Causes, symptoms and treatment of cervical dysplasia

The content of the article:

• What is cervical dysplasia?
• Dysplasia from the point of view of the doctor
• Causes of cervical dysplasia
• Symptoms of cervical dysplasia
• Degree of dysplasia
• The consequences of cervical dysplasia
• Cervical dysplasia and pregnancy
• Diagnosis of cervical dysplasia
• Treatment of cervical dysplasia
• Medication

What is cervical dysplasia?

Cervical dysplasia (cervical dysplasia) is a condition covering the cervix epithelium, which is characterized by the change in the number of layers and the structure of its constituent cells. In this case, the process does not involve the basement membrane and the upper cell layers. Dysplasia refers to the diseases which in certain circumstances can cause development of malignant tumors of the cervix.

Cervical dysplasia is an extremely dangerous disease and the most frequent precancerous form, changing the structure of the mucous membrane of the cervix and vagina. Dysplasia can have different origins, but it is always accompanied by a violation of the cellular structure of the epithelium. It affects not only the upper layers, but can penetrate much deeper.

Often dysplasia is called cervical erosion, but the term was not fully captured the essence of the phenomenon. The main difference between these two processes consists in that erosion occurs due to mechanical damage of tissue and dysplasia is characterized by impairment of the cellular structure of tissues.

Depending on the depth of the lesion of the mucous membrane of the cervix, there are:

weakly expressed (mild) form of dysplasia (affected up to a third of the thickness of the layers of the squamous epithelium; the cells of the intermediate layer can swell);

moderately expressed (average) form of dysplasia (struck from one third to two thirds of the strata, disturbed polarity arrangement of the epithelium);

expressed (severe) form of dysplasia (affected all layers of the epithelium).

Every year there are about 40 million women for the first time put or confirmed diagnosis of cervical dysplasia. This disease makes up approximately 15-18% of the cases revealed abnormalities of the cervix. Characteristic of women in the reproductive age 34-35 years. The average frequencytransition severe forms of cervical dysplasia to cancer is about 10-30% according to different studies.

The majority of patients, not realizing the essence of pathological mechanisms, confuse dysplasia cervical erosion or cancer. Wrong neither statement. To understand what is the difference, need to refer to the anatomy.

Dysplasia from the point of view of the doctor

The cervix is the border between the vagina and the uterus. It consists of 3 types of fabrics:

• epithelial;
• muscle;
• connective.

The feature of its epithelium is that it is heterogeneous in its structure. The cervix is the meeting point of the 2 types of surface epithelium: cylindrical, cells of which are arranged in one layer have a rectangular shape and lined with the uterine cavity and the cervical canal and the squamous characteristic of the vagina and includes several rows of flattened cells forms. And the other epithelium is a thin basement membrane consisting of collagen fibers and plays a role solid Foundation and limiter.

It is because of this complex structure of the cervix in this area often have different pathological processes associated with changes in the characteristics of the cells.

The most basic of them are:

• Erosion is the displacement of the columnar epithelium towards the vagina. Structure, function, growth characteristics of cells is not violated. Due to the difference of conditions in the cervical canal and the vagina, cylindrical cells are damaged by the acidic environment, the waste products of the normal microflora of the female genital tract, trauma during intercourse, forming a poorly healing wound – erosion. During a gynaecological examination chair-it looks like the plot of a juicy red on a pale pink background.

  Read more: Causes, symptoms and treatment of cervical erosion

• Cervical cancer is the process of changes in the structure and functions of epithelial cells, which have acquired the capacity for unlimited growth. If the enlarged cells have not gone beyond the basement membrane, we speak of "cancer in place" (CIS carcinoma in situ), it is the initial phase of developing cancer of any internal organs. If a cancerous tumor has invaded the basal membrane, from a medical point of view, we are talking about invasive cancer (this iscancer in the popular sense).

