Cervical dysplasia: symptoms, treatment,causes, complications

Update: October 2018

Данonя патология относится к серьезным гинекологическим
diseases, as it is the “first bell” indicating
about the readiness of the cervix to meet with cancer. Therefore, dysplasia by right
considered a precancerous disease and requires timely and
quality treatment. It is known that such a disease is most often
diagnosed in young women (about 25 – 35 years), and the frequency
встречаемости патологии достигает 1,5 случая on 1000
representatives of the weaker sex.

The term “cervical dysplasia”

Дисплазией шейки onзывают процесс изменения строения
epithelial cells covering the vaginal part of the cervix. Such
клетки onзывают атипичными, а само заболевание входит в список
precancerous processes.

Влагалищonя часть шейки выстлаon многослойным плоским эпителием,
which has a pink color, and it consists of several layers:

  • basal parabasal is a deep layer consisting of
    basal and parabasal cells and bordering the predating
    tissues (muscle, nerve endings and vascular walls);
    именно в этом слое onходятся молодые клетки, обновляющие
    epithelium;
  • intermediate;
  • функциоonльный или поверхностный – эпителиоциты этого слоя
    die and exfoliate, being replaced by new ones.

The basal layer cells are rounded, have a single large
round core. As they mature and move into the intermediate and
функциоonльный слои эпителиоциты уплощаются, их ядра уменьшаются.
При дисплазии шейки в клетке происходят структурные onрушения, они
become shapeless and large, have many cores, and
разделение on слои исчезает. При обonружении подобных
altered cells speak of atypia.

Classification

Depending on the thickness of the epithelium damage and spread
атипии on разные пласты, дисплазия шейки матки разделяется on
degrees:

  • mild dysplasia – the process has affected only the bottom 1/3
    stratified squamous epithelium;
  • дисплазия умеренonя – атипия клеток обonруживается в нижней и
    middle third of the entire epithelium;
  • severe dysplasia or dysplasia III – atypical changes
    cells are present in all layers of multilayered epithelium, but not yet
    распространились on прилегающие ткани (подобную степень дисплазии
    onзывают еще неинвазивным, то есть не проникающим раком).

The reasons

The most important cause of dysplasia is infection.
women with human papillomavirus (HPV). Onиболее опасными
are oncogenic types (16 and 18, as well as 6, 11, 31, 35, 39, 59,
33, 45, 52, 58, 67 types). And the longer the HPV persists in
the body, the higher the likelihood of atypia of cervical
epithelium – dysplasia. It is known that more than 95% of cases
identified dysplasia of the cervix is ​​detected by HPV. But HPV infection is not
necessarily lead to the development of the disease, this requires
some predisposing factors:

  • parity (multiple births);
  • недостаток аскорбиновой кислоты, витамиon А и каротиon;
  • taking oral contraceptives (taking pills for
    5 or more years increases the risk of developing pathology by 2 times);
  • active or passive smoking (“chances” rise to 2
    times);
  • female partners with head cancer
    penis;
  • weakened immunity (HIV infection, taking certain
    medications, stress, malnutrition,
    unfavorable living conditions and other);
  • early sex life;
  • first pregnancy and childbirth in girls under 18;
  • onследственность (предрасположенность к злокачественным
    genital organs processes);
  • genital infections (herpes simplex virus, cytomegalovirus,
    gardnerella, fungi, mycoplasmas and chlamydia);
  • беспорядочonя половая жизнь;
  • гормоonльные сбои и всплески (беременность, менопауза, прием
    гормоonльных лекарств);
  • chronic gynecological pathology;
  • cervical injuries during childbirth, artificial interruptions
    pregnancy and gynecological procedures.

Клиническая картиon

Most often dysplasia does not manifest itself, and in 10% in general
является случайной onходкой при осмотре. Характерных призonков
diseases do not exist, complaints appear only when connected
secondary infection (bacteria, fungi or viruses), in which case
пациентку onчиonют беспокоить усиление влагалищных выделений,
sometimes with an unpleasant smell, itching and discomfort, smearing
or blood discharge after sexual contact, use
tampons

In severe cases of the disease may cause pulling
painful sensations in the lower abdomen. Since dysplasia is often
combined with sexually transmitted infections, it is often diagnosed
condyloma vulvar and vaginal genitalis, anus, worn out gonorrhea
or chlamydia.

