Cervical dysplasia refers to precancerous diseases and represents changes in the structure of cells of the mucous membrane of the cervix uteri, which are expressed in thickening, proliferation, violation of the “specialization” of cells, as well as in maturation and rejection of the epithelium.
Unlike erosion of the cervix, dysplasia captures not only the superficial layers of the epithelium, but also deep.
Most often, women of childbearing age, from 25 to 35 years old, suffer from cervical dysplasia.
Depending on the level of damage to the mucous membrane, cervical dysplasia has three degrees:
- the first (light) degree – 1/3 of the epithelium is involved in the process;
- second (medium) degree – up to 2/3 of the epithelium is affected;
- the third (heavy) – the whole layer is pathologically changed, the cells of the intermediate and deep layers have an atypical structure.
The main cause of cervical dysplasia is the long-term existence in the mucosa of human papillomavirus (oncotypes of HPV-16 and HPV-18).
Without timely and adequate treatment after 1-1.5 years of existence in the epithelium of the cervical mucosa, the virus causes changes in its cells, as a result of which dysplasia develops.
In addition, predisposing factors play an important role in the development of the disease:
- early onset of sexual activity (up to 16 years);
- parity (multiple births);
- abortions and curettage of the uterus;
- smoking (increases the risk of the disease 4 times);
- sexually transmitted infections ( gonorrhea,chlamydia and others);
- cancer of the head of the penis at a partner;
- lack of vitamins A, C and micronutrients in the diet;
- heredity (genetic predisposition to cancer);
- adverse social conditions;
- cervical background processes (erosion, leukoplakia, ectropion other);
- hormonal changes (pregnancy, premenopause, hormonal birth control pills);
- immunodeficiency (chronic stress, treatment with antibiotics and other drugs, HIV infection).
As a rule, mild and moderate dysplasia does not manifest itself clinically. Approximately every tenth woman’s disease is hidden.
Symptoms of the pathological process are manifested in severe dysplasia or in the accession of a secondary infection ( colpitis, cervicitis ).
Signs of inflammation are characteristic:
- itching and burning of the vulva,
- pain during intercourse,
- copious discharge from the genital tract with an unpleasant odor.
In addition, there are contact bleeding (after intimacy, gynecological examination, douching). With severe cervical dysplasia, aching pain in the lower abdomen is possible.
Without treatment, the process progresses and, over time, a mild dysplasia flows into a severe stage and then into squamous cell carcinoma.
Examination for cervical dysplasia includes a number of instrumental and laboratory studies that make it possible to confirm or deny the diagnosis. By visual examination of the cervix in the mirror often, there are no visible changes.
The main methods of examination:
- Colposcopy – This is an examination of the cervix with a special device (colposcope) under magnification of 10 or more times. Colposcopy is an absolutely safe and painless procedure.
- Cytological smear examination is performed annually for prophylactic purposes in all women and allows identification of atypical epithelial cells and markers of human papillomavirus infection.
- Target biopsy – a piece of tissue is excised from the most suspicious part of the cervix under the control of colposcopy for further histological examination. Histological examination of the most reliable method of diagnosis and in 100% of cases confirms the diagnosis.
- The PCR method (polymerase chain reaction) is the most reliable method for determining HPV in any body fluid (in blood, urine, mucus).
The tactics of the doctor when choosing a method of treatment depends on the age of the patient, the size of the pathological focus, the presence of concomitant diseases, the degree of dysplasia.
In some cases, treatment of the disease is not carried out:
- age 20 years and under;
- point lesions of the cervical mucosa;
- dysplasia has not spread to the cervical canal;
- absence of human papillomavirus infection.
When HPV is detected, antiviral therapy is pre-prescribed, followed by colposcopy (often after treatment, dysplasia disappears or becomes a milder degree).
In this case, the observation and delivery of smears for cytology every 3-4 months is shown.
Grade 1-2 dysplasia is treated by a local gynecologist, and a gynecologist-oncologist supervises severe dysplasia.
Surgical treatment of dysplasia
Surgical treatment of dysplasia is carried out in the first phase of the menstrual cycle (6-10 days) and in the absence of inflammation.
- cytological smear (not more than 6 months),
- smear on the purity of the vagina (no more than 10 days)
- tests for sexually transmitted infections (chlamydia, ureaplasmosis, mycoplasmosis).
- diathermocoagulation (cauterization and / or excision of the pathological focus using electric current);
- cryotherapy (destruction of the focus of dysplasia with liquid nitrogen);
- lasersporting – the method is based on the effect of a low-intensity laser beam on the damaged cervical focus, as a result of which pathological tissues are destroyed when heated, forming a zone of necrosis at the junction with healthy tissue;
- knife conization of the cervix – surgery, during which the cone-shaped portion of the cervix is removed (usually performed by a loop of a diathermocoagulator after anesthesia);
- amputation of the cervix.
Contraindications to surgical treatment:
- infection of the cervix and vagina;
- inflammatory diseases of the pelvic organs.
In the postoperative period, aching pain in the lower abdomen and abundant mucous discharge from the genital tract are possible. When the temperature rises, bleeding occurs, an urgent need to consult a doctor.
The patient is recommended
- abstain from sex for 4-6 weeks
- limit weight lifting
- not to visit baths and saunas, not to take a bath,
- do not use tampons and do not douche.
The recovery period lasts 4 to 6 weeks.
After 3 months, a control colposcopy and smear cytology are performed. In case of a negative result, the woman is removed from the dispensary registration after a year.
Complications of surgical treatment
- violation of the menstrual cycle;
- cicatricial deformity of the cervix;
- recurrence of the disease (incomplete or inaccurate examination);
- exacerbation of chronic inflammatory diseases of the pelvic organs;
Complications during or after surgical treatment are quite rare and depend on the complexity of the procedure, the conditions for its implementation, the qualifications of the doctor and the compliance of the patients with recommendations in the postoperative period.