  Read more: Causes, symptoms, stages, consequences and treatment of cervical cancer

• Dysplasia is a change in the structure of stratified squamous epithelium that covers the cervix, thus there are cells with "abnormal"shape of the kernel, multi-core, irregular in shape, lost the anatomical division into layers. However, the changed cells do not have the capacity for unlimited growth and do not penetrate beyond the basement membrane. Columnar epithelium in the transition zone on the cervix remains unchanged.

Modern medicine has long does not use the term"dysplasia", instead, and in the diagnosis and in the scientific literature one can find the following definition: cervical intraepithelial neoplasia (CIN, or CIN), which means the formation of new not characteristic of the tissue cellular elements of the cervical epithelium.

Causes of cervical dysplasia

The appearance of cervical dysplasia, as well as any other precancerous lesions, does not occur under the influence of any one factor. It's always a complex combination of many provoking components.

The main reasons for the formation of foci of dysplasia are:

• infection with certain types of human papillomavirus (HPV);
• hormonal birth control pills long-term use (5 years);
• early sexual life (14-15 years);
• a large number of sexual partners;
• unhealthy habits (Smoking).

Also its role in the development of dysplastic processes can provide:

• monotonous diet with lack of vitamins C, A;

• immunity disorders;

• genetic predisposition to any cancer;
• sexual infections;
• low levels of education, life, antisocial behavior;
• a large number of genera.

The discovery of the dominant role of HPV in the development of dysplasia and malignant tumors of the cervix was a breakthrough in the development of efficient methods to combat cancer of the female reproductive system.

The viral factor

Cervical dysplasia most often occurs due to human papillomavirus (HPV). This disease is usuallyasymptomatic, since displacing processes before the advent of cervical cancer usually takes about 10 years.

Infection with human papillomavirus can occur at all, but at risk are women who lead an active sexual life and with multiple partners. Neglecting contraception and not cured inflammation of the reproductive system also increase the likelihood of Contracting HPV. Injury of the cervix can also occur due to abortions or frequent childbirth.

There are many types of HPV, each of which can cause characteristic lesions. For example: common warts on the hands and feet, genital warts in the genital area; dysplasia and cancer of the cervix.

According to the degree of the cancer "risk" all types of HPV can be divided into 3 categories:

• Neochanna and types low-risk types occur in warts and genital warts, are types 1, 2, 3, 5, 6, 11, 42, 43, 44.

• Low oncogenic risk. The virus related to a highly oncogenic serotypes detected in 90% of all cases of dysplasia and malignant neoplasms of the cervix. It 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 types.
• High-risk types. Especially aggressive ones are 16 and 18, which occur most frequently in half of the cases lead to the development of cervical cancer.

Read more: Causes, symptoms and treatment of HPV

How HPV causes cellular changes?

In a healthy organism, any damaged cell is immediately destroyed by the immune system and internal anti-cancer mechanisms, not allowing her to join in the process of dividing to reproduce defective cells. In addition, the number of divisions each cell type severely restricted genetic program. This determines the aging process in the body, with all the desire man can not live forever.

When the body gets the HPV virus, having a high oncogene activity, it is carried by the blood to the genitals, and is embedded in the flat cells of the cervical epithelium. Viral particles produce specific proteins that block the "security system"epithelial cells, damage DNA. The result is atypical cells, which do not expire, are not removed by the immune system, they are able to divide and reproduce their own kind"abnormal" specimens. Thus there ischanges in the structure of layers of the cervical epithelium, which in the analysis is defined as cervical intraepithelial neoplasia (CIN, or CIN). However, if dysplasia, in contrast to cancer, atypical cells do not possess the property of unlimited unrestrained growth.

The use of contraceptives

Been well studied the influence of long-term use of hormonal combined oral contraceptives (COCs) on the occurrence of dysplastic processes of the cervix.

This is an 2 individual effect (KOK):

• indirect;
• direct.

An indirect effect is that a constant state COC women, usually of young age 20-40 years old, sexually active frequently change sexual partners, they are more likely in populations suffering from venereal diseases and Smoking. The combination of these factors increases the risk of dysplastic processes of the cervix.

The mechanism of direct effect is not fully understood, however on the basis of statistical data it was concluded that prolonged use of COC (5 years or more) increases the risk of cervical dysplasia almost 2 times.