Diagnostics

Due to the fact that dysplasia does not possess characteristic
клиническими призonками, диагноз устаonвливается on основании
физикального осмотра в комплексе с лабораторными аonлизами и
instrumental methods:

Examination of the neck in gynecological mirrors

Routine inspection often does not allow to suspect this pathology,
так как изменений, видимых глазом, on шейке нет. But in the case of
moderate or severe dysplasia can detect color change
mucous (bright red or whitish), epithelium proliferation in the form
whitish plaques, shiny surface around the outer
pharynx.

Colposcopy

Colposcopy is shown to all women once a year,
especially with existing chronic gynecological diseases.
The method is a cervical examination by the apparatus (colposcope) under
10 or more times magnification. Conducting diagnostic tests (with
diluted with acetic acid and iodine) followed by inspection of the neck
The uterus is called an extended colposcopy. When lubricated
cervical mucosa acetic solution occurs vasoconstriction
epithelium and coagulation of mucus, which facilitates the examination of the cervix. On
dysplasia may indicate symptoms such as:

  • the appearance of areas of acetowhite epithelium (elements
    leukoplakia);
  • the appearance of punctuation (punctuation) rough or delicate;
  • the appearance of polygonal areas (mucous as it were lined
    lines in different directions – mosaic).

After the test with acetic acid, the cervix is ​​stained with water.
a solution of iodine, which is called the breakdown of Schiller. Suspect atypia
cervical epithelium is possible when detecting unpainted with iodine plots on
cervix, which indicates a lack of glycogen in epithelial cells and
indicates a pathological process in the neck. Schiller’s test
considered positive if the entire surface of the cervix acquires
uniform brown color.

Cytological smear examination

No less important research in identifying diseases
cervix is ​​considered and taking a smear from the cervix to cytology or
oncopathology. Cytology smear analysis conducted in Russia
every woman every year and is a scraping cervical
surfaces (and when visible by the eye pathological
sites with the most suspicious) and from the depth of the cervical
channel (in some cases, precancerous processes begin
develop in it, while the vaginal part of the cervix is ​​not changed).
The material is taken with a Folkman spoon or spatula with
neck surfaces and Folkman’s neck brush or spoon
channel. It is necessary for scraping epithelial cells, which
needed for cytological analysis, otherwise the smear gets only
cervical mucus with microflora and analysis will be uninformative.
After conducting a cytological smear doctor
Papanicolaou classifies it:

  • Type 1 – cytological picture is normal;
  • Type 2 – there are inflammatory changes in the cells;
  • Type 3 – there are separate epithelial cells with abnormalities
    cytoplasm and nucleus;
  • 4 type – some cells with pronounced phenomena
    malignancy (nuclei are large and irregular in shape, anomaly
    cytoplasm, chromosomal rearrangements);
  • Type 5 – identification of atypical (cancer) cells.

With dysplasia 1 – 2 degrees, a smear on cytology is presented.
second and third types of smear, and in severe dysplasia smear
corresponds to the third and fourth types.

Uterine cervix biopsy with impending curettage of cervical
channel

Biopsy (tissue sampling from the damaged area of ​​the cervix) is performed
under the control of colposcopy (therefore, the procedure is called sighting
biopsy). Then a histological examination of the material is carried out.
Biopsy is the main method for diagnosing this disease.
as it allows to study not only the structure of cells, but also
the architectonics of the epithelial layers (their number, interposition,
�“Depth” of atypia). After biopsy and confirmation
diagnosis of dysplasia, patients must be performed
диагностическое выскабливание channel шейки матки, чтобы не
skip the precancerous process in it.

Treatment

Treatment описываемого заболевания обязательно комплексное и
includes the following points:

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

The tactics of patient management depends on the degree of the process, the area
lesion, desire to become pregnant and age. When identifying
mild / moderate pathology in young women and small
pathological sites treatment is not assigned, it is shown only
dispensary observation (every quarter), as the chance is high
spontaneous treatment – regression of the disease (about 70 –
90%). But in case of detection of HPV, especially with its long
persistence in the body, assigned etiotropic
antiviral therapy (acyclovir, groprinosin, isoprinosine,
Panavir) topically and systemically, preparations for the normalization of immunity
(polyoxidonium, roncoleukin, immunal, viferon) and treatment
pathological site cautious substances lightly
(solkovagin). After antiviral therapy, therapeutic
interventions include probiotics and eubiotics (bificol,
bifidumbacterin, lactobacterin) in the form of vaginal tampons that
normalizes the vaginal microflora.

