Drug treatment of cervical dysplasia. Cervical dysplasia: symptoms, treatment, causes, complications. Post-operative care

At the end of the 20th century, epithelial dysplasia was characterized by the decision of experts of the World Health Organization as a combination of three main signs:

• Atypical development of epithelial tissue cells.
• Disturbance at the stage of cell differentiation.
• Violation of tissue architectonics.

This definition is considered complete and accurate. Epithelial dysplasia is not limited to cellular atypia, but is global in nature. The complex of elements that make up epithelial tissue undergoes pathological transformation.

Often the occurrence of dysplastic processes in epithelial tissues is not primary. As a rule, the preceding process is development against the background of long-term inflammation, reactive hyperplasia of epithelial cells, and disruption of the regeneration processes of damaged cells. In some cases, instead of hyperplasia, atrophic changes in epithelial tissue develop. This combination is considered quite natural; the processes of dysplasia and atrophy show common genetic patterns and formation mechanisms. Genes responsible for the processes of cellular mitosis, stimulating the proliferative activity of epithelial cells, take part in the initiation of processes. An important role is played by the suppressor gene, which stops cell reproduction and differentiation and triggers the process of cell apoptosis.

Activation of these genes causes either hyperplasia or atrophy of the cellular elements of the epithelium.

Histological and biochemical studies of the affected tissues revealed changes in the normal production and functioning of active substances that regulate cell growth and development. This includes cell growth factor, receptors and adhesion molecules, factors for the synthesis of oncogenic proteins.

In some cases, when describing precancerous changes in epithelial tissues, it is not used by specialists in clinical practice. To make a diagnosis characterizing a pathological process in a number of body systems, special terms such as “adenomatosis” or “glandular hyperplasia” are used.

Severity of dysplasia

In medical practice, the classification of dysplasia, which is carried out according to degrees, is considered widespread.

1. Weak degree.
2. Moderate.
3. Pronounced or severe.
4. Atypical hyperplasia.

The criterion for determining the degree is the intensity of the atypical process in epithelial cells.

As the severity increases, changes develop:

1. Increase in the size of the cell nucleus of epithelial cells.
2. Polymorphism of nuclei and the entire epithelial cell.
3. Hyperchromatism when staining preparations.
4. Changes in the structure of chromatin, which forms rough clumps.
5. Increase in the number of cell nucleoli and their size
6. Activation of mitosis.

The course of epithelial dysplasia can be progressive, stable or regressive. Dynamic transformations in the structure of cells directly depend on the duration of the pathological process and the degree of intensity.

The mildest degree of epithelial dysplasia often has a favorable prognosis and is subject to reverse regression in 100% of cases. The higher the degree of activity of the pathological process, the greater the percentage of likelihood of cancerous degeneration of cells. As an extreme case, we can consider the appearance of cancer in situ.

Severe dysplasia

Severe dysplasia is commonly called intraepithelial neoplasia. The condition in clinical practice is regarded as obligately precancerous. It can be considered the initial stage of pathomorphological changes, which gradually transform into a malignant neoplasm.

The histological picture of severe dysplasia shows many similarities with the morphology of cancer cells. A distinctive feature is the absence of invasion into adjacent tissues. This explains the need for emergency treatment and a number of preventive measures when detected in a patient. Treatment of this stage is necessarily surgical and is radical in nature. The patient must be seen by an oncologist.

Squamous epithelial dysplasia

Disorders of the tissue structure in dysplasia of stratified squamous epithelium are expressed in the loss of differentiation of the various layers of the epithelium. The upper layers of squamous epithelium are replaced by cellular structures characteristic of the basal layer with disruption of the process of their maturation, differentiation and keratinization.

Clinically, dysplasia of stratified squamous epithelium manifests itself in the form of focal areas of proliferation with impaired vertical differentiation, hyperplasia of basal layer cells, atypical cell polymorphism, disruption of normal staining, and an increase in nuclear size. The upper layers of the epithelium exhibit the phenomena of hyperkeratosis and dyskeratosis. All described pathological structural elements, to a certain extent, replace normal cell layers.

Glandular epithelial dysplasia

This type of dysplasia is characterized by a violation of the cellular structure of the glandular ducts, atypical development of cells, excessively close arrangement of epithelial cells, increased branching of the ducts or their flattening. The formation of pathological growths of epithelial cells of the papillary layer is possible.

Columnar epithelial dysplasia often develops in the cervical canal. Disturbances in a woman’s hormonal balance, in particular, increased levels of estrogen or progesterone in the body, can contribute to the development of the process. Hormonal imbalance is both endogenous and exogenous. Often, weak atypia of the columnar epithelium develops during pregnancy, after childbirth, as a result of taking a number of hormonal drugs. In this case, the characteristic lesion will be small glandular hyperplastic formations. Disorders of the proliferation of columnar epithelium often coexist with similar disorders of stratified squamous epithelium. This is considered an extremely important criterion for treatment.

Cervical epithelial dysplasia

The mild or moderate form itself does not give subjective clinical manifestations; in 10% of cases it is asymptomatic. As a rule, symptoms are detected when inflammation or infection with bacterial or fungal flora occurs. Symptoms similar to the clinical phenomena of endocervicitis may appear - burning, itching, pathological discharge, sometimes mixed with blood.

Etiological factors contributing to the development of dysplastic processes in the cervical epithelium can vary widely. These include mechanical impacts and injuries, microscopic defects, consequences of inflammatory processes, general hormonal imbalance in a woman, decreased immune defense, a history of pregnancy, abortion and childbirth.

With a favorable outcome, epithelial dysplasia can regress on its own.

However, in a number of clinical cases, dysplasia is determined only during laboratory and instrumental procedures.

