenium.

If during a follow-up examination carried out 2 years after diagnosis, there is no tendency of grade 1 dysplasia to decrease or, conversely, there are signs of its transition to grade 2, then there is a need to use more aggressive treatment methods.

Small areas of grade 1 cervical dysplasia are successfully treated by treating them with a chemical coagulation drug such as solcogin and vagotide.

2nd and 3rd degree

To treat grade 2 and 3 cervical dysplasia, surgical methods are used:

cauterization;

freezing (cryodestruction);

laser treatment;

radio wave treatment;

excision (conization).

Surgical treatment should be carried out immediately after the end of menstruation, this prevents the development of endometriosis and improves the healing process. Before the procedure, it is necessary to take smears for cytological examination, colposcopy and biopsy.

Cauterization:

• The principle of cauterization is based on the fact that pathologically altered cells are destroyed under the influence of low voltage current. The procedure is performed using a special device with electrodes in the form of a loop.

  The advantages of the method are its low cost, availability of equipment, and technical ease of implementation.

  Disadvantages of the technique: inability to control the depth of exposure, rough scars after healing, high risk of developing complications in the form of endometriosis.

Freezing (cryodestruction):

• With this method, the removal of altered epithelial cells is carried out by flash freezing them with liquid nitrogen. The temperature of liquid nitrogen is -196 C%, the water contained in the epithelial cells instantly turns into ice, thus the altered tissue areas die.

  The advantages of the method are that it does not leave behind rough scars, so it can be recommended to nulliparous women if it is impossible to use more technologically advanced methods.

  Disadvantages include abundant clear discharge after the freezing procedure, which can bother a woman for up to 1 month, the need to abstain from sexual intercourse for up to 2 months from the date of treatment, and the inability to adequately control the depth of treatment.

Laser treatment:

• This method is based on the “evaporation” of affected tissue under the influence of laser energy.

  Advantages: does not leave rough scars, modern equipment allows you to control the depth of penetration of the laser beam, which allows you to completely remove all pathological tissue.

  Disadvantages: burns may occur to adjacent healthy areas of the cervix; short-term anesthesia may be required, since the effectiveness directly depends on the patient’s immobility.

Radio wave treatment: Refers to relatively new techniques, it is based on the removal of the focus of dysplasia under the influence of high-frequency waves. Performed on the Surgitron device.

The advantages of the method are:

• low morbidity;

  the ability to control the depth of impact;

  painlessness;

  short rehabilitation period;

  absence of rough scars after the healing period;

  a small percentage of reoccurrence of areas of dysplasia;

  possibility of use in nulliparous women.

Disadvantages: very expensive method, which is available only in private clinics.

Excision (conization): Removal of areas of dysplasia using a scalpel. Due to the high level of trauma and the large number of complications after the procedure, it is not used in women of childbearing age. Currently, instead of conization with a scalpel, conization with a laser beam is used. With this operation, the likelihood of bleeding is reduced both during the procedure and during the rehabilitation period, which is associated with the cauterizing effect of the laser.

With any method of treatment in the postoperative period, it is necessary to adhere to a certain regimen during the first month:

sexual rest;

do not lift heavy objects;

do not engage in sports;

do not visit the pool, sauna, beach;

do not sunbathe or go to the solarium, especially for women infected with HPV;

do not take a bath, only showers are allowed;

do not introduce any drugs or solutions into the vagina, except those prescribed by a doctor;

It is imperative to conduct a control gynecological examination after the next menstrual cycle after treatment.

Many women, afraid of hearing a diagnosis, put off visiting a gynecologist, but this is a false fear. Cervical dysplasia is highly treatable if treated on time and using the right method.

Cervical dysplasia 1st and 2nd degree

One of the fairly common female diseases in the cervix is ​​dysplasia. Gynecologists note that the danger of this pathology is that without proper treatment it can develop into a cancerous tumor of the cervix.

Cervical dysplasia is a gynecological disease, indicating that the epithelium that covers the cervical canal of the cervix has abnormalities in its structure and structure.

The underdevelopment of the epithelial cover of the cervix is ​​manifested in the fact that it has an abnormal number of layers and an incorrect internal structure of the cells of which it consists.

Dysplasia, as a rule, does not cover the deep cellular layers of the epithelium and does not affect the basement membrane.

Some patients may confuse the diagnosis of dysplasia with the diagnosis of erosion. But under no circumstances should they be combined. Erosion occurs as a result of mechanical trauma and manifests itself in a violation of the integrity of epithelial tissue. The reasons for the development of dysplasia can be various factors, but its distinguishing feature from erosion is that it affects the structure of epithelial cells.

Division of dysplasia into different degrees of severity

Cervical dysplasia is a very dangerous diagnosis. The progress of the disease must be closely monitored.

According to medical statistics, dysplasia of the mucous membrane of the cervical canal is the most common factor in the formation of cancerous tumors.

Under the influence of dysplasia changes on the vaginal lining and uterine cervix, processes of malignancy of their cells can occur.

Doctors distinguish three main degrees of severity of the disease:

Cervical dysplasia should not be confused with erosion or cancer. These are different diseases that have an excellent history and treatment methods.

Below are some statistical and information data about what features are characteristic of the disease cervical dysplasia:

• Over the course of 1 year, this disease is diagnosed in 39–40 million women worldwide.
• Among other pathologies of the cervix, dysplasia occurs in 16–18% of cases.
• Women in the age group of 34 years and older are most often affected by the disease.
• Grade 3 dysplasia develops into a malignant tumor in approximately 10–30% of cases.

What is the treatment prognosis for grade 1 and 2 dysplasia?

The disease in the form of dysplasia brings a large number of unpleasant symptoms and complications to the body.

The duration of the treatment period will depend on how deep the pathological process has spread into the layers. That is, the course of the disease can be described by its degrees.

1 degree of severity

According to research data, the disease of the 1st degree of severity goes away on its own after the human papillomavirus that caused dysplasia is removed from the body. This happens in 57% of cases.

Human papillomavirus is considered the most common cause of cervical dysplasia.

In 9 out of 10 people, the virus is suppressed by the immune system on its own. The virus ceases to be detected in the blood after 6–12 months.

In 32% of patients, the course of the disease can last a very long period. At the same time, there is no movement: not towards recovery, not towards deterioration.

The remaining 11% of patients move from stage 1 to stage 2 of the disease.

2nd degree of severity

In the 2nd degree of severity, it is also possible for the body to independently suppress the HPV virus in 43% of cases. After this, the disease goes away on its own.

35% of women can fight the disease within 2 years after diagnosis.

22% of patients are susceptible to 2nd degree dysplasia progressing to 3rd degree.

Does grade 1 and 2 dysplasia affect pregnancy?