Women that use for protection progesterone drugs (the contraceptive pill for pregnant women), in the category of risk do not fall, as this type of contraceptives on cervical epithelium is not affected. The same applies to women in menopause or with remote ovaries who receive hormone replacement therapy, the risk of developing dysplastic processes are not increased.

Other reasons

Causes of cervical dysplasia can become unhealthy lifestyle, and bad habits (especially Smoking), as reduced immunity and hypoxia increase the likelihood of micro-lesions of the cervical epithelium.

Other reasons, such as the early sexual activity, greater number of sexual partners, low social level – they are all directly related to the frequent contamination of this group of women different types of HPV.

The lack of vitamins A and C, immunodeficiency, genetic predisposition lead to the violation of the body's defense system and disruption to the program of destruction of the damaged cell elements, which also contributes to the development of dysplastic processes.

In General the development of cervical dysplasia can be explained using the theory of "weeds,"which in 1995 invited Professor, University of California, gynecologist Michael Polikar (Michael Policar). In his view, the cervical epithelium is the ground where the"seeds"of cellular changes in HPV, however, for they have sprouted, you need to"water, light, heat",which perform the role of other factors in the development of dysplastic processes – non-Smoking, lowered immunity, vitamin deficiency, genetic predisposition. Without them, even in the presence of HPV, development of cervical dysplasia does not occur.

Today confirm this theory clinically and laboratory failed. However, the combination of HPV with other risk factors most women favor this scientific hypothesis.

Symptoms of cervical dysplasia

In the primary form of the disease is often asymptomatic. The disease manifests itself only in running conditions: in women, pain in lower abdomen, can be scant vaginal spotting. To avoid this, and time to begin treatment, it is necessary to undergo regular gynaecological examinations, providing instrumental, laboratory and clinical studies.

Signs of dysplasia can be detected only if the symptoms are accompanied by other diseases. According to gynecologists, in most cases, with dysplasia of cervix and cervical erosion. Therefore, a competent doctor will send the patient for analysis PAP (SMEAR) when it detects it erosion.

Symptoms of dysplasia may include:

• profuse leukorrhea without unpleasant odor, milky-white color;
• streaks of blood in vaginal discharge after intercourse;
• pain during sexual contact.

Again it is necessary to repeat: these symptoms are not specific for cervical dysplasia may not be used for diagnosis, but are only a reminder to the woman that her female health needs to be carefully examined.

Degree of dysplasia

Depending on how deep the affected cervical epithelium, there are 3 degrees of cervical dysplasia:

• 1 degree (mild);
• 2 degree (moderate);
• 3 degree heavy.

If you imagine the area of the epithelium in the form of a rectangle, the lower side of which presented a basal membrane, and the upper surface a series of cells, different degrees of dysplasia are as follows.

Cervical dysplasia 1 degree (mild)

In the medical records (the results of the analysis or the statement) it is indicated as follows: CIN I (cervical intraepithelial neoplasia I). She placed in the case, if pathologicalthe changes undergone only the lower 1/3 of the epithelial layer adjacent to the basement membrane.

Cervical dysplasia of 2 degrees (moderate)

The diagnosis is referred to as CIN II (cervical intraepithelial neoplasia II). Is set when the spreading of the pathological process at 2/3 of the depth of the epithelium, while the upper 1/3 is left intact.

Cervical dysplasia grade 3 (severe)

Referred to as CIN III (cervical intraepithelial neoplasia III). Is the most severe form of cervical dysplasia, when disturbed structure of all layers of the epithelium. This degree is a subtle distinction between dysplasia and as such the initial stage of cancer ("cancer in place", or carcinoma in situ). Nor that in any other case, the basement membrane remains intact. The only difference between the functions of the cells that acquire the ability to indefinitely divide. To help to establish the severity of the pathological process may histological examination.