Diagnostic tests that can detect dysplasia:

1. Examination of the uterus and cervix in gynecological mirrors. Upon examination, changes visible to the naked eye are detected. The color of the mucous membrane changes, the epithelial layers grow, the presence of uncharacteristic spots on the mucous membrane of the cervix, and the specific shine of the affected tissues.
2. Colposcopy is an examination using a special optical device that can magnify the area in question up to 10 times. If the cervix is ​​pre-irrigated with a solution of iodinol or Lugol, this will detect mild defects in epithelial tissue that are not visible to the naked eye.
3. Histological examination will reveal characteristic changes in the structure and proliferative functions of cells described above. The research method is considered the most reliable and the only one that allows us to determine the severity of the process.
4. Diagnostics using the PCR method makes it possible to detect oncogenic changes in tissues and the presence of antibodies to viruses in the body. When conducting diagnostic studies, it is necessary to remember that a number of infectious pathogens can give a picture of a dysplastic process in a vaginal smear. Taking this into account, the examination is carried out as complete as possible.

Treatment of dysplasia

Before prescribing treatment, a thorough histological examination is mandatory. The choice of therapeutic methods directly depends on its results.

The choice of treatment method is made by the doctor taking into account the following factors:

• Patient's age.
• The degree of severity of the dysplastic process.
• The size of the proliferation focus.
• Presence of concomitant acute and chronic diseases.
• When treating uterine epithelial dysplasia, the woman’s age, her potential ability, and desire to bear children are taken into account.

Treatment methods often used:

1. Prescription of immunomodulatory drugs. The method is aimed at increasing the body's immune activity and is indicated when dysplasia of stratified squamous epithelium occupies a large area of ​​the mucous membrane or skin. The tendency of the process to recur is taken into account.
2. Surgical treatment is carried out using the following methods:

• Cryogenic destruction of the affected area of ​​stratified squamous epithelium using liquid nitrogen;
• Radio wave method of destruction;
• Laser therapy using carbon dioxide or argon;
• Surgical excision of the lesion using a standard scalpel.

In some cases, when the patient’s age is young and dysplasia does not exceed the first or second degree of severity, it is possible to choose a wait-and-see approach. This method is chosen when the lesion is not too large. There is a high degree of probability that dysplasia will be able to regress on its own without medical intervention. A diagnostic examination is required every 3 months.

If progression of the process is observed during double examination, the question of using surgical treatment methods is raised.

Severe treatment is carried out by an oncologist using one of the surgical methods. Before proceeding with a radical elimination of the problem, a course of anti-inflammatory treatment is prescribed, and a complete sanitation of the affected area is carried out. In some cases, the methods help reduce the severity, even complete regression of the pathological process.

This pathology is one of the most serious gynecological diseases, since the presence of dysplasia is the first signal that the cervix is ​​ready to face oncology. Therefore, dysplasia is classified as a precancerous condition that requires timely, competent treatment. It is known that this pathology is most often detected in young women (aged 25 to 35 years), and the incidence of the disease reaches 1.5 cases per thousand women.

Etiology of the term “cervical dysplasia”

Cervical dysplasia is a process of degeneration of the epithelial cells that line the vaginal part of the cervix. These cells are called atypical; the pathology itself is included in the list of precancerous diseases.

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

Superficial, or functional - the epithelial cells of this layer die and periodically exfoliate, and new ones form in their place;

intermediate;

basal-prebasal - deep layer, which consists of prebasal and basal cells. It borders on the underlying tissues (vascular walls, nerve endings, muscle tissue). It is this layer that contains young cells necessary for epithelial renewal.

The cells of the basal layer have a round shape and a large round nucleus (single). As the cell matures, it moves into the intermediate and further into the functional layer, the epithelial cells are flattened, and their nuclei decrease in size. In the case of cervical dysplasia, a structural disorder occurs in the cell itself, which leads to its enlargement, loss of shape, formation of additional nuclei, while differentiation into layers disappears. If such modified cells are detected, one should speak of atypia.

Classification

Based on data on the thickness of the lesion in the epithelial layer and the spread of cell atypia to various layers, cervical dysplasia is divided into the following degrees:

mild dysplasia - the process extends to only 1/3 of the squamous stratified epithelium;

moderate dysplasia - cell atypia, which is present in the middle and lower third of the entire epithelium;

dysplasia III, or severe dysplasia - atypical changes are present in all layers of the epithelium, but have not yet spread to neighboring tissues (this degree of dysplasia is also called non-invasive (non-penetrating) cancer).

Causes

The main reason for the development of cervical dysplasia is infection of a woman with HPV (human papillomavirus). Oncogenic types are the most dangerous (67, 58, 52, 45, 33, 59, 35, 39, 31, 11, 6, and especially 16 and 18). The longer the human papillomavirus persists in the body, the higher the likelihood of atypia of cervical epithelial cells - dysplasia. It is known that in more than 95% of cases of diagnosis of cervical dysplasia, the human papillomavirus is also detected. However, HPV infection is not a mandatory factor that leads to dysplasia; additional predisposing factors are also required:

early sexual life;

weakened immunity (unfavorable living conditions, malnutrition, stress, taking certain medications, HIV infection);

sexual partners who suffer from cancer of the head of the penis;

passive or active smoking (the probability increases by 2 times);

taking oral contraceptives (using pills for 5 or more years increases the risk of developing pathology by 2 times);

lack of carotene, vitamin A, ascorbic acid;

parity (numerous births);

cervical injuries during gynecological procedures, artificial termination of pregnancy, during childbirth;

chronic gynecological pathology;

hormonal surges and disruptions (taking hormonal medications, menopause, pregnancy);

promiscuous sex life;

sexually transmitted infections (chlamydia and mycoplasma, fungi, gardnerella, cytomegalovirus, herpes simplex virus);

heredity (genetic predisposition to the occurrence of malignant tumors in the organs of the reproductive system);

first pregnancy and, accordingly, childbirth in a girl under 18 years of age.