Gynecologists note that dysplasia does not threaten the course of pregnancy.

Carrying a fetus also cannot have a detrimental effect on the course of the disease. On the contrary, during pregnancy the body’s suppression of the disease may accelerate.

If a woman has 1st degree dysplasia, then monitoring of the disease will be carried out in the form of a colposcopy at the beginning of pregnancy. Follow-up monitoring will be carried out 1 year after the birth of the child.

When diagnosing the 2nd degree, dysplasia is monitored at the beginning of pregnancy and after it. This also involves the use of a colposcopy procedure.

How is the disease treated?

In medical practice, there are quite a few methods that are used to treat dysplasia. The choice of treatment method depends on the severity of the disease.

Treatment method for 1st degree

As already mentioned, in most cases, dysplasia goes away on its own, provided that its root cause is eliminated. Therefore, in practice, with the 1st stage of the disease, it is customary not to apply any treatment for 2 years.

However, this does not mean that the patient does not need to be monitored at all. The complex of treatment and preventive measures for dysplasia of the 1st degree includes:

1. Regular examinations for 48 months after diagnosis.
2. Colposcopy and cytological examination are performed every year.
3. Treatment of infections of the reproductive system is mandatory.
4. It is advisable that the patient give up bad habits.
5. Treatment of negative manifestations of the endocrine gland.
6. The patient is advised to follow a proper diet and also take vitamin complexes.

Method of treatment for 2nd degree

If within 2 years the patient does not experience improvement, but on the contrary, there is a transition to the 2nd stage of the disease, then more aggressive methods of treatment must be used.

All types of treatment at this stage are carried out only after the end of menstruation. This will help prevent endometriosis. At the beginning of the menstrual cycle, healing is better.

The list of treatment methods for cervical dysplasia of the 2nd degree includes:

• Chemical coagulation (treatment of affected areas with drugs such as vagotide, solcogin).
• Cryotherapy (exposure to cold using liquid nitrogen. Frozen cells die).
• Surgical excision (operation to remove the affected area, performed with a scalpel).
• Cauterization (pathological cells are destroyed using low voltage current).
• Laser treatment (removal of areas of epithelium using a laser).
• Treatment using radio waves (exposure to layers of epithelium with high frequency waves).

Remember, cervical dysplasia, although a dangerous disease, is highly treatable. If you suspect a disease, you must visit a gynecologist to make an accurate diagnosis.

jenskoe-zdorovie.com

Cervical dysplasia, symptoms and treatment | 1, 2, 3 degrees of cervical dysplasia

Education:

In 2008 she graduated from the Yaroslavl State Medical Academy with a degree in general medicine.

From 2008 to 2010, she completed clinical residency training at the Department of Obstetrics and Gynecology of the Yaroslavl State Medical Academy on the basis of the gynecological department of the Yaroslavl Regional Clinical Oncology Hospital.

Professional activities:

Since 2010 he has been working in the gynecology department of the State Autonomous Institution of Healthcare of the Moscow Region "Central City Clinical Hospital of Reutov"

Scientific and practical interests: gynecological oncology, laparoscopic gynecology, pregnancy management.

Cervical dysplasia (cervical intraepithelial neoplasia, CIN)

Cervical dysplasia is a pathological process of degeneration of normal cervical epithelial cells into atypical ones. Most often, dysplasia occurs in the zone of transition of the cylindrical epithelium of the cervical canal into the multilayered squamous epithelium of the cervix. Dysplasia is a precancerous process. If left untreated, grade III dysplasia will necessarily transform into squamous cell carcinoma, but with timely treatment, complete relief from this disease is possible.

Degrees of cervical dysplasia

Currently, the following types of cervical intraepithelial neoplasia are distinguished:

1. CIN I (grade 1 dysplasia, mild dysplasia). Atypical cells only in the lower third of the epithelium - Fig. A.
2. CIN II (grade 2 dysplasia, moderate dysplasia). Atypical cells in the lower two thirds of the epithelium - Figure B.
3. CIN III combines severe dysplasia (grade 3 dysplasia) and non-invasive cancer (carcinoma in situ). Atypical cells in all layers of the epithelium - Fig. C.

Causes of cervical dysplasia

The main cause of cervical dysplasia is considered to be infection with highly oncogenic types of human papillomavirus - HPV-16 and HPV-18. Among the associated factors are early onset of sexual activity, a large number of sexual partners, smoking, and low socioeconomic status.

The clinical picture of dysplasia is very blurred. As a rule, the disease occurs without any symptoms. Sometimes, with CIN II-III degrees, spotting is observed after sexual intercourse.

The main methods for diagnosing cervical dysplasia include:

• Examination of the cervix in a speculum (allows you to identify changes in the cervix that are visible to the eye). However, with low-grade lesions it is not always possible to suspect the presence of dysplasia.
• Colposcopic examination (examination of the cervix using a colposcope under high magnification). There are simple and extended colposcopy. To conduct extended colposcopy, the cervix is ​​additionally stained with iodine solution. In this case, healthy cervical tissue turns brown, while the affected areas remain white.
• Another mandatory test method for diagnosing cervical dysplasia is a cytological smear (PAP smear).

• To do this, smears are taken from the surface of the cervix with special brushes, which are then examined under a microscope for the presence of atypical cells. If atypical cells are found in the PAP smear, a histological examination must be performed.
• Histological examination (the most accurate of all research methods). For histological examination, it is necessary to take a biopsy of the cervix from suspicious areas. If moderate or severe dysplasia is suspected, an additional diagnostic curettage of the cervical canal is performed.
• PCR diagnostics. To identify risk groups for cervical dysplasia, the determination of highly oncogenic HPV types is used. Women who have been diagnosed with HPV types 16 or 18 should be seen by a gynecologist at least twice a year.

Treatment of cervical dysplasia

Treatment of cervical dysplasia depends mainly on the degree of dysplasia and the age of the patient. In the presence of mild dysplasia in young nulliparous women, expectant management is possible with mandatory observation by a gynecologist and cytological control at least once every 6 months. Surgical treatment in this case is indicated for extensive lesions, in patients over 35 years of age, long-term observation of CIN I (more than 1.5-2 years) and when further observation is impossible.

In patients with moderate dysplasia, destructive treatment methods are used using (electronic knife, radio waves (Surgitron), liquid nitrogen (cryodestruction), argon laser. The affected area is removed with histological examination and assessment of the resection margins.

Treatment of CIN III should be carried out by a gynecological oncologist. In this case, wait-and-see tactics are not used even in young patients. Surgical treatment is required. Conization of the cervix is ​​performed using an electric or radio knife or high knife amputation of the cervix with mandatory histological examination of the resection edges.

