Among the precancerous pathologies of the reproductive system, dysplasia of the cervix takes a separate place. It is associated with a change in the structure of cells, so it is difficult to diagnose this disease. Often it is found at a late stage, which is fraught with the development of complications.
Cervical dysplasia - what is it?
Cervical dysplasia is a pathological process, accompanied by a violation of the development of flat epithelium in this area. As a result of these changes, cells gradually lose their properties, causing disruptions in the functioning of epithelial tissue. This is due to a disruption in the lamination of the epithelium. This change in gynecology is called hyperplasia.
Detection of cervical dysplasia is possible by microscopy of a tissue sample from a modified site (cervical and uterine dysplasia). The patient herself can not suspect her presence for a long time. This explains the diagnosis of hyperplasia in the examination for concomitant gynecological diseases. The appearance of atypical cells in the epithelial tissue of the cervix often causes a thorough examination of the patient.
What is dangerous cervical dysplasia?
The main danger of the disease is a high risk of malignancy - degeneration into cancer. Severe dysplasia of the cervix almost always turns into an oncoprocess. The probability of developing such a complication depends on several factors:
- The stages of the pathological process - the higher the degree of disease, the greater the risk of degeneration.
- The age of the patient. When dysplasia affects the reproductive system of young women, who are 25-35 years old, there are difficulties in choosing the mode of therapy. In order to preserve reproductive function, doctors do not prescribe surgical treatment, and the risk of progression of pathology is greatly increased.
- Concomitant diseases of the reproductive system - chronic infections and inflammatory processes in the uterus are often accompanied by a change in the epithelium of the cervix, becoming a trigger mechanism for the development of hyperplasia
- Timeliness of the beginning of the therapeutic process - later detection of dysplasia causes a high risk of malignancy.
Cervical dysplasia - degree
The disease develops gradually. In his current doctors distinguish three degrees. The definition of each is as follows:
- results of a biopsy ;
- data of histological examination (evaluation of the structure, morphology of cells) of the cervical mucosa.
Depending on the observed changes, it is customary to distinguish the following stages of pathology:
- mild dysplasia of the cervix (1st degree);
- moderate (2nd degree);
- severe (3rd degree).
Cervical dysplasia of 1 degree
Light dysplasia or dysplasia of the cervix of the 1st degree is characterized by an intensified process of multiplication of the cells of the basal layer of the flat epithelium. Surface layers do not change their structure: their microscopy does not reveal pathological changes. The structure completely corresponds to the norm, topographic changes are not recorded. Changes are observed in 1/3 of the entire thickness of the tissue. This degree is well amenable to therapy.
Cervical dysplasia of the 2nd degree
Cervical dysplasia of the 2nd degree is accompanied by proliferation of the cellular structures of the basal and parabasal layers of the cervical epithelium. There is a disruption of layering: in some parts of the tissue cells of the adjacent layer can be detected. This is confirmed by microscopy. With a thorough examination of the affected area, doctors fix the mosaic in the structure of the parabasal layer. At this stage of the disease, 2/3 of the entire epithelium of the cervix is involved in the pathological process.
Cervical dysplasia of the third degree
Indication for the diagnosis of cervical dysplasia of the third degree is the defeat of all layers of multilayer epithelium. When carrying out a differential diagnosis of the pathological process, many atypical cells are found in the epithelial tissue itself. They have a different structure, and their structure is different from the physiological one. The superficial layer of the epithelium has a normal structure. If there is no necessary therapy, the risk of degeneration into cancer exceeds 90%.
Causes of cervical dysplasia
The causes of dysplasia are often due to several factors. This fact complicates the diagnostic process and requires a lot of analyzes. Among the main provoking factors:
- Human papillomavirus. This causative agent is able to affect the reproductive system, causing genital herpes . In this disease, as a result of the vital activity of the virus, the mucous membrane of the cervix is affected, which leads to a change in its cellular structure.
- Injuries to the cervical tissues. Operations on the reproductive system, frequent curettage, the presence of abortions in an anamnesis often provoke changes in the cellular structure of the cervical epithelium. Also, injuries activate regeneration processes, in which cell division is enhanced. If the process is accompanied by a violation of the local circulation, the probability of dysplasia increases.
- Chronic inflammatory processes. Prolonged inflammation leads to a reorganization of the epithelium, which is accompanied by a violation of the body's defenses, an increased risk of dysplasia.
- Hormonal failures. Disruption of the hormonal system may be accompanied by an enhanced synthesis of sex hormones. Under their influence begins increased growth of uterine tissues, because of which and develops dysplasia of the cervix of a mild degree.
- Infectious processes in the reproductive system. Studies conducted by doctors have shown an increased risk of dysplasia in the presence of infections of the reproductive system. Trichomoniasis , gonorrhea, chlamydia are frequent companions of the disease.
Cervical dysplasia - symptoms
The disease does not show itself for a long time. Often, women learn about it during the prophylactic examination, examination of the gynecological system for the presence of other pathologies. Symptoms of dysplasia of the cervix are not specific, so they can be recorded in other diseases of a gynecological nature. The doctors' suspicion of a pathology such as cervical dysplasia may occur if the following symptoms occur:
- Pain in the groin area, in the lower third of the abdomen. Appear with progression of pathology and have a diverse character: aching, pricking, pulling.