Clinical picture

Most often, dysplasia occurs without symptoms, and in 10% of cases it is discovered by chance during a gynecological examination. There are no characteristic symptoms of the pathology; patients complain only of discomfort when a secondary infection (viruses, fungi, bacteria) occurs. In such cases, the patient notes an increase in vaginal discharge, which in some cases has an unpleasant odor, the presence of discomfort and itching, bloody or spotting discharge after using a tampon or sexual intercourse.

With severe pathology, painful sensations may appear in the lower abdomen. Since cervical dysplasia is quite often combined with infections of the reproductive system, chlamydia, gonorrhea, genital warts of the anus, vagina and vulva are quite often recorded.

Diagnostics

Considering the fact that cervical dysplasia does not have characteristic clinical signs, the diagnosis can be established based on a physical examination with laboratory tests and instrumental studies:

Examination of the cervix using a gynecological speculum.

With the help of a routine examination, it is very often possible to suspect a pathology, since there are no changes in the cervix that could be determined visually. However, if the dysplasia is severe or moderate in development, changes in the color of the mucous membrane (whitish or bright red), as well as the growth of the epithelium in the form of plaques and a shiny surface in the area around the external pharynx may be detected.

Colposcopy.

Colposcopy is recommended for all women annually, especially for patients who have chronic gynecological pathologies. The method involves examining the cervix using a special colposcope apparatus, which allows for 10x or more magnification. Extended colposcopy is an examination of the cervix with diagnostic tests (with diluted iodine and acetic acid). When the cervix is ​​lubricated with a vinegar solution, mucus coagulates and blood vessels constrict, which greatly facilitates inspection of the cervix. The following signs may indicate the presence of dysplasia:

the appearance of polygonal areas (delineation of the mucous membrane with lines directed in different directions, like a mosaic);

the appearance of punctuation (precision), gentle or rough;

the appearance of areas of aceto-white epithelium (leukoplakia).

After a test involving the treatment of the cervix with acetic acid, the uterus is stained with a solution of iodine and water, this is called the Schiller test. Atypia of the epithelial layer of the cervix can be suspected if areas unstained with iodine are detected. This indicates a lack of glycogen in the epithelial cells and, accordingly, the presence of pathology in the cervix. The Schiller test will be positive provided that the entire surface of the cervical epithelium has a uniform brown color.

Cytological examination of a smear.

Of significant importance for identifying pathologies of the cervix is ​​a study with a smear taken for cytology and oncopathology. A smear analysis by a cytologist is carried out for every woman in Russia annually and consists of scraping from the surface of the cervix (if a suspicious area is visually identified, then the scraping is taken from the most suspicious of them) or from the cervical canal (sometimes precancerous processes begin precisely in it, while the cervix and the vagina do not tolerate changes). The material is taken with a spatula or a Volkmann spoon from the surface of the cervix; scraping from the cervical canal is done with a brush or a Volkmann spoon. This is necessary in order to scrape off the epithelial cells (necessary for cytological examination), since only microflora with mucus from the cervical canal can get into the smear, and they are not very informative for analysis. After a cytological examination is performed, it is classified according to Papanicolaou:

first type – cytological analysis is normal;

the second type – there are inflammatory changes in the cells;

third type – in individual epithelial cells abnormalities of the nucleus and cytoplasm were detected;

fourth type - some cells have pronounced manifestations of malignancy (chromosomal rearrangements, cytoplasmic abnormalities, nuclei are irregularly shaped, large);

fifth type – cancerous (atypical) cells are detected.

In the presence of dysplasia of 1-2 degrees, a smear for cytological examination is classified as types 2 and 3, and in the presence of a severe degree, the smear corresponds to types 3 and 4.

Biopsy of the cervix with future curettage of the cervical canal.

Tissue sampling from the damaged area (biopsy) is performed only under the control of colposcopy (which is why this procedure is called targeted biopsy). Then a histological examination of the material is performed. Biopsy is one of the main methods for diagnosing this pathology, since it allows one to study the structure of cells and the architectonics of the epithelial layers (“depth” of atypia, relative position, their number).

After performing a biopsy and confirming the diagnosis of cervical dysplasia, the patient must undergo diagnostic curettage of the cervical canal in order not to miss a possible cancerous process.

Treatment

Treatment of pathology should be comprehensive and include the following points:

restoration of vaginal microbiocenosis;

normalization of immunological disorders;

carrying out anti-inflammatory therapy.

The management tactics for such patients depend on the extent of the process, whether there is a desire to become pregnant, the age of the patient and the area of ​​the lesion. If there is a moderate or mild degree of pathology in small areas of pathology in young women, treatment is not prescribed. Such patients should be registered at the dispensary, since there is a high chance of self-healing of the pathology and regression of the lesion in 70-90% of cases. However, if the patient has HPV, especially with long-persistent papilloma, etiotropic antiviral therapy (Panavir, Isoprinosine, Groprinosin, Acyclovir) should be prescribed systemically and locally, drugs to normalize the body’s protective properties (Viferon ", "Immunal", "Roncoleukin", "Polyoxidonium"). The affected area should be treated with light cauterizing substances (Solkovagin). After antiviral therapy, therapeutic measures should include eubiotics and probiotics (Lactobacterin, Bifidumbacterin, Bifikol) in the form of vaginal tampons in order to normalize its microflora.

Conservative therapy does not always have a positive effect. Indications for surgical treatment are:

unsatisfactory results of colposcopy and cytological smears when monitoring the patient for a year;

cervical cancer at the first stage;

third degree of dysplasia.

Surgical methods for treating cervical dysplasia include:

DTC, or diathermocoagulation.