After surgical treatment of cervical dysplasia, it is necessary to be observed by a gynecologist every 3 months with PAP smears taken for 2-3 years.

Prevention of dysplasia

The main method of preventing cervical dysplasia is regular visits to the gynecologist at least once a year and taking PAP smears. In addition, it is necessary to protect against HPV infection (use of condoms, avoid casual sex, and a vaccination program against highly oncogenic strains of HPV is currently being developed)

Cervical cancer ranks third among malignant neoplasms, accounting for 16%. Its emergence is not a sudden process. This is a consequence of the gradual development of a precancerous condition such as dysplasia (improper formation of tissue) of the cervix, or cervical intraepithelial neoplasm (CIN - according to the WHO classification).

Timely detection and treatment of cervical dysplasia provide a real opportunity to prevent its degeneration into cancer. This is all the more important because the time of transition to cancer without germination into the underlying tissue and up to 10 mm in diameter is on average 5 years in the presence of mild dysplasia, 3 years in the case of moderate dysplasia and 1 year in severe dysplasia.

Cervical dysplasia and the reasons for its formation

Every year around the world, about 30 million women are diagnosed with a mild degree of this disease and another 10 million with moderate and severe cases. According to the definition of the World Health Organization (WHO), dysplasia is a pathological condition accompanied by the appearance of atypical cells in the thickness of the epithelial layer with varying degrees of disruption of their differentiation (differences) and a further change in the layering of epithelial cells without the participation of supporting structures (stroma) in the pathological process.

This definition becomes more understandable with further acquaintance with the structure of the mucous membrane of the cervix.

Anatomical and histological structure of the cervix

The cervix consists of two sections - the supravaginal, located in the pelvis, and the vaginal, accessible for examination by a gynecologist. The cervical (cervical) canal passes through the cervix, opening with an internal os into the uterine cavity, and an external os into the vagina. The cervical canal is covered with columnar epithelium, and the entire cervix on the vaginal side, including the area of ​​the external pharynx, is covered with stratified squamous epithelium. The border between the transition of one type of epithelium to another is called the transformation zone. Up to 90% of dysplasias are localized here.

Stratified epithelium consists of the following layers:

1. Main (basal), deepest. It is separated by a layer of connective tissue from the stroma (basement membrane). The stroma consists of muscles with vessels and nerves. The cells of the basal layer are the youngest; they have a large rounded nucleus. As they divide (reproduce) and grow, they become flattened, with the nucleus shrinking and the cells themselves moving to more superficial layers. Therefore, the surface layer is represented by flat cells with a small nucleus.
2. Intermediate.
3. The surface layer facing the cavity of the cervical canal.

The closer to the surface layer, the more the cells of each layer differ from the previous one.

Types of dysplasia

A biopsy of the cervix for dysplasia allows us to study under a microscope the histological structure of the material taken from the mucous membrane. With the disease, atypical epithelial cells are found, that is, cells with an altered shape and structure - multiple small nucleoli or an excessively large shapeless nucleus with unclear boundaries appear in them. In addition, a violation is detected in the division of cells into appropriate layers.

Depending on the epithelial layers in which atypical cells are found during histological examination, three stages of the pathological process are distinguished:

• I - atypical cells are found throughout 1/3 of the thickness of the epithelial layer of the mucous membrane, counting from the basement membrane;
• II - for 2/3;
• III - more than 2/3.

In accordance with the WHO classification, which is based on the histological characteristics of the location of the epithelial layers, dysplasia is divided into three main forms according to the severity of the lesion:

1. 1st degree, or “CINI” (mild), in which the superficial and intermediate layers are located normally.
2. 2 degrees, or “CINII” (moderate) - changes cover more than 1/3, but less than 2/3 of the thickness of the entire epithelial layer.
3. 3 degrees, or “CINIII” (severe) and non-invasive cancer (not penetrating the stroma) - pathological changes are determined in most of the epithelial layer, except for the basement membrane and several layers of mature epithelial cells with normal shape and structure on the side of the cervical canal.

Non-invasive cancer and grade 3 cervical dysplasia are combined into one group due to the difficulty of differentiating them during histological examination. In the structure of this disease, 30% are moderate and half are severe forms. Dysplasia processes in women under 40 years of age are more often localized on the mucous membrane of the vaginal cervix, and at a later age - in the cervical canal.

Causes of the disease

The main reason for the development of dysplasia is considered to be infection primarily with the 16th or 18th strain (type) of the human papillomavirus (HPV). According to some results of scientific studies, in 50-80%, and according to others, even in 98% of cases, grade 2 cervical dysplasia and severe dysplasia are accompanied by the detection of HPV using existing research methods.

It is believed that after 2 years of sexual activity, on average, 82% of women are infected with HPV, most of them are women 15-25 years of age. However, not every infection leads to the development of dysplasia and its transition to cancer. This requires the presence of risk factors:

• weakening of local immune defense, manifested by a significant decrease in the content of immunoglobulins type “A” and “G” and an increase in immunoglobulin “M” in the mucus of the cervical canal; such a violation also causes frequent relapses of already cured papillomavirus lesions;
• disease of the endocrine glands, as well as hormonal dysfunctions associated with adolescence, pregnancy, artificial termination of pregnancy, involution period, long-term use (over 5 years) of hormonal contraceptives - all this can lead to the formation of intermediate aggressive forms of estradiol (16-alpha- hydroxyestrone), which affects the degeneration of cells affected by HPV;
• hereditary predisposition - increases the risk of the disease by 1.6 times;
• long-term inflammatory processes of the genital organs caused by bacterial infection (bacterial colpitis), herpes simplex virus (type “2”) or sexually transmitted infections - chlamydia, trichomoniasis, human papillomavirus infection, cytomegalovirus;
• the presence of dysplastic processes and condylomas of the labia or vagina;
• deviations of the results of cytological smears from the norm;
• early (before 16 years of age) sexual contacts and frequent changes of partners;
• frequent childbirth, especially accompanied by trauma to the birth canal;
• injuries associated with repeat abortions performed using instrumental methods;
• two or more abortions by artificial means;
• sexual contact with a man who has been diagnosed with cancer of the glans penis, as well as non-observance of personal hygiene by sexual partners - smegma accumulating under the foreskin has carcinogenic properties;
• deficiency of folic acid, beta-carotene, vitamins “A” and “C” in food products, as a result of which the metabolism of progesterone in the liver and the removal of its intermediate products from the body are disrupted;
• active or passive smoking increases the risk of developing dysplasia by 4 times.