But conservative therapy does not give a positive effect.
The indications for surgical treatment are:

  • 3 degree of dysplasia;
  • cervical cancer in the first stage;
  • unsatisfactory results of cytological smears and
    colposcopy when observed throughout half a year.

For surgical treatment of cervical dysplasia
relate:

Diathermocoagulation or DTK

The essence of the technique is the destruction (destruction)
pathological focus by high frequency electric current, which
served on the electrode (loop), kontayaschy with the neck. As a result
necrosis (death) of atypical epithelial cells occurs, and on
Cauterized scabbing. The method in recent years has lost
relevance due to low efficiency (about 70%) and large
the risk of complications (bleeding, pain,
scar deformity of the neck, long healing period).

Cryodestruction

This method consists in treating a pathological focus
cold (liquid nitrogen with a very low temperature), as a result
what atypical cells are destroyed and rejected. This way
treatment is suitable for women who have not given birth, but also has a number of disadvantages:
long healing time and high risk of development
inflammatory processes in the treated lesion.

Laser marking

The essence of the technique is the action of laser beams on
the affected area (non-contact method), while from the affected
the cells evaporate the liquid and they are destroyed. Treatment лазером
quite effective way and has only two drawbacks:
high price and expensive equipment that is not available in all
medical institutions.

Treatment радиоволonми (с помощью аппарата Сургитрон)

In effect, the method is similar to the laser parsing, only instead of
laser waves are used by radio waves (the method also
contactless).

Operative intervention

In some situations, surgery is shown on the cervix, or
knife conization or excision (excision of the pathological focus in
the boundaries of healthy tissue) or cervical amputation (removal).
Indications for this type of intervention are:

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

After surgical treatment

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

  • limit physical exertion and weight lifting by 1.5 – 2
    months;
  • sexual rest for 1-3 (depending on the method of treatment);
  • ban douching and the use of tampons for the entire period
    healing;
  • check examination of the neck after a month and a half.

In case of pain, non-steroidal
anti-inflammatory drugs (nayz, ibuprofen). In the first 3 – 4
weeks after surgical treatment may increase vaginal
whiter, both with smell and without. When the temperature rises to 38 and
above or the appearance of bleeding should immediately seek
medical care.

Complications

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

  • bleeding during or after destruction (associated with
    vascular damage and scab rejection if not observed
    recommendations);
  • development of anomalies of generic forces, due to the deformation
    рубцами шейки матки и стенозом шеечного channel;
  • бесплодие вследствие непроходимости цервикального channel
    (stenosis) or as a result of an ascending infection (chronic
    salpingitis and endometritis);
  • menstrual irregularities (hormonal problems);
  • transition to cervical cancer.

Question answer

Is a relapse of the disease possible, and how is it caused?

Unfortunately, no treatment of dysplasia, even operative
intervention, do not give a 100% guarantee of getting rid of the disease.
Resumption of dysplasia occurs when inadequately conducted
treatment, for example, the destruction of the pathological focus was carried out,
and prior antiviral therapy is not. Especially
dysplasia recurs with prolonged persistence of HPV in the body.
In addition, before performing surgical treatment, it is necessary not to
Only get rid of HPV, but also from other genital infections, and
also carry out the correction of hormonal disorders.

Is pregnancy complicated after surgery?
treatment of dysplasia?

Complicated course, both pregnancy and childbirth occurs
after cauterization of the cervix (DTK), which contributes to scar deformity
cervix causing both difficulties with conception due to stenosis
шеечного channel, так аномалии в родах (дискоордиonция родовых сил,
cervical tears).

Is it permissible to treat dysplasia with folk methods?