This technique involves the destruction (destruction) of a pathological focus using high-frequency electric current, which is supplied through a loop (electrode) that is in contact with the neck. As a result, necrosis of atypical epithelial cells occurs, and a scab appears at the site of cauterization. In recent years, this method has lost its relevance, since its effectiveness is low (70%), and there is a significant risk of complications (long healing period, cicatricial deformation of the neck, pain, bleeding).

Cryodestruction.

This technique involves treating foci of pathology with cold (liquid nitrogen), as a result, atypical cells are destroyed and then rejected by the body. This method is most suitable for nulliparous women, but also has certain disadvantages: a high risk of inflammation at the site of cryodestruction and a long healing time.

Laser vaporization.

The technique consists of exposing the pathological area to laser beams (non-contact technique), while the pathologically altered cells lose fluid and are destroyed. Laser treatment is a fairly effective method, which has only two drawbacks: the high cost of the procedure and the high cost of equipment, which not every clinic can afford.

Treatment with radio waves (using the Surgitron apparatus).

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

Surgery

In certain cases, surgery on the cervix, knife conization or excision (resection of pathological foci within healthy tissue), or removal of the cervix is ​​required. Indications for such intervention are:

repeated treatment against the background of lack of effect from the use of destruction methods;

severe deformation of the cervix, regardless of what degree of pathology is present;

moderate and severe dysplasia, first degree cervical cancer, which is confirmed by biopsy;

spread of pathology along the cervical canal.

After surgical treatment

After the patient has undergone destruction of the pathological focus, the following should be done:

undergo a follow-up examination after 1.5 months;

avoid douching and not using tampons throughout the healing period;

sexual rest for 1-3 months;

Limit heavy lifting and physical activity for 1-2 months.

If pain occurs, you can use non-steroidal anti-inflammatory drugs (Ibuprofen, Nise) to relieve it. During the first 3-4 weeks after surgical therapy, vaginal leucorrhoea may be intense. With or without scent. If your body temperature rises above 38 degrees or if bleeding occurs, you should seek emergency medical help.

Complications

Cervical dysplasia can cause complications, which in most cases occur after surgical therapy:

transition to cervical cancer;

menstrual irregularities (hormonal imbalances);

infertility due to obstruction of the cervical canal (formation of stenosis) or in the presence of an ascending infection (chronic endometritis and salpingitis);

development of anomaly of labor forces, which is provoked by stenosis of the cervical canal and deformation of the cervix;

bleeding during the destruction of foci of pathology or after (occurs due to damage to blood vessels, rejection of the scab if the doctor’s instructions are not followed).

FAQ

Can dysplasia relapse and why?

Unfortunately, none of the methods of treating cervical dysplasia, including surgical treatment, provides a 100% guarantee of cure. Relapse of dysplasia occurs with inadequate treatment, or when antiviral therapy was not completed before destruction of the lesion. Cervical dysplasia recurs especially often with prolonged persistence of HPV. In addition, before performing surgical treatment, it is necessary to get rid of the human papilloma virus, sexually transmitted infections, and correct the hormonal state.

Can pregnancy be complicated after surgical treatment of dysplasia?

Complications during pregnancy and childbirth occur if the cervix is ​​cauterized. The technique leads to cicatricial deformation of the cervix, which causes difficulties during conception (due to the presence of cervical stenosis), as well as anomalies during childbirth (cervical rupture, discoordination of labor forces).

Is it possible to treat cervical dysplasia using folk remedies?

Absolutely not. Firstly, there are no traditional medicine methods to treat such a pathology. Secondly, any “folk” methods of treatment (douching, tampons with aloe juice or sea buckthorn oil) will not only not cure the pathology, but will also accelerate the degeneration of dysplasia to more severe degrees, since they will provoke the proliferation of atypical cells. The only useful traditional medicine is taking immunostimulating and vitamin teas, infusions, and decoctions. But only under the careful supervision of the attending physician and only at certain stages of therapy.

Are cervical erosion and dysplasia the same disease?

Cervical erosion is a background disease, the essence of which boils down to the proliferation of columnar epithelium that lines the endocervix of the vaginal part of the cervix, while normally it is covered with stratified epithelium. In other words, one type of epithelium is replaced by another. Dysplasia is a precancerous condition in which epithelial cells change their structure and, in the absence of adequate treatment, can develop into cancer.

Is dysplasia a contraindication for having sex?

No. This pathology does not prohibit sexual activity, however, in the presence of dysplasia, it is recommended to use barrier contraception in order not to infect the sexual partner with sexually transmitted infections and HPV. But if the pathology is severe, spotting may appear during sexual intercourse. It is also worth observing complete sexual rest after surgical treatment of pathology in order to prevent the development of complications and promote rapid healing.

Can dysplasia disappear without treatment?

In the presence of mild dysplasia, self-resolution of the process occurs in 90% of cases, with a moderate degree in 70%, however, if the presence of HPV is detected in the body, treatment is mandatory.

How does childbirth differ when dysplasia is detected during pregnancy?

If a moderate or mild degree of dysplasia has been established, the patient is allowed to spontaneously give birth naturally; surgical intervention is performed only if there are obstetric indications. Pregnancy and the condition of the fetus are not affected by either dysplasia itself or its course (self-healing is observed in 60-70% of cases in the presence of grade 2-3 dysplasia, and only 1% can develop minimally invasive cancer). Treatment of the pathology is postponed until the postpartum period, since all known methods of destruction negatively affect the fetus. However, if there is a need for conization of the cervix (for example, in the presence of severe dysplasia), it is performed during gestation followed by a suture on the cervix (prevention of premature birth), delivery is carried out depending on the situation (independently, or operatively).

Should you follow a diet if you have dysplasia?