In the absence of risk factors, in most cases the virus is eliminated from the body on its own (in young people - within 8 months). Over the course of 3 years, grade 1 cervical dysplasia undergoes reverse development in 50-90% of cases, moderate - in 39-70%, severe - in 30-40%. Other diseases are accompanied by an increase in severity and transition to cancer. However, such an option is also possible when two lesions that are different in etiology, severity and dynamics of development are present simultaneously. Detection of HPV in women with cervical dysplasia has great prognostic significance and plays a role in deciding the need for treatment and choosing its methods.

Pregnancy and cervical dysplasia

Dysplasia occurs in 3.4-10% of pregnant women and with the same frequency as in non-pregnant women of the same age category. Only 0.1-1.8% of them are diagnosed with stage 3. The disease does not progress during pregnancy, and after childbirth, 25-60% of CINII and 70% of CINIII are susceptible to reverse development. However, other studies indicate progression of dysplasia during pregnancy in 28% of cases. The peculiarities of its diagnosis during pregnancy, especially the first, and in the near future after childbirth, are due to the high content of estrogens and the physiological changes in the genital organs occurring in the body:

• production of opaque thick mucus by the glands;
• an increase in blood flow to the uterus, as a result of which the mucous membrane of the cervix becomes cyanotic (bluish) in color;
• progressive softening and increase in volume of the cervix under the influence of estrogens due to thickening of the stroma;
• ectopia of columnar epithelium as a normal variant, etc.

These changes complicate diagnosis, but do not affect the reliability of laboratory tests. A biopsy is not recommended during pregnancy. As a rule, careful sampling of the material with a special brush is sufficient to perform a cytological examination of the smear.

If the need arises, then a knife biopsy is not performed, but with the help of forceps designed specifically for this purpose, and the material is taken from the most suspicious area of ​​the mucous membrane based on the minimum number of samples. Conization (cone biopsy) is performed only if cancer is suspected. Colposcopy in pregnant women is performed only under strict indications or in the presence of pathological changes found in smears taken before pregnancy.

Diagnostic methods

The main methods of diagnostic research are:

1. Cytological examination of a smear, the reliability of which increases with increasing severity of dysplasia. Of great importance is the use of liquid technology for preparing preparations for microscopic examination, which can significantly improve the quality of smears.
2. Colposcopy, which is the next stage in diagnosing the disease. It is performed for women whose cytological examination of smears revealed abnormalities. Colposcopy allows you to more accurately determine the presence of pathological areas and decide whether a biopsy is necessary. Thus, it is one of the main methods complementing smear cytology.
3. Cytological examination of several samples of material taken by biopsy.
4. Carrying out polymerase chain reaction (PCR) to detect HPV. This method is characterized by a significant number of false positive and false negative results. More accurate studies are possible using the HCII technique.

Biopsy results

If the need for treatment of grade 1 dysplasia is disputed by many specialists, and only the need for constant regular monitoring is expressed to prevent progression to a more severe degree, then treatment of moderate cervical dysplasia is mandatory. At this stage, complex therapy is necessary:

• increasing general and local immunity; For this purpose, the dual antiviral drug Isoprinosine can be used; it indirectly and directly suppresses the mechanisms of HPV nuclear division and the synthesis of viral proteins;
• radio wave treatment of cervical dysplasia, which is the most effective and painless method that prevents the formation of scars and the introduction of atypical cells into neighboring tissues; It is also possible to use cryodestruction, electrodestruction or laser vaporization, but these methods are less effective.

Treatment of severe cervical dysplasia consists of surgical intervention through diathermoexcision using a special electrode, electroconization (cone-shaped excision of a section of tissue) using a knife from the Surgitron radio wave apparatus, or knife amputation of the cervix.

The effectiveness of treatment of dysplasia depends on the correct conduct of comprehensive clinical and laboratory examinations, treatment of identified local inflammatory processes, complex therapy with the use of antiviral and antibacterial drugs, dynamic monitoring during and after treatment.

ginekolog-i-ya.ru

Cervical dysplasia - symptoms, photos, treatment of dysplasia

Cervical dysplasia is a disease associated with changes in the epithelial tissue of the mucous lining the cervix. Unlike cervical erosion, this pathology is rare, mainly in women of childbearing age (from 25 to 40 years).

Experts consider dysplasia as a precancerous condition and recommend not delaying treatment of the disease until a later date. The diagnosis is made depending on how extensive the epithelial changes are. Timely treatment of dysplasia is the surest prevention of cervical cancer, which is very common today.

Classification of the disease

A classification system for cervical dysplasia was developed to facilitate diagnosis. In its development, the disease goes through three main stages, each of which requires special treatment. The more advanced the dysplasia, the higher the risk of developing cancer.

Cervical dysplasia of the 1st degree (CIN1) affects individual cells of the mucosal epithelium, located, as a rule, in its uppermost layers, has no characteristic signs and is quite difficult to diagnose. The disease can be identified at an early stage of its development by resorting to screening.

Cervical dysplasia grade 2 (CIN2) involves the spread of the process of cell change to the deeper layers of the mucosa. There are also no external signs of the disease.

Cervical dysplasia of the 3rd degree (CIN3) is characterized by strong and extensive changes in the structure of the epithelium of the uterine mucosa, affecting the deepest layer of the mucosa - the basal one, an actual precancerous condition. Sometimes, at this stage of the development of the disease, carcinoma in the city is already diagnosed (a local tumor that has not yet spread in the body).

Dysplasia can affect various parts of the mucous membrane of the cervix, in particular it can be found on its outer part, in the canal connecting the vagina and uterus, and in the area adjacent to the uterus itself.

Symptoms of dysplasia

In itself, the presence of pathological processes in the uterine mucosa does not manifest itself in any way, but it is often associated with various infectious diseases of the genital area (STIs), which have pronounced symptoms. Many women with a similar diagnosis also have cervicitis (inflammatory process of the cervical canal), HPV, and trichomoniasis.

Suspicion of cervical dysplasia should arise if the following symptoms are present:

• rare nagging pain in the lower abdomen;
• bloody vaginal discharge not associated with menstruation;
• copious discharge with an unpleasant odor.

These symptoms are characteristic of many diseases of the female reproductive system, including those associated with cervical dysplasia. In the absence of concomitant diseases, dysplasia does not manifest itself in any way and can only be detected during a medical examination of the patient.

A specialist may notice changes in the mucosa characteristic of dysplasia even during examination. The mucous membrane affected by the disease becomes red, loose, spots of various diameters and colors (most often light pink), minor ulcerations, and erosions may be observed on it.

Treatment of dysplasia

To determine the disease, it is necessary to conduct a number of studies, in particular:

• colposcopy, which allows not only to see structural changes in the mucous membrane, but also to take tissue for further study in the laboratory;
• a biopsy, during which a small fragment of the changed mucosa is taken. Next, this fragment is subject to cytological examination to detect the presence of cancer cells;
• examination of the cervix by a gynecologist.

