What is cervical dysplasia
Dysplasia is a reversible transformation of cervical tissue into an abnormal state. The transition occurs gradually and imperceptibly for a woman - this is the main danger of pathology.
The epithelial layer of the cervical mucosa is a sequence of basal, intermediate and superficial layers. In the basal cell division occurs, in the intermediate they mature, and the superficial one performs a barrier function. With dysplasia, atypical cells appear among normal cells: multinuclear, irregular in shape, size, and abnormally located with respect to the basement membrane. As a result, thickening (hyperplasia) and proliferation of cells (proliferation) in the layers of the epithelium develop. Because of this, normal renewal, maturation, aging and rejection of cells is impossible. Until a certain point, dysplasia is not dangerous. However, in a neglected state, 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 biopsy of the cervix, a specialist under a microscope will examine the histological structure of the material taken. In the presence of pathology, abnormal epithelial cells with many small nucleoli or an excessively large shapeless nucleus with fuzzy borders will be detected. Next, it is necessary to determine the degree of depth of the lesion and the state of the cells on the corresponding layers.
Stage (severity) of cervical dysplasia means the depth of distribution of altered cells in the cervix. The account for determining the thickness of the lesion of the epithelial layer of the organ is 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 in 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%), first-degree neoplasia resolves on its own;
Stage II - the 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: the risk of pathology transition to severe dysplasia and cervical cancer is high;
Stage III - more than 2/3. Doctors use in this case the definition of carcinoma in situ, CIS (carcinoma in situ) or "cancer in situ", non-invasive cancer. This is the name of a malignant tumor in the first stages of development, which is characterized by the accumulation of histologically altered cells without germination in the underlying tissue.
The mild stage rarely goes into a moderate or severe stage: this is facilitated by an improper lifestyle, poor immunity and the absence of periodic examinations by a gynecologist. Transition time to cancer in the deep tissue of the cervix:
with a mild form and predisposition - about 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 the oncogenic strains of the human papillomavirus (HPV16 and HPV18). Analysis for the detection of this virus is positive in 95-98% of cases of cervical dysplasia. Therefore, HPV is considered to be the trigger in the formation and development of the disease.
Papillomavirus is a sexually transmitted infection that affects the skin. Its most frequent manifestation: papillomas and warts.
When diagnosing even a mild form of neoplasia, the doctor draws attention to the following factors:
the duration of the virus in the body (more than a year - the basis for starting treatment);
general condition of the patient’s body and health;
a woman’s lifestyle, bad habits and sexual characteristics.
Causes of dysplasia:
endogenous (internal) - the 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 the hormonal background;
patients with chronic infectious and inflammatory processes in the organs of the reproductive system;
women who started sex early;
women who have had many births or abortions (the cervix is subjected to repeated trauma).
The 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, the presence of chronic diseases. You also need to tell the treating doctor about the nature of nutrition, stress, treatment with drugs that reduce immunity.
For a long time it was believed that dysplasia is a "disease of the young", that girls aged 20-30 are exposed to it. However, current 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). It is possible to identify pathology only by the results of a medical examination and tests.
But it is worthwhile to seek an additional examination from a specialist if there are places to be:
atypical vaginal discharge;
intermenstrual bleeding or blood after intercourse;
pain in the lower abdomen.
Severe, but not obvious symptoms, are only the third degree of neoplasia:
pain during intercourse and after;
itching, burning and irritation on the external genitalia;
vaginal discharge is plentiful and has a pungent odor;
periodic pressing or aching pains in the lower abdomen.
Signs of cervical dysplasia
Only a gynecologist can find out that a woman’s cervix is affected by dysplasia. To make a diagnosis, the specialist will be guided by the indications of laboratory tests and external manifestations - damage to the epithelium is characterized by a specific change in the color of the cells. Affected areas are light, often yellowish.
With a mild form of CIN, the epithelium looks smooth, uniform in color;
With moderate dysplasia, the tissues differ in obvious changes in the structure of cells, which are determined visually and by palpation. That is why doctors often call dysplasia erosion, so that the patient can understand what is happening to her body and what it looks like at the moment. But nevertheless, these pathologies have a significant difference: erosion - erosion of tissues, dysplasia - pathological transformation of tissue.
Severe CIN is characterized by damage to the mucous membrane of the vaginal cervix. In addition, in women older than 40 years, pathological processes can take place in the cervical canal.