One of the risk factors for dysplasia is poor or irrational nutrition and a lack of certain vitamins (vitamins C and E, folic acid, B vitamins). The diet should primarily consist of vegetables and greens, which are rich in B vitamins (beans, green peas, cabbage, soybeans, broccoli, parsley, dill, lettuce) and folic acid, ascorbic acid (sea buckthorn, currants, bell peppers, citrus fruits), vegetable oils (vitamin E).

Is it possible to sunbathe with dysplasia?

No. The presence of any precancerous processes in the body excludes prolonged exposure to the sun. Ultraviolet rays promote mutation of genes in cells, aggravating the course of the pathology. Therefore, visiting the solarium and sunbathing is prohibited.

Is it possible to do IVF with dysplasia?

This pathology is not an absolute contraindication to IVF (in vitro fertilization). However, the doctor must examine and, if necessary, treat the patient before moving on to IVF, since if HPV is present in the body, this can have a detrimental effect on the unborn child, or cause it to become infected during childbirth.

Is it possible to cure cervical dysplasia using photodynamic therapy, and what is it?

Photodynamic therapy is the most promising and high-tech method of treating dysplasia at the moment. But this method is effective only in the treatment of moderate and mild dysplasia. The technique involves exposing a laser with low beam energy and a specific wavelength to the affected area, previously treated with a photosensitizer gel. This gel absorbs laser radiation and triggers specific chemical reactions. The gel transmits a laser pulse to oxygen inside the cell, which foams and destroys the cell. The method has a number of significant advantages: absence of scars on the cervix, rapid healing, bloodlessness, painlessness.

An abnormal change in the epithelial layer of the cervix is ​​called uterine dysplasia. This pathology is very dangerous, as it is a precancerous condition and in advanced stages can develop into cancer.

With cervical dysplasia, you cannot do without the help of a doctor.

Causes of uterine dysplasia

The epithelium lining the cervical and cervical canal of the uterus has a heterogeneous structure, consisting of 3 types of tissue - epithelial, connective and muscle. Directly in the cervix of the reproductive organ there are 2 types of epithelium - cylindrical (lining the uterus and cervix) and flat (formed from several layers of cells). It is in the zone of transition of the cervical canal into the vagina that processes associated with pathological changes in cellular structures often appear.

Why does dysplasia happen? There are several reasons for this condition:

1. Infection with human papillomavirus (HPV).
2. Long-term use of hormonal contraceptives (over 5 years).
3. Onset of sexual activity in adolescence (13–15 years).
4. Inflammatory processes in the organs of the reproductive system of a chronic nature, sexually transmitted infections.
5. Injury to the cervix as a result of frequent childbirth or multiple abortions.
6. Decreased immunity due to inflammation, poor nutrition, bad habits, chronic stress and overwork.

The papilloma virus causes dysplasia or cancer of the cervix and genital organs.

The main reason Cervical dysplasia is HPV. Women at risk of contracting the virus include those who:

• lead a chaotic intimate life;
• abuse alcohol, smoke;
• are below the poverty line, uneducated, and have poor living conditions.

Provoking factors for dysplastic changes are often a genetic predisposition to cancer pathologies, a lack of vitamin A, C, erosive and adhesive processes in the cervical canal.

Symptoms of the disease

In the initial stages of its development, cervical dysplasia does not cause any discomfort in a woman. Exactly latent course often provokes a precancerous condition, and in advanced forms – oncology. Late signs of dysplastic changes include pain or cramping in the lower abdomen, and blood appears in the discharge.

Pain in the lower abdomen is one of the signs of the disease.

Pathological growth of the layers of the mucous membrane of the cervical canal is sometimes accompanied by abundant secretion from the vagina, whitish in color, without any foreign odor. In the case of concomitant diseases in the reproductive system, cervical dysplasia manifests itself:

• discomfort and pain during intimacy;
• a small amount of bleeding after sexual intercourse;
• aching pain in the lower abdomen that appears at regular intervals;
• burning and itching in the vagina;
• copious discharge with an odor or increased vaginal dryness.

In the vast majority of cases, dysplastic changes in the epithelium of the cervix do not manifest themselves for a long time. On average, 7–10 years pass from the onset of abnormal processes to oncology.

Classification of cervical dysplasia

According to ICD 10 (international classification of diseases), dysplasia is designated cervical intraepithelial neoplasia - CIN. According to the degree of damage to the cervical canal by abnormal CIN cells has 3 stages of development.

1. Weak or mild - CIN I (grade 1). Pathological processes have affected the lower part of the squamous epithelium. The affected area is no more than 1/3 of the adjacent layer to the basement membrane.
2. Moderate dysplasia – CIN II (grade 2). Abnormal cells penetrate into the lower layer of the epithelium and 2/3 into the middle layer. A third of the thickness of the deepest layer remains untouched.
3. Heavy stage – CIN III (grade 3 – non-invasive cancer). The entire thickness of the epithelial layer, except for blood vessels, nerves, and muscles, is subject to dysplastic changes.

Pathological changes in stages 1, 2, 3 of cervical dysplasia.

In advanced stages of the disease, the division of the epithelium into layers is erased. The photo shows what deformed cells look like - they become shapeless, several nuclei appear, or there is only one, but of an abnormal shape.

Diagnostics

A number of measures help to identify dysplastic processes in the cervix.

1. Study of the state of the epithelium using gynecological speculum. The purpose of the procedure is to identify visible abnormalities in the reproductive organ.
2. Examination of the cervical and cervical canal with a colposcope. Colposcopy allows you to examine the affected organ in detail and take material from the injured areas for analysis.
3. Cytology – PAP smear examination. Analysis of scrapings from all affected tissues for abnormal cells and the presence of HPV.
4. Histology is the study of material obtained through a biopsy of the cervix. Detects dysplasia and identifies its degree with high accuracy.
5. PRC methods. Study of biological material from the cervical canal for human papillomavirus, identification of oncogenic strains. The analysis allows not only to identify the cause of dysplasia, but also to select the most effective therapy.