Most women with suspected dysplasia are recommended to be tested for STIs, since the main cause of the development of this disease is considered to be a fairly common infection - HPV. PCR gives the most accurate result.

The question of how to treat cervical dysplasia is answered by gynecologists and gynecological oncologists. Therapy is prescribed taking into account the degree of development of the disease and the cause of its occurrence. There are many causes of the disease. Atypical processes in the mucous membrane can be triggered by pregnancy, difficult childbirth, any surgical interventions in the woman’s genital area, as well as smoking and low immunity.

Treatment of the initial stage of the disease is carried out using conservative methods. The patient is prescribed immunostimulating drugs and vitamins. A woman with a similar diagnosis, regardless of age, should be under the supervision of a specialist and undergo regular examinations (every 3 months). There are cases of spontaneous cure of cervical dysplasia.

In cases where the likelihood of developing cancer is high, more radical treatment methods are used, in particular cauterization of dysplasia. If there is a high risk of cervical cancer, the altered area of ​​the mucosa is simply removed. The procedure is carried out using a laser, liquid nitrogen, and a radio knife. If the initial stage of cancer is detected, amputation of the cervix is ​​recommended, while the uterus itself remains intact and fully performs its functions.

Conization of the cervix with dysplasia

The procedure of conization of the cervix is ​​a radical treatment method. Among its main indications are grade 2 and 3 dysplasia. During conization, the altered area of ​​the mucous membrane is completely removed, while the adjacent tissues remain intact and unharmed.

This method of treatment is not used if a malignant tumor of the cervix is ​​detected. Conization is also contraindicated in the presence of an STI. In such a case, the infection is first treated with antibiotics, then the dysplasia is removed.

Conization of the cervix with a scalpel is considered an outdated method of treatment. Today, the procedure is carried out using more gentle methods (laser and radio wave conization). In the first case, the area of ​​tissue being removed is exposed to a laser beam that completely burns out the atypical tissue; in the second case, a high-frequency current is applied, under the influence of which the cells of the mucous membrane literally evaporate.

The operation is performed in a hospital setting. After its completion, the patient remains in a medical facility for 3-4 days and is subject to medical supervision. In the first few hours after the procedure, she may be bothered by nagging pain and slight bleeding from the vagina. The result of treatment is assessed 2-3 weeks after the operation.

Conization of the cervix is ​​performed under local anesthesia; complications are rare. If the procedure is carried out correctly, a slight scar remains on the mucous membrane, which is not a subsequent obstacle to the birth of a child.

Dysplasia often occurs in pregnant women due to changes in the hormonal levels of their body. If the disease progresses slowly and is at an early stage of development, there is no particular need for treatment. In such cases, experts recommend waiting until the baby is born. Often after childbirth the disease progresses, so in such cases, medical supervision is simply necessary.

If a woman expecting a future pregnancy has been diagnosed with grade 2 or 3 dysplasia, treatment is carried out using the most gentle method (laser conization of the cervix).

You can also watch the video for more detailed information about cervical dysplasia.

pro-simptomy-treatment.ru

at 56 years old, grade 1-2 cervical dysplasia.

Sergey Yurievich Buyanov

It’s an amazing thing - what kind of farriers did you end up with?
1-2 degrees - surgical treatment, funny.
To begin with, anti-inflammatory treatment, the usual one, as for colpitis, then a second smear on the cells - and 95% will show the norm!!!

Prokopyuchka

what does cytology show?

If the cytology is normal, then why remove everything? It is enough to remove the lesion from the cervix with a laser and live in peace, do a colposcopy every six months, just observe. Very good reinsurance from doctors, remove everything. Last year they showed in health that there is now a new method for preventing cancer in women, everything is removed, including the breasts. But this is for those women who have already had cancer, for example in one breast. And if everything is good, then why so radical, but this is my opinion.

Often, in women undergoing a gynecological examination, including taking tests from the vagina, doctors diagnose cervical dysplasia.

The knowledge of most women comes down to the precancerous nature of the detected deviation. It is not always worth associating dysplasia with oncology, but leaving this condition unattended is fraught with serious consequences.

Cervical dysplasia: what is it?

Cervical dysplasia (neoplasia) is the appearance of atypical cells in the cervix, consisting of multilayered squamous epithelium. Atypicality consists in a change in the shape of the cell, its structure (the appearance of many nuclei or an increase in the size of a single nucleus), the loss of the layer-by-layer structure of the epithelium covering the neck.

Cells that are atypical for the structure of a given organ begin to reproduce their own kind, thereby replacing healthy epithelium. All these changes occur during cancerous degeneration. However, the only thing that distinguishes dysplasia from oncology is that the altered cells do not spread deeper than the basal layer of the epithelium.

A pathological mutation of cells occurs at the junction of the cervical mucosa, lined with columnar epithelium, and the vaginal part of the uterine cervix, covered with stratified squamous epithelium. Initially, atypical inclusions form in the basal layer of the epithelium, then they invade more and more superficial layers.

In this case, not only the correct shape of typical cells disappears, but also the boundary between the epithelial layers is blurred. Depending on the layer-by-layer localization of mutated cells, several stages of disease development are distinguished.

Cervical dysplasia grade 1 (CIN 1)

Mild cervical dysplasia 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.

Neoplasia grade 2 (CIN 2)

Moderate dysplasia is the spread of the process of replacing normal epithelium with altered cells into the thickness of the cervical integument. The damage to the thickness of the epithelial layers varies in the region of 1/3 - 2/3.

Dysplasia grade 3 (CIN 3)

Severe cervical dysplasia - called non-invasive cancer, covers all epithelial layers, but does not extend beyond the boundaries of the basement membrane.

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

Cell mutation is far from a spontaneous process. In order for cells to change their structure and begin to divide chaotically, 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, the influence of several of the following factors is necessary:

• infection with an oncogenic type of papillomavirus (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-term (more than 5 years) contraception with combined hormonal pills;
• burdened heredity - oncology of the genital organs in blood relatives;
• traumatization of the mucous membrane - abortion, multiple births;
• immunodeficiency - stress, poor nutrition, chronic infections in the body, long-term treatment with antibiotics and corticosteroids;
• frequent or untreated infections of the reproductive system;
• alcohol, active/passive smoking - increase the risk of dysplasia formation by 4 times.

Women at risk for precancerous neoplasia include:

• those who began sexual intercourse at the age of 14-15;
• indiscriminate in choosing partners;
• large families;
• with a large history of abortions;
• leading an antisocial life;
• neglecting basic hygiene and condoms.

In women in the postmenopausal period and who have undergone ovarian removal with hormonal replacement prescribed by a doctor, the likelihood of dysplastic pathology does not increase.