- Pathological discharge from the vagina. More often have a bloody character and are not associated with menstrual. When the infectious agent is attached, there is an increase in secretions, a change in their consistency.
- Strengthening menstrual flow, increasing the duration of menstruation.
- The increase in body temperature occurs only when the inflammatory process in the cervix is attached.
Cervical Dysplasia - Diagnosis
Cervical dysplasia is diagnosed by the following studies:
- The Schiller test is the detection of sections of multilayered flat epithelium in a sampled tissue sample.
- PAP-test - microscopy of a smear taken from the cervix, with the definition of the structure, nature and number of cells.
- Colposcopy - examination of the mucous membrane of the neck with a microscope with a large increase.
- Dajin test - the detection in the patient's blood of fragments of the DNA of the papilloma virus, which often causes dysplasia.
With the diagnosis of "cervical dysplasia," a biopsy is performed not only to establish the cause of the pathology, but also to evaluate the structure of cells. Manipulation is carried out aiming: with a modified section of the cervix, the doctor takes a tissue sample, which is then microscopized. By the nature of the changes, one can judge the stage of the pathological process, its prevalence.
Cervical dysplasia - treatment
Before treating dysplasia of the cervix, doctors conduct a comprehensive examination of the patient. Its purpose is to determine the cause, which became the trigger mechanism for the development of the disease. After diagnosis of cervical dysplasia, doctors determine how to treat the disease considering the factors that triggered the pathology. The medical measures implemented by the doctors are aimed at:
- slowing progress of dysplasia;
- removal of altered tissue sites;
- elimination of relapse.
Treatment of cervical dysplasia by radio wave method
Treatment of dysplasia of the cervix by radio waves is carried out in an outpatient setting. The procedure proved to be as atraumatic - the recovery period has a short duration, scar formation after healing is excluded. The essence of the technique is the use of radio waves of high frequency (3.8-4 MHz), through which a non-contact cut is made.
During the therapeutic session, there is no painful contraction of the myometrium, so the patient does not feel pain. The need for anesthesia in this procedure is absent. Radio wave therapy for dysplasia is indicated when:
- When carrying out colposcopy on the cervix of the uterus, a patch of epithelial tissue was found with spreading into the cervix region.
- Dysplasia of the cervix of the 2-3 degree, which is subject to the results of the PAP test, is revealed.
- There is a cancerous tumor found in cytology.
Treatment of cervical dysplasia with laser
A relatively new technique for treating this pathology, the effect of which is noticeable immediately after the procedure. With this method of treatment, the doctor performs cauterization of cervical dysplasia using a laser beam as a tool. Before the manipulation, the intensity of the radiation is selected, the depth of penetration is determined, according to the degree of the disease.
The procedure is assigned to the beginning of the menstrual cycle. 5-7 day is the ideal time for it. Before treatment the woman goes through colposcopy, gives a smear to cytology. According to the results of these studies, the doctor determines the scale of therapy, establishes the exact location of the affected cervical region. The leprosy itself lasts 15-20 minutes. Complete recovery of uterine tissues occurs in 4-6 weeks. During the recovery period, gynecologists advise:
- Exclude sexual intercourse in the first 1-14 days.
- Do not take a warm bath, refuse to visit the sauna, baths, solarium.
- Limit exercise.
Cervical dysplasia - surgical treatment
Surgical treatment is indicated for severe dysplasia. Obligatory is a preliminary smear for cytology, the purpose of which is to exclude the oncological process and determine the stage of the disease. When performing surgical treatment, doctors use the technique of excising sections of the epithelial tissue of the neck with a modified structure. It is called surgeons as conization of the cervix (with grade 3 dysplasia it is the main way of treatment). During the operation, doctors remove a part of the neck tissue of a cone-shaped shape.
Cervical dysplasia - prognosis
The prognosis for this type of pathology depends on:
- time of disease detection;
- the age of the patient;
- presence of concomitant disorders in the reproductive system.
So, when a woman is diagnosed with cervical dysplasia of 1 degree, the prognosis is favorable. The probability of a full recovery is more than 90%. However, the detection of dysplasia at the 2 nd and 3 rd stage is fraught with degeneration into cancer. In such cases, even surgical treatment does not exclude relapse, which is observed in 40-55% of cases of the disease.
Cervical dysplasia and pregnancy
The presence of this pathology is not a contraindication for bearing a baby when it is first identified. The violation itself does not affect the processes of intrauterine development of the baby, does not interfere with the functioning of the placenta. Moreover, pregnancy does not aggravate this pathological process, it does not complicate it. Detected dysplasia of the cervix in pregnancy is an indication for the dynamic observation of the patient.
With an average degree of dysplasia, doctors prescribe colposcopy . Re-examination is carried out after delivery. When there is a suspicion of severe dysplasia, a targeted biopsy may be prescribed - excluding malignancy. When the diagnosis is confirmed, colposcopy is repeated every three months, until the very birth. After delivery, surgical intervention is prescribed.