Examination of the cervix with a colposcope is called colposcopy.

The results of instrumental and laboratory methods make it possible to accurately determine the diagnosis and choose the appropriate treatment regimen - conservative or surgical.

Treatment of dysplasia of various degrees

The method of treatment largely depends on the degree of the disease. For grade 1 dysplasia, a young woman is prescribed drug therapy. The mild form of the disease is characterized by small zones of pathologically changed tissues that are capable of independent regression. Therefore, doctors monitor the woman’s condition, conducting cytological studies every 3–4 months. If tests show the proliferation of abnormal cells 2 times in a row, surgery is prescribed.

Dysplasia of 2 and 3 degrees can only be treated surgically. The scale of excision depends on the advanced stage of the disease.

Medications

Drug correction of cervical dysplasia involves the use of several groups of drugs simultaneously.

Table “Groups of drugs for the correction of dysplastic changes”

The treatment regimen is selected for each patient individually, taking into account her age, severity of the disease and concomitant pathologies.

Drug treatment of cervical dysplasia should be comprehensive.

Other methods

To prevent this, surgical intervention is prescribed. Surgical treatment has a number of methods that allow the progressive disease to be stopped in time. To effectively remove affected areas, the most suitable option is selected, taking into account the focal spread of pathogenic cells.

Laser removal (vaporization)

The method of removing dysplastic changes in the epithelial layer of the uterus is carried out by exposing the affected tissue to infrared rays of high and low intensity - cauterization. The inside of abnormal cells evaporates as a result of laser influence, which leads to their death.

Using a laser helps to accurately determine the depth of the incision and remove only the affected areas. To prevent injury to healthy cells, the woman is given a short-term anesthesia to completely immobilize.

The method practically does not provoke scarring, has a short rehabilitation period, and does not cause discomfort to the patient.

Radio wave treatment

The operational method is based on the use of high frequency radio waves. With the help of the Surgitron apparatus, a detrimental effect on abnormal cells occurs. After the operation there are no scars left, the rehabilitation period is about 3 weeks.

With radio wave treatment it is important to exclude malignant processes in the reproductive organ, otherwise there is a risk of starting irreversible processes - the rapid progression of cancer.

Treatment with radio waves is allowed for nulliparous girls, as it does not affect reproductive function. The procedure is painless, patients recover quickly, and the risk of re-growth of dysplasia is minimal.

Cryodestruction

Pathological cells are exposed to liquid nitrogen, the temperature of which is -190 degrees. Overgrown tissues turn into ice and die. Dead cells are excised, and healthy epithelium grows in their place.

The procedure for cryodestruction of the cervix is ​​performed with a special apparatus - a cryodestructor.

The advantages of the method are the absence of scars, accessibility, and ease of operation.

Cryodestruction has a long rehabilitation period - up to 2 months, during which sexual contact and physical activity are not allowed.

The method is used more often for grade 2 CIN. Abnormal cells are removed using a special instrument with electrodes in the form of a loop. The affected areas are exposed to low voltage current. The procedure is done under local or general anesthesia in an outpatient setting.

Electric cauterization is a cheap method of surgical intervention, but it has disadvantages - rough scars that can provoke the development of endometriosis and problems with conception and childbirth. Not recommended for nulliparous girls.

Electric cauterization, or electrocoagulation, is a cheap and accessible method, but is fraught with consequences and complications.

Excision with a scalpel

Excision of focal lesions with a scalpel is used in the case of precancerous and cancerous conditions. Using a scalpel, cone-shaped incisions are made and all pathogenic tissue is excised. Healthy tissues are often injured and endocervical glands are destroyed. The operation is performed under general anesthesia.

Removing dysplastic areas with a scalpel helps prevent them from turning into cancer or stop the development of oncology at an early stage. Due to the large trauma to the cervical canal, the recovery period after surgery reaches several months, stenosis of the cervical canal and severe scarring are possible.

Cervical amputation

Surgery to remove the cervix is ​​used when other methods have failed, a precancerous condition or the first stages of cancer are detected. Surgery is performed using laparoscopy (incisions in the abdominal cavity) or through the vagina.

During the operation, the affected organ is completely excised - resection of the cervix. When the cervix is ​​amputated, the ovaries, the uterus itself and its tubes are not removed - menstrual function is preserved, but childbearing function is lost in most cases.

Rehabilitation after removal of the cervical canal lasts more than 1.5 months. During this time, a woman should not be sexually active, lift heavy objects, or overwork.

Cervical dysplasia during pregnancy

Mild and moderate cervical dysplasia during pregnancy has virtually no effect on the condition of the expectant mother and the development of the fetus. Therefore, colposcopic examinations are not recommended during pregnancy.

Colposcopy is not prescribed during pregnancy.

At this time, the cervical canal changes under the influence of hormonal changes. To obtain reliable tests, colposcopy is performed after childbirth (for grade 2 CIN) and a year later if there is suspicion of a mild form of the disease.

Severe dysplasia in pregnant women does not worsen their condition, but requires constant monitoring, as there is a high probability of premature birth.

During pregnancy, surgical treatment of dysplasia is not used, otherwise there is a risk of intrauterine fetal death, miscarriage, and stillbirth.

Forecast

With timely consultation with a doctor and adequate treatment, it is possible to:

• completely cure the mild stage of dysplasia;
• convert CIN 2 to 1 degree;
• detect a precancerous condition in time and prevent its transformation into oncology.

With timely treatment of DSM, the prognosis is favorable.

Possible consequences

Atypical epithelial cells of the mucous layer of the cervix do not disappear on their own. Without proper treatment, the disease worsens, dysplastic changes penetrate deeper and deeper, which ultimately leads to the development of cancer. The process of pathological transformations takes from 3 to 10 years and ends with oncology.