Cervical dysplasia does not give specific symptoms. Women often present complaints associated with concomitant inflammation:

• unusual discharge;
• itching and burning sensation in the perineum;
• bloody spotting during sexual intercourse;
• pain is usually absent and can occur when the delicate mucous membrane of the cervix is ​​traumatized during sexual intercourse.

Neoplasia does not cause infertility and does not have a negative effect on the developing fetus. In addition, hormonal changes during pregnancy cause physiological changes in the cervix, often mistaken for dysplastic processes.

The cylindrical epithelium moving from the cervical canal protrudes from the external os of the cervix in the form of a red corolla (ectropion or pseudoerosion).

Diagnostics

Pathological changes are detected in the following studies:

• gynecological examination of the uterine cervix in the mirror - whitish plaques that practically do not change color when stained with Lugol's solution (Schiller testing);
• colposcopy - pale color of the dysplastic lesion, increased blood pattern;
• cytology (PAP test) - detection of atypical cells (sensitivity increases with severe neoplasia) and HPV markers
  targeted biopsy and histology of the material taken;
• - immunological test that detects HPV infection.

Methods and means for treating cervical dysplasia are selected depending on the results of a diagnostic examination.

Since in most cases, minor degeneration of the epithelial layer and the papilloma virus that caused it eliminate themselves within 1-2 years, when treating grade 1 cervical dysplasia it is recommended:

• regular monitoring by a gynecologist, including annual cytology and colposcopy;
• complete treatment of vaginal inflammation;
• replacing combined oral contraceptives with alternative means;
• eliminating endocrine disorders and strengthening the immune system;
• lifestyle correction - good nutrition, quitting cigarettes, adequate hygiene.

Treatment of cervical dysplasia grades 2 and 3

Developing neoplasia requires a more radical approach; lifestyle correction and inflammation relief are not enough to treat grade 2 and 3 cervical dysplasia; surgery is required.

• Electrocoagulation is the removal of atypical cells by cauterization with electric current. The financially accessible method does not allow adjusting the depth of impact. During the healing stage, it often forms rough scars that prevent the dilation of the cervix in subsequent births.
• Cryodestruction is freezing the altered area with liquid nitrogen. It does not leave scars (indicated for the treatment of nulliparous patients), and is fraught with long-term (up to 1 month or more) leakage of fluid.
• Laser coagulation - evaporation of altered epithelium using a laser. To avoid damage to healthy cells, the woman should not move/shudder during the procedure. High efficiency is due to the ability to regulate the depth of exposure.
• Radio wave treatment - removal of grade 2, 3 cervical dysplasia by heating with high-frequency radio waves. Fast recovery, absence of scars and high precision of treatment ensure the absence of relapses and complications. Used in nulliparous women. Quite an expensive treatment method.
• for dysplasia - surgical excision of the pathological formation. The most traumatic intervention is not recommended for women of childbearing age. If the clinic has special equipment, removal of neoplasia with a scalpel is replaced by laser excision. This reduces the likelihood of post-operative bleeding and infection, and healing occurs faster.

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

With any surgical treatment option, it is necessary to abstain from sexual intercourse, bathing and visiting the sauna/swimming pool, visiting beaches and solariums. At the end of menstruation after surgery, a gynecological examination is necessary.

Forecast

The prognosis for cervical dysplasia clearly depends on the degree of pathology:

• When mild neoplasia is diagnosed, only in 1% of cases does a transition to moderate and severe occur.
• In patients diagnosed with CIN 2, a severe precancerous form develops only in 16% of cases over 2 years and in 25% over 5 years.
• A severe form of neoplasia (grade 3) develops into invasive cancer (spread of altered cells beyond the basement membrane) in only 12-32% of patients.

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

Dysplasia 2 cin2 is a pathology of the uterine cervix of moderate severity, in which the epithelial layer is affected by more than half. The initial focus of the spread of this gynecological pathology is the basement membrane. Moreover, the pathology is accompanied by a wide range of morphological changes, thanks to which it is quite easy to diagnose the disease. We will talk about some features of the clinical manifestations and diagnosis of this pathology of the cervical canal of the uterus in this article.

Differentiation of disease development

The cervix often becomes the site of localization of dysplasia - that is, the development of an accumulation of atypical cellular material prone to proliferation. In the absence of proper treatment, this pathology can very likely prolong into an oncological lesion, dangerous to the health and life of the patient.

To avoid these undesirable consequences, it is worthwhile to become more familiar with the nature and dynamics of the development of the pathology of dysplasia, as well as its medical classification and the presumed nature of treatment.

So, based on some medical indicators and morphological manifestations, the following types of dysplasia are distinguished:

• Dysplasia cin 1 is the first degree of development of the pathology, in which the structure of the epithelium does not experience significant changes. With cin 1, cells in the basal layer undergo moderate proliferation. Characteristic signs of the development of pathology are the presence of koilocytosis and dyskeratosis. These are common morphological signs accompanying papillomavirus infection. Cin1 dysplasia covers no more than a third of the epithelial thickness of the uterine cervix. The type of pathology under consideration is difficult to conduct diagnostic studies - primarily cytology.
• Dysplasia type 2 - CIN 2. This form of pathology is associated with an increased risk of irreversible changes in the structure of the epithelial tissues of the uterine cervix. It can manifest itself with a wide range of symptoms, including painful manifestations of a spasmodic nature. Stage 2 cervical dysplasia is associated with more intensely expressed morphological manifestations. Accordingly, the diagnostic process is simplified. In addition, with the development of a disease of this type, changes cover more than half of the epithelial layers of the uterine cervix, which cannot but affect the functioning of the reproductive system. With 2 cin2 dysplasia, the risk of pathology developing into an oncological form increases, but this is not inevitable.
• Stage 3 dysplasia is the most severe degree of damage to the uterine cervix. The presence of morphological changes is pronounced. The pathology covers more than 2/3 of the epithelial surface of the uterine cervix. This form of the disease is characterized by a high degree of proliferation and a significant level of threat of oncological complications.

Initial stage of development: features and dynamics

If grade 1 dysplasia is relatively safe for the health and life of the patient, this does not mean that in the future it cannot progress into a more dangerous form of pathology that threatens the development of malignant tumors.

It is worth remembering that about 30% of cancers of the reproductive system begin with one form or another of dysplasia, as an unidentified precancerous condition.

Stage 1 dysplasia is associated with the development of damage to 1/3 of the epithelial covering of the cervix. But this is not the only manifestation. There is also a number of specific morphologies, which can only be identified by a qualified specialist. When diagnosing the disease in question, it is necessary to begin treatment immediately to prevent further development of the pathology.