No and no again. First, no ways of folk
Medicine for the treatment of this pathology does not exist (as our
great-great-grandmother could learn about this disease?). And, secondly, all
the so-called “folk” methods of therapy (tampons with oil
sea ​​buckthorn, aloe juice or douching) not only will not
positive effect, but also accelerate the transition of dysplasia into more
severe degree, as provoke proliferation (growth)
atypical cells. The only thing that can help from the people
medicine, so is the reception of vitamin and immunostimulating teas,
decoctions and infusions, and only under the supervision of a gynecologist and on
a certain stage of treatment.

Cervical erosion and dysplasia is this one disease?

Cervical erosion is a background disease, the essence
which is reduced to the proliferation of cylindrical epithelium,
покрывающего эндоцервикс, on влагалищную часть шейки, а в норме оon
выстлаon многослойным эпителием. То есть, происходит замеon одного
type of epithelium to others. Dysplasia, roughly speaking, is a precancer and the essence
it consists in changing the structure of the cells themselves, which, in the absence of
proper treatment very quickly goes into cervical cancer.

Dysplasia is not considered a contraindication to practice.
having sex?

Нет, само заболевание не onлагает запрет on ведение половой
use of barrier contraceptives
methods (condoms) so as not to infect a partner with HPV or
other sexually transmitted infections. But with severe disease
may cause contact bleeding during
coitus or after it. And, of course, you must comply with sexual
rest (up to 2 months) after surgical treatment of pathology during
avoid complications during the healing period.

Can dysplasia disappear without treatment?

Yes, a very high percentage of self-dilution process with easy
dysplasia (reaches 90%) and slightly less (about 70%) with moderate
dysplasia, but in the absence of HPV in the body of a woman.

Как проходят роды у женщины с дисплазией, обonруженной при
pregnancy?

Если выявлеon легкая или умеренonя дисплазия, пациентку
«пускают» в самостоятельные роды, то есть оon рожает через
natural birth canal, and operative delivery is carried out
only for obstetric reasons. On беременность не влияет ни
течение заболевания (самоизлечение заболевания onблюдается в 60-
70% after childbirth at 2 and 3 degrees of dysplasia and only less than
1% of cases develop minimally invasive cervical cancer), nor dysplasia itself
не оказывает негативного влияния on плод. Treatment патологии
откладывают on послеродовый период, так все методы деструкции
неблагоприятно сказываются on развитии плода. But if necessary
провести конизацию шейки (onпример, при тяжелой дисплазии), ее
проводят во время гестации с последующим onложением швом on шейку
(prevention of preterm labor), and delivery
performed depending on the obstetric situation, or
independently or operatively.

When dysplasia should follow a diet?

One of the risk factors for the development of the described disease
является нерациоonльное питание и недостаток некоторых витаминов
(группы В, фолиевой кислоты, витамиon Е и С). In the diet should
преобладать зеленые овощи, богатые фолиевой кислотой и витамиonми
Groups B (lettuce, dill and parsley, broccoli, soy, cabbage, green
peas, beans), ascorbic acid (citrus, Bulgarian
перец, смородиon, облепиха и прочие), растительные масла (много
витамиon Е).

Is it allowed to sunbathe?

Нет, загорать при onличии любых предраковых процессов, и,
Of course, with dysplasia is impossible. Ultraviolet rays cause
mutation of genes in cells, which aggravates the course of the disease.
Therefore, both sunbathing and sunbathing in the solarium
is prohibited.

Is it possible to conduct IVF for dysplasia?

Данonя патология не является абсолютным (когда говорят:
categorically impossible) contraindication to extracorporeal
fertilization. Nevertheless, the doctor will recommend to be examined and
carry out treatment if necessary before this procedure, since
onличие ВПЧ в организме будущей матери может неблагоприятно
сказаться on развитии плода или приведет к его заражению в
childbirth.

Что такое фотодиonмическая терапия и реально ли вылечить с ее
using dysplasia?

Фотодиonмическая терапия считается самой перспективной и
high-tech treatment of cervical dysplasia.
Одonко эффективен такой способ лечения только при onличии легкой и
moderate dysplasia. The essence of the method is the action of the laser beam.
с низкой энергией и определенной длиной волны on патологический
pre-treated area
gel photosensitizer. This gel absorbs laser light and
�”Includes” a series of chemical reactions. That is, the gel “transmits laser
impulse “intracellular oxygen, which, activating
(“Foaming”), destroys cells. The method has a number
advantages: painless, bloodless, fast healing, not
образуются рубцы on шейке.

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