Scars are formed as a result of surgical intervention, as a result the tissue loses its elasticity, which in the future complicates the birth process.

After surgery, tissue immunity decreases, microflora decreases, and the risk of infections increases.

Cervical dysplasia is pathological changes in the epithelial layer of the cervix, which can lead to the formation of a malignant tumor. Analogue names: cervical intraepithelial neoplasm, cervical intraepithelial neoplasia - abbreviated CIN or CIN.

Dysplasia is a reversible transformation of cervical tissue into an abnormal state. The transition occurs gradually and unnoticed by the woman - this is the main danger of the pathology.

The epithelial layer of the cervical mucosa is a sequence of basal, intermediate and superficial layers. In the basal one, cell division occurs, in the intermediate one they mature, and the superficial one performs a barrier function. With dysplasia, atypical cells appear among normal cells: multinucleated, irregular in shape, size and abnormally located in relation to the basement membrane. As a result, thickening (hyperplasia) and cell proliferation (proliferation) develop in the epithelial layers. Because of this, normal cell renewal, maturation, aging and cell rejection are impossible. Up to a certain point, dysplasia is not dangerous. However, if neglected, it can lead to serious problems - the development of a cancerous tumor. Therefore, timely diagnosis and treatment of dysplasia prevents the development of cancer in the cervix.

Types of cervical dysplasia

After a cervical biopsy, a specialist will examine the histological structure of the material taken under a microscope. If pathology is present, abnormal epithelial cells with many small nucleoli or an excessively large shapeless nucleus with unclear boundaries will be detected. Next, it is necessary to determine the depth of the lesion and the condition of the cells in the corresponding layers.

Stages (severity) of cervical dysplasia indicate the depth of distribution of altered cells in the cervix. The calculation to determine the thickness of the lesion in the epithelial layer of the organ is carried out from the basement membrane:

• Stage I - the anomaly extends to 1/3 of the thickness of the epithelial layer. Only 10% of patients with the development of dysplasia at the first stage are predisposed to the transition of the pathology to moderate or severe dysplasia in the next 2-4 years. In most cases (90%), grade 1 neoplasia goes away on its own;
• Stage II - spread of atypical cells over 2/3 of the thickness. Precancerous condition. At this stage, active treatment is necessary; wait-and-see tactics are inappropriate: there is a high risk of pathology developing into severe dysplasia and cervical cancer;
• Stage III - more than 2/3. Doctors use the term carcinoma in situ, CIS (carcinoma in situ) or “carcinoma in situ,” a non-invasive cancer. This is the name of a malignant tumor in the first stages of development, which is characterized by an accumulation of histologically altered cells without germination into the underlying tissue.

The mild stage quite rarely turns into a moderate or severe stage: this is facilitated by an unhealthy lifestyle, weak immunity and lack of periodic examinations by a gynecologist. Time of transition to cancer in the deep tissues of the cervix:

• with a mild form and predisposition - approximately 5 years;
• with moderate form - 3 years;
• in case of severe dysplasia - 1 year.

Causes of cervical dysplasia

The main reason for the formation of atypical cells in the cervix is ​​oncogenic strains of the human papillomavirus (HPV16 and HPV18). The test for the detection of this virus is positive in 95-98% of cases of cervical dysplasia. Therefore, HPV is considered to be a trigger in the formation and development of the disease.

Papillomavirus is a sexually transmitted infectious disease that affects the skin. Its most common manifestations are papillomas and warts.

When diagnosing even a mild form of neoplasia, the doctor pays attention to the following factors:

• duration of existence of the virus in the body (more than a year - the basis for starting treatment);
• the general condition of the patient’s body and health;
• a woman’s lifestyle, the presence of bad habits and characteristics of sexual life.

Causes of dysplasia:

• endogenous (internal) - pathology is caused by hormonal disorders and/or reduced immunity;
• exogenous (external) - these include HPV, other viruses and infections.

At risk:

• women whose close relatives had cancer;
• patients who have been taking oral contraceptives for a long time - this leads to changes in hormonal levels;
• patients with chronic infectious and inflammatory processes in the organs of the reproductive system;
• women who began sexual activity early;
• women who have undergone many births or abortions (the cervix is ​​subjected to repeated trauma).

A state of immunodeficiency can lead to the development of cervical dysplasia and its transformation into a cancerous tumor. Therefore, the doctor needs to know about the frequency of inflammatory processes in the human body and the presence of chronic diseases. You also need to tell your doctor about your diet, stress, and treatment with drugs that reduce immunity.

For a long time it was believed that dysplasia is a “disease of the young”, and that girls aged 20-30 are susceptible to it. However, modern data show that cell transformation in the cervical epithelium can begin at any age, including after 70 years.

Symptoms

Dysplasia cannot be diagnosed by specific symptoms or signs except in rare cases (see below). Pathology can only be identified based on the results of an examination by a doctor and tests.

But you should seek additional examination from a specialist if:

• intermenstrual bleeding or blood after sexual intercourse;

Only the third degree of neoplasia has pronounced but not obvious symptoms:

• vaginal discharge is profuse and has a strong odor;
• periodic pressing or aching pain in the lower abdomen.

Signs of cervical dysplasia

Only a gynecologist can know that a woman’s cervix is ​​affected by dysplasia. To make a diagnosis, a specialist will be guided by laboratory test readings and external manifestations - epithelial damage is characterized by a specific change in cell color. The affected areas have a light, often yellowish tint.

In mild forms of CIN, the epithelium appears smooth and uniform in color;

With moderate dysplasia, tissues are distinguished by obvious changes in cell structure, which are determined visually and by palpation. This is why doctors often call dysplasia erosion, so that the patient can understand what is happening to her organ and what it looks like at the moment. But still, these pathologies have a significant difference: erosion - erosion of tissue, dysplasia - pathological transformation of tissue.

