Cervical leukoplakia is a lesion of its mucous membrane, with the upper layer of the epithelium and underlying layers being involved in the process.
That is, the upper layer of the epithelium is hypertrophied (thickened), which corresponds to the process of keratinization. Clinically, leukoplakia sites appear as whitish or whitish plaques. The disease is not so rare, and is diagnosed in about every 20th woman.
There are 3 forms of cervical leukoplakia:
- flat leukoplakia – the affected areas are on the same level as the normal stratified squamous epithelium (diagnosed by chance, during a routine inspection);
- warty – white patches rise above the level of the cervix, can layering on each other, which changes the surface of the cervix, it becomes uneven;
- erosive leukoplakia – in the area of whitish areas there are damages in the form of erosion and / or cracks.
Depending on the results of the histological examination (the presence or absence of atypical cells), leukoplakia is distinguished, which refers to background processes of the cervix (flat leukoplakia) and leukoplakia related to precancerous processes (there are atypical cells).
The starting point of the development of the disease today is not enough clarified. It is known that all causes of cervical leukoplakia can be divided into 2 groups: endogenous (acting inside the body) and exogenous (influencing from the outside) factors.
Endogenous factors include:
- hormonal imbalance at any level of the hypothalamic-pituitary-ovarian system ( anovulation , excess or deficiency of sex hormones, endometrial hyperplastic processes, and others);
- chronic inflammatory diseases of the uterus and appendages;
- metabolic disease;
- weakening the body’s defenses.
Exogenous factors include;
- cervical injuries (in childbirth, abortion, gross sexual intercourse);
- early sex life, frequent change of sexual partners;
- urogenital infections (human papillomavirus, genital herpes , ureaplasmosis, chlamydia and others);
- cervical diseases ( erosion, cervicitis and others).
As a rule, cervical leukoplakia occurs, is hidden, that is, asymptomatic and is an accidental find during a routine examination.
Some patients may observe such manifestations of the disease as dyspareunia (pain during intercourse) and increased vaginal discharge with an unpleasant odor. The color of the vaginal whiter may be different. These symptoms are usually associated with concomitant gynecological diseases.
In the event of leucoplakia lesions spread beyond the cervix (to the walls of the vagina), itching and burning may occur.
In some cases, a woman may notice the appearance of small bleeding from the vagina after intercourse.
When viewed in the mirrors on the cervix, coarse or delicate raids of white or grayish-white color are found, which have clear, jagged or blurred boundaries. Plaques are not removed with gauze pads.
Differential diagnosis of cervical leukoplakia is performed with colpitis , cervical erosion, condylomas , cancer. Flat leukoplakia must be differentiated with lumps of mucus, fungal raids ( thrush ), and metaplasia.
In addition to the mandatory examination of the cervix in the mirrors, during which white raids are detected, additional studies are being conducted:
- Cytological smear: scraping must be taken from a whitish plaque. But cytology does not always show the correct result, since atypical cells of the deep layers of the cervical epithelium may not get into the scraping.
- Colposcopy: colposcopy allows you to determine the boundaries and sizes of pathological foci, as well as to suspect areas of atypia . When conducting a Schiller test, the raids do not turn brown (iodine-negative areas).
- Biopsy: A targeted biopsy is performed under the control of the colposcope, which in 100% of cases allows the presence / absence of a precancerous process to be determined.
- Tests for urogenital infections: in addition to a smear on the microflora of the vagina, it is necessary to conduct a bacteriological study on the subject of urogenital infections, primarily on the human papilloma virus.
- Hormonal status: according to indications determine the level of hormones in the body.
Treatment of cervical leukoplakia is performed after a mandatory biopsy.
In the case of simple leukoplakia, the gynecologist is involved in treatment, but if signs of atypia are identified, the oncologist will determine and treat the disease.
The goal of treatment is to eliminate the affected cervical foci.
Cauterization of leukoplakia lesions with electric current is a fairly effective treatment method, but has recently lost its popularity due to the large number of postoperative complications.
Freezing of damaged areas with liquid nitrogen. An effective and fairly safe method, but it has a drawback: the inability to process deep layers of the cervical epithelium (recurrence of the disease).
Treatment of leukoplakia sites with a laser beam (abnormal cells evaporate and disappear). Painless, reliable method and allowed its use in nulliparous women.
Treatment of pathological areas with chemicals that contain acids. Painless and effective way.
Radio wave surgery
In the apparatus ” Surgitron ” there is an electrode, which is supplied to the center of leukoplakia, but does not touch it. Radio waves are transmitted from the electrode to the leukoplakia site, destroying the pathological cells.
All of these treatments are carried out on an outpatient basis, on the 5-7 day of the menstrual cycle. The healing process lasts from 2 weeks to 2 months. In the postoperative period it is recommended to limit lifting weights, taking baths, insolation is prohibited.
With gross deformation of the cervix and the severity of keratinization processes with atypia , more radical operations are performed (for example, amputation of the cervix).
When a disease is detected, it is necessary to treat it at the planning stage of pregnancy.
Cervical leukoplakia does not affect the course of pregnancy and fetal development. But pregnancy causes a surge in sex hormones, which can affect the course of the disease (progression). Therefore, pregnant women with a diagnosis of cervical leukoplakia should be monitored more closely.
Leukoplakia treatment is delayed for the postpartum period, and labor is carried out through the birth canal. If the disease progresses and spreads to the tissues of the vagina and vulva, preference is given to operative delivery (cesarean section).
In 15% of cases, leukoplakia of the cervix is able to turn into a malignant tumor.
The prognosis for flat leukoplakia without atypia and deformity of the cervix is favorable both for life and for pregnancy.