Cervical dysplasia of the 1st degree rarely progresses into subsequent forms of development of the disease - this requires the influence of a whole range of factors, ranging from genetic predisposition to gynecological diseases, and ending with a negative environmental situation. In addition, the progress of dysplasia is not directly related to the development of oncological manifestations, which is what many patients are so afraid of. Although, of course, disturbances in the structure of the epithelial tissues of the uterine cavity and appendages with syn 1 dysplasia create a favorable environment for the further development of malignant manifestations.

Second degree: what is its peculiarity?

Cin 2 dysplasia is a much more complex form of the disease than its initial degree. At this stage, morphological changes progress and become more obvious for diagnosis. In addition, the lesions cover more than half of the cervical epithelium.

When the disease develops to cynic 2, it requires much longer treatment and careful diagnosis. Dysplasia of the second type progresses to the third degree in 25% of clinical cases.

Cervical dysplasia of the 1st and 2nd degrees is not as dangerous as is commonly believed - although it is certainly necessary to treat this type of pathology. However, to draw up the correct course of treatment, first of all, it is necessary to have a competent diagnosis and determine the nature and dynamics of the development of the pathology, as well as drawing up a prognostic map of its clinical consequences and complications that are possible with further progression. Only by taking into account all these factors can we draw up an optimal map of treatment measures and avoid further prolongation of the disease.

Severe dysplasia: cin 3

Cin 3 dysplasia is the most severe form of the disease, accompanied by significant morphological changes in tissue structure and damage to up to 70% of the epithelial cover of the uterine cervix.

The third degree of development of the pathology is considered the most severe, since in 10-12% it develops into cancer. It is worth noting the symptoms that may accompany the development of the disease at stage 3:

• spasmodic pain localized in the lower abdomen;
• anovulatory vaginal bleeding;
• menstrual irregularities;
• general weakness, anemia;
• dizziness;
• difficulties conceiving a child.

Another important feature of type 3 dysplasia is pathological mitosis, as well as huge hyperchromic cell nuclei, the transformation of which occurs under the influence of pathogenic processes in epithelial tissues.

Diagnosis of pathology

CMM 1 dysplasia is diagnosed by a qualified specialist using special equipment and diagnostic techniques. Since at the first stage of development of the pathology the morphological manifestations of the disease are minimal, one has to rely largely on the results of laboratory tests. For this purpose, a smear of epithelial tissue is taken from the patient, which is subsequently examined in detail for the development of one or another form of dysplasia.

The Pap smear is one of the most effective methods for diagnosing pathology, allowing one to accurately determine the dynamics and nature of the development of the disease, as well as the possibility of its proliferation.

Using a PAP smear, you can effectively diagnose dysplasia at any stage of development, as well as predict the possibility of further proliferation. The cervix is ​​surgically scraped, and the resulting material is carefully studied by specialists. This method helps to avoid the risk of dysplasia developing into oncological manifestations, and minimize the risk of other undesirable complications. In addition, timely and qualified diagnosis allows you to draw up an effective and thoughtful pathology treatment plan.

Features of treatment

To understand how to treat manifestations of uterine dysplasia cin 1-3, a specialist should obtain as detailed laboratory results as possible of the scraped cellular material. Based on these data, the attending physician makes a decision on prescribing certain medications or using a surgical method of intervention.

Treatment of this pathology depends on many factors:

• results of the diagnostics;
• dynamics of the progressive development of the disease;
• stages of development of dysplasia;
• manifested symptoms of the disease;
• predicted clinical consequences and complications.

The effectiveness of treatment depends not only on correctly selected drugs and therapeutic manipulations, but also on the individual characteristics of the body and the tendency to rapid remission after experiencing stress.

For cervical dysplasia types 1, 2 and 3, a wide range of medicinal measures are used, ranging from drug therapy to surgical intervention.

At the same time, the disease of the first two types is much more effective in treatment and is not associated with such a wide range of possible complications such as cancer, infertility and other negative clinical consequences.

Recently, abnormal cells in the epithelium of the uterine cervix are very effectively removed using cryotherapy. One of the most effective treatment methods for advanced cases of the disease is cervical conization. In addition, loop electroconization is also used. The effectiveness of these methods has been proven in the laboratory, and their use is not associated with even a minimal risk of a threat to the health and life of the patient.

In cases where the disease is at the last stage of development and there is a high risk of proliferation of the pathology, the method of hysterectomy is used with the possibility of complete removal of the uterine organ. Of course, this is associated with enormous stress for the body and loss of reproductive function - but, in the vast majority of cases, the attending physician makes this decision if no alternative treatment exists.

Cervical dysplasia is a disease accompanied by atypical changes in the epithelial cells of the cervix.

The diagnosis of “cervical dysplasia” was used in the 80s of the last century. Until 2012, foreign medicine used the term “cervical intraepithelial neoplasia” (Cervical intraepithelial neoplasia, or CIN in English). ICD10 code: N87.

Since 2012, a new term has been introduced in foreign medicine: SIL - squamous intraepithelial lesion. SIL in English: squamous intraepithelial lesion.

This term more clearly reflects a process of change in cervical cells that is different from cancer. If the term neoplasia meant “new growth,” that is, a tumor. The term “defeat” is precisely the damage to epithelial cells by the virus, and cancer is still far away.

In this article, we will agree to call this pathology by both terms. But gynecologists, I repeat, diagnose CIN.

What it is? Photo.

Cervical dysplasia, or neoplasia, is the degeneration of normal epithelial cells of the vaginal part of the cervix. Cells become unnatural and cease to perform their function. Such cells are a little similar to cancer cells, but are not yet entirely cancerous (see photo).

In the photo: normal, dysplasia and cervical cancer

Scheme of development of cervical dysplasia

Remember: dysplasia is not cervical cancer!!! Cancer still takes time to develop: on average 10-20 years.

Causes

The main cause of cervical dysplasia, or CIN, is the human papillomavirus, its types 6, 11, 16, 18, 31, 35, 39, 59, 33, 45, 52, 58, 67. .

According to the latest data from foreign studies, a woman’s smoking increases the risk of virus penetration into the epithelial cells of the cervix by several times.

Occurrence in diseases

• In 73-90% of cases of cervical cancer, the following are found: HPV types 16, 18 and 45
• In 77-93% of cases with cervical cancer, the following are found: HPV types 16, 18, 45, 31 and 59
• In 80-94% of cases of cervical cancer, the following are found: HPV types 16, 18, 45, 31, 33 and 59
• Precancerous conditions in urology and gynecology are often combined with types 61, 62, 68, 70, 73 of HPV.
• Globally, 500,000 new cases of cervical cancer are diagnosed every year.