Diagnostics
In order to prevent cervical dysplasia, you must periodically see a gynecologist, undergo a screening examination and take HPV tests. Every three years, it is recommended to undergo a cytological analysis, especially if the woman is at risk. Also, a vaccination against HPV virus is a preventive measure for girls: 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 the diagnosis of cervical dysplasia
Instrumental and clinical:
examination in the mirrors - visual diagnosis of color changes, smoothness of the surface of the cervix, spots or growth of the epithelium, etc.
colposcopy - examination with an optical device that magnifies the image tens of times.
Laboratory Techniques:
PAP test or Pap test - collection of cytological material for subsequent examination under a microscope. Identification of abnormal cells requires the following examination - biopsy.
cervical biopsy - when examined by colposcope, a little material is plucked from the affected area of the cervix, which is then examined in the laboratory. A biopsy can determine the thickness of the layer and the severity of tissue damage.
HPV analysis - is a scraping from the surface of the cervix.
immunohistochemistry with tumor markers - analysis performed in case of suspected oncology.
Which specialists need to be contacted
Naturally, the first specialist in this field is a gynecologist - only he can diagnose dysplasia, conduct the necessary tests and examinations. However, CIN is rarely caused by the papilloma virus alone. Therefore, it is necessary to undergo examination and, if necessary, treatment at the following doctors:
endocrinologist - hormonal changes can significantly affect the development of abnormal processes in the genitals;
infectious disease specialist - in addition to HPV, other microorganisms can be in the body that reduce the body's resistance;
immunologist - immunity can be reduced 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 course of the disease, determine the treatment strategy for cervical dysplasia.
General features for all stages of CIN can be distinguished:
effective drug treatment currently does not exist;
all known treatment methods are based on the removal or destruction of the affected areas of tissue.
The method of treatment is chosen by the doctor based on:
degree of infection of the cervix;
patient age;
the desire of a woman to have children.
Methods of treatment depending on the degree of infection
Light degree - expectant tactics are used and general strengthening drugs are used. At this stage, it is required to prevent infectious and inflammatory diseases, as well as regularly appear at the examination by a gynecologist.
The average degree - depends on the depth of the lesion and the speed of spread: in 70%, shallow penetration can be cured on its own, however, if HPV is detected, treatment begins immediately.
Usually, medication is required at this stage:
douching, antiviral suppositories and tampons;
antiviral drugs;
immunostimulating agents.
With the ineffectiveness of conservative treatment, as well as with the persistent course of the disease, surgery is performed:
cauterization of the cervix with solkovagin;
laser vaporization or conization;
removal of pathologically altered areas by radio waves (using the Surgitron apparatus);
cryodestruction (cauterization with liquid nitrogen).
Severe - treatment is carried out by the same methods as in the diagnosis of moderate dysplasia. With this degree of the disease, treatment must be carried out urgently. Of surgical methods, conization of the cervix is usually used.
Surgical methods
Knife conization
This is an old and already almost gone method of removing tissues affected by dysplasia using a scalpel. Actually not used due to the high efficiency and safety of other methods.
Electric shock
This method is also known as loop electroexcision, diathermocoagulation. The mechanism is the removal of transformed tissues through electric current. The method is effective, but 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 carried out on an outpatient basis - you do not need to go to the hospital. The procedure is painless, because before the start of the operation, the doctor will administer an anesthetic injection.
Laser removal
Laser radiation is safer than using electric current, because it does not leave cicatricial deformities on the cervix. Distinguish between laser vaporization and laser conization of the cervix.
Laser vaporization means evaporation of infected areas without removing healthy tissue. The procedure is painless and safe for young nulliparous women who plan 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 because it requires precision in beam guidance, otherwise healthy areas of the cervix may be affected.
Radio wave method
One of the most popular and affordable way to get rid of dysplasia, recommended for young and nulliparous patients, is considered a safe and effective method. In this case, the Surgitron apparatus 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 body. The procedure is performed on an outpatient basis and does not require the introduction of painkillers. After cryodestruction, the patient may begin to watery transparent discharge of a yellowish tint.
To exclude relapse after treatment, patients need a regular examination by a gynecologist and undergo a preventive examination (smear for cytology, HPV tests, colposcopy).
Pregnancy Dysplasia
Cervical dysplasia does not adversely affect conception, gestation or development of the fetus. Therefore, surgical intervention is recommended to be postponed until the postpartum period.
You also need to remember the risk of premature birth in women who have been treated with dysplasia through conization of the cervix.
Disease prevention
To reduce the risk of developing pathology, as well as to exclude recurrence of dysplasia, it is necessary to follow simple rules:
compliance with the diet and the inclusion of all necessary vitamins and minerals in the diet;
timely treatment of inflammatory processes of the female genital area;
rejection of bad habits;
the use of barrier methods of contraception with frequent changes in sexual partners
regular examination by a gynecologist.