Severe CIN is characterized by damage to the mucous membrane of the vaginal cervix. In addition, in women over 40 years of age, pathological processes can also occur in the cervical canal.

Diagnostics

In order to prevent cervical dysplasia, it is necessary to periodically visit a gynecologist, undergo a screening examination and be tested for HPV. Once every three years, it is recommended to undergo a cytological analysis, especially if the woman is at risk. Also a preventive measure for girls is vaccination against the HPV virus: it can be carried out at the age of 11 to 26 years (but not younger than 9 years and older than 26).

Methods for diagnosing cervical dysplasia

Instrumental and clinical:

• examination in mirrors - visual diagnosis of color changes, smoothness of the surface of the cervix, spots or epithelial growth, etc.
• Colposcopy is an examination using an optical device that magnifies the image tenfold.

Laboratory techniques:

• PAP test or Papanicolaou smear - collection of cytological material for its subsequent examination under a microscope. Detection of abnormal cells requires the following examination - a biopsy.
• cervical biopsy - during examination with a colposcope, a small amount of material is pinched off from the affected area of ​​the cervix, which is further examined in the laboratory. A biopsy allows you to determine the thickness of the layer and the severity of tissue damage.
• HPV test is a scraping from the surface of the cervix.
• immunohistochemistry with tumor markers - an analysis performed in case of suspected oncology.

Which specialists should you contact?

Naturally, the first specialist in this field is a gynecologist - only he can diagnose dysplasia, conduct the necessary tests and examination. However, CIN is rarely caused by the papillomavirus alone. Therefore, it is necessary to undergo examination and, if necessary, treatment from the following doctors:

• endocrinologist - hormonal changes can significantly affect the development of abnormal processes in the genitals;
• infectious disease specialist - in addition to HPV, the body may contain other microorganisms that reduce the body’s resistance;
• immunologist - immunity can decrease due to a huge number of factors and various diseases.

Treatment

The degree and depth of the lesion, as well as the duration of the disease, determine the treatment tactics for cervical dysplasia.

Common features can be identified for all stages of CIN:

• There is currently no effective drug treatment;
• all known treatment methods are based on the removal or destruction of affected areas of tissue.

The treatment method is selected by the doctor based on:

• degree of cervical infection;
• patient's age;
• a woman's desire to have children.

Treatment methods depending on the degree of infection

Mild degree - wait-and-see tactics are used and general restorative drugs are used. At this stage, it is necessary to prevent infectious and inflammatory diseases, and also to regularly appear for examination by a gynecologist.

Medium degree - depends on the depth of the lesion and the speed of spread: in 70%, shallow penetration is cured on its own, however, if HPV is detected, treatment begins immediately.

Usually at this stage drug treatment is required:

• douching, antiviral suppositories and tampons;
• antiviral drugs;
• immunostimulating agents.

If conservative treatment is ineffective, as well as if the disease persists, surgical intervention is performed:

• cauterization of the cervix with solkovagin;
• laser vaporization or conization;
• removal of pathologically changed areas using radio waves (using the Surgitron device);
• cryodestruction (cauterization with liquid nitrogen).

Severe degree - treatment is carried out using the same methods as when diagnosing moderate dysplasia. At this stage of the disease, treatment must be carried out urgently. As a rule, conization of the cervix is ​​used as a surgical method.

Methods of surgical treatment

Knife conization

This is an old and almost a thing of the past method of removing tissue affected by dysplasia using a scalpel. In fact, it is not used due to the high efficiency and safety of other methods.

Cauterization with electric current

This method is also known as loop electroexcision, diathermocoagulation. The mechanism is to remove transformed tissue through electric current. The method is effective, but is not recommended for young and nulliparous women: after the procedure, scars remain on the cervix, which can lead to infertility or premature birth.

Cauterization is performed on an outpatient basis—there is no need to go to the hospital. The procedure is painless, since before the operation the doctor will administer an anesthetic injection.

Laser removal

Laser radiation is safer than using electric current because it does not leave scar deformities on the cervix. There are laser vaporization and laser conization of the cervix.

Laser vaporization means vaporizing infected areas without removing healthy tissue. The procedure is painless and safe for young nulliparous women planning to have children. The operation takes about half an hour and is performed on an outpatient basis.

Laser conization is a method of cutting off affected tissue with a laser beam. This method is also used to conduct a histological examination of cells affected by dysplasia. The procedure is performed under general anesthesia, as it requires precision in targeting the beam, otherwise healthy areas of the cervix may be damaged.

Radio wave method

One of the most popular and accessible ways to get rid of dysplasia, recommended for young and nulliparous patients, it is considered a safe and effective method. In this case, the Surgitron device is used.

Cryodestruction

Destruction of foci of dysplasia by freezing them with liquid nitrogen. The method is safe because it does not affect healthy areas of the organ. The procedure is performed on an outpatient basis and does not require painkillers. After cryodestruction, the patient may experience watery, transparent discharge of a yellowish tint.

To exclude relapse after treatment, patients need regular examination by a gynecologist and undergo a preventive examination (cytology smear, HPV tests, colposcopy).

Treatment of dysplasia during pregnancy

Cervical dysplasia does not adversely affect conception, gestation or fetal development. Therefore, it is recommended to postpone surgical intervention until the postpartum period.

You also need to remember the risk of premature birth in women who have undergone treatment for dysplasia through cervical conization.

Prevention of disease

To reduce the risk of developing pathology, as well as to exclude relapses of dysplasia, you must follow simple rules:

• compliance with the diet and inclusion of all necessary vitamins and microelements in the diet;
• timely treatment of inflammatory processes in the female genital area;
• rejection of bad habits;
• use of barrier methods of contraception with frequent changes of sexual partners
• regular examination by a gynecologist.