Penetrating the epithelium of the cervix, this virus integrates into the DNA of cells and disrupts their functioning. As a result, the cells become unnatural, different in shape and size, do not fulfill their purpose, and can later degenerate into cancer.

CIN progression process

Symptoms

There are practically no symptoms of cervical dysplasia (or neoplasia). Most often, a woman does not have any signs of the disease. And only in rare cases, with severe dysplasia, the only symptom may be slight bleeding from the vagina after sexual intercourse.

Classification

The classification of cervical intraepithelial dysplasia is as follows (see also in the photo):

1. Cervical dysplasia 1st degree(CIN I, mild): cells are affected in 1/3 of the thickness of the entire epithelial layer. Treatment in this case is not required. Just an observation. Usually in 90% of women the process goes away on its own, without treatment. Mandatory: after 6 months, re-examination and testing by a gynecologist.
2. Cervical dysplasia 2 degrees(CIN II, moderate or moderate): cells are affected at 1/3 - 2/3 of the thickness of the epithelial layer. Treatment required.
3. Cervical dysplasia 3 degrees(CIN III, severe): 2/3 of the cells are affected - the entire thickness of the epithelial layer. Comprehensive treatment is required.

What do dysplasia cells look like?

New classification (since 2012):

1. LSIL, or Low grade SIL, or light grade (corresponds to CIN 1 according to the old classification)
2. HSIL, or Hight grade SIL, or severe degree (corresponds to CIN 2-3 according to the old classification).

Cytologists have adopted the terminology of The Bethesda System, or TBS:

• NILM. This is the norm. In English it means "Negative for intraepithelial lesion or malignancy". That is, “there is no intraepithelial lesion.”
• ASC-US. There are atypical flat cells of unknown origin. In English: "Atypical squamous cells of undetermined significance."
• ASC-NSIL. There are atypical squamous cells of unknown origin, most likely due to intraepithelial changes.
• LSIL, or Low grade SIL, or mild intraepithelial changes.
• HSIL, or High grade SIL, or severe intraepithelial changes.
• AGS. There are atypical glandular cells of unknown origin. That is, these are cells from the cervical canal.
• AGC, favor neoplastic. There are atypical glandular cells, the development of neoplasia is possible.
• AIS. This is adenocarcinoma in situ, that is, cancer of the cervical canal in situ.

How to make a diagnosis?

1) PAP test.
Another name is Pap smear. This is a cytological test, or "liquid-based cytology". During a gynecological examination, the doctor runs a special instrument over the surface of the cervix, and the material is sent for examination under a microscope.

If abnormal cells are detected, then dysplasia exists, but the degree still needs to be determined. The woman is offered a biopsy.

2) Cervical biopsy.
During colposcopy, a special device is used to pinch off a microscopic piece from the cervix in the area of ​​the pathological area and send it for examination under a microscope.

As a result, the degree of dysplasia (neoplasia) of the epithelium is assessed based on the thickness of the affected layer and the severity of cell damage.

3) HPV test.
A smear is taken from the surface of the cervix and sent for PCR. If HPV is detected, their types are determined.

4) Immunohistochemistry with tumor markers.
This test is not performed on all women, but only if cervical cancer is suspected. If the patient has cancer, then when tumor proteins bind to special reagents, this test becomes positive.

If there is no cervical cancer, then there are no specific tumor proteins (or markers), therefore the test result will be negative.

Questions about analyzes

- If my HPV is positive, and my partner’s is negative, how can this be and is it necessary to treat the partner?

The main thing: treatment is prescribed only when there are manifestations of the virus on the skin or mucous membranes. Or when cytology or biopsy showed neoplasia. In some cases, when planning a pregnancy, both partners should undergo treatment.

Now for the reasons for this discrepancy in the analyses. The main reason: the partner’s immunity is strong enough to suppress the virus and prevent it from developing.

- Why does liquid cytology show the presence of dysplasia, but biopsy does not?

Because for liquid cytology, material is taken from many areas of the mucosa, and for biopsy - from one or two. It is possible that the biopsy material was taken from healthy areas.

Brief infographic diagram on CIN

Treatment of cervical dysplasia

Remember: how, with what and when to treat - only a doctor can answer this question. You cannot introduce any folk remedies into the vagina, otherwise you will provoke complications.

Principles of treatment depending on the degree of disease

1) Mild treatment.
It is carried out with general strengthening drugs. That is, drugs are used, including folk remedies, that increase immunity. According to modern recommendations, a mild degree does not require specific treatment, since in 90% of cases it goes away on its own.

2) Medium treatment.
Drug treatment is necessary, although in some cases you can also get by with restorative drugs.

Moderate degrees heal on their own in 70% of affected women. If human papillomavirus is detected in the tests, then treatment should be started immediately.

3) Severe treatment.
Drug treatment is mandatory, otherwise there is a very high risk of neoplasia degenerating into cervical cancer.

Treatment regimen for cervical dysplasia

Treatment methods

Therapeutic treatment

1) Antiviral drugs locally - in the form of douches, suppositories, tampons

2) General antiviral agents - to suppress the virus in the body as a whole:

• isoprinosine (or groprinosine) -
• allokin-alpha -
• epigen intimate -
• Panavir - instructions for the drug

3) immune drugs (polyoxidonium, roncoleukin, immunal, viferon, genferon and other interferon drugs).

Surgery

1) electrocoagulation, or electroconization, or loop electroexcision of the cervix. Conducted by a gynecologist. A special metal loop under the influence of electric current influences the epithelium of the cervix.

2) laser vaporization, laser conization of the cervix. The mechanism of action is the same, only a different factor of influence is not electric current, but a laser.

3) treatment with radio waves using the Surgitron device. The method of exposure is similar to laser, but the main factor is radio waves.

4) cryodestruction, or cauterization with liquid nitrogen. Thermal destruction of the affected epithelium occurs, it dies and a new, unaffected epithelium grows in its place.

5) ultrasonic destruction. The mechanism is similar to the effect of a radio wave or laser, only the active factor is ultrasound.

6) conization with a scalpel. Classic surgery using a scalpel. Currently rarely used, as the above methods are more effective.

7) amputation of the cervix. This is already an extended operation. Used for cervical cancer.

Alternative treatment intravaginally

It is generally not recommended to introduce any medications into the vagina yourself, except for official pharmaceutical drugs prescribed by a gynecologist. Otherwise, you may get serious complications that the doctor will not be able to cope with.

Remember:

Self-medication is unacceptable!!!

Have courage and patience, and go to the doctor!

If you doubt the competence of a doctor, contact another, a third doctor. But do not try to cure cervical dysplasia with home remedies.

We present to your attention an expert opinion on this issue. Watch the video:

• What is cervical erosion? How does it differ from dysplasia?

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