The consequences of cervical dysplasia

What can threaten a woman cervical dysplasia depends on its degree:

1 degree

Cervical dysplasia 1 degree in 57% of cases go away on their own after removal of the virus from the body of a woman. In a healthy person 9 times out of 10 the virus cannot be found in blood tests in six months to a year from the moment of exposure. Occurs self-destruction of viral particles by the immune system.

In 32% of cases, there is a long disease with no progress neither in the worst nor the best. In 11% of patients recognized a shift of 1 degree in the second.

2 degree

Cervical dysplasia of 2 degrees in 43% of cases also go away on their own after the liberation of the body from HPV. In 35% there is a long-term stable stream. Thus, 70% of women is there a recovery within 2 years from the time of diagnosis.

22% of women patients 2 the degree of the dysplasia passes to 3 degree.

3 degree

According to studies conducted among different categories of women, the probability of transition 3 degrees of cervical dysplasia to cancer is 10-30%. The reason for this variability is the presence of different numbers of individual risk factors among different categories of women (age, methods of contraceptio, bad habits, way of life, number of sexual partners).

Cervical dysplasia and pregnancy

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Cervical dysplasia does not apply to the contraindications to child bearing women, which was first diagnosed during pregnancy. The presence of this pathological process does not affect the development of the unborn child, does not inhibit the function of the placenta. At the same time and the pregnancy has no impact on cervical dysplasia, does not impair its flow and does not contribute to the transition to a more severe form.

In addition, under the influence of hormonal changes in a pregnant woman, the cervix can develop physiological changes that can be taken for cervical dysplasia. We are talking about ectropion (pseudo) in which the cells characteristic of the cervical canal move towards the vagina. Upon inspection this is like a red rim on the cervix.

Therefore, if the woman for 1-3 years before pregnancy was surveyed and has a negative result of cytological analysis, re-control is not assigned.

If a pregnant has never been surveyed nor a carrier of HPV, no abnormal cells, when first discovered changes on the cervix at any time there is a collection of the smear for the study by Papanicolaou (smear test).

Further tactics depends on the result. If it is negative, then no further action is taken and assigned to the control through 12 months after birth. If the test is positive and found a slight degree of dysplasia, then a colposcopy and control 12 months after childbirth.

In mild cases of cervical dysplasia are assigned a colposcopy and re-examination after birth.

If you suspect a 3 degree of dysplasia is performed a target biopsy – taking a piece of tissue for analysis. Upon confirmation of severe dysplasia required a colposcopy every 3 months until the birth, and the first 1,5 month from the moment of delivery.

If cancer is detected further tactics of the patient agreed with the oncologist and depends on the specific situation.

Diagnosis of cervical dysplasia

Since dysplasia can develop into cancer under certain conditions, the most important in the prevention of complications is early diagnosis. All women over 21 years old sexually activehave 1 once a year to visit a gynecologist for examination and 1 every 3 years to undergo cytological examination.

In the diagnosis of this disease use the following common methods:

• inspection;
• Cytology smear (PAP or smear test);
• colposcopy;
• the fence is a piece of cloth (target biopsy).

When viewed in the mirrors areas of dysplasia look like sections of irregular shape (plaque) balsavage color. When holding the sample Schiller – painting of the cervical epithelium with Lugol's solution – is determined by uneven staining. Areas of dysplasia remains lighter than healthy tissue.

Cytology is able to detect the presence of cervical dysplasia with an accuracy of 60-90%. The sensitivity of the method increases with increasing degree of dysplasia.

Colposcopy is an instrumental method of examination the vaginal portion of the cervix with special magnifying device – colposcope. Upon inspection would be visible misplaced branching blood vessels in the area of dysplasia, mosaic, pale color of the changed epithelium. During the processing of the cervix by acetic acid modified areas will be white.

It should be remembered that none of these methods are unable to differentiate between severe dysplasia from cancer. This is possible only with histological examination of a piece of epithelium. Method by which this is done is called the target biopsy with endocervical curettage. The resulting procedure, the tissues are subjected to scrutiny. This method has 100% accuracy.

Treatment of cervical dysplasia

Before treatment of cervical dysplasia doctor detects and corrects the cause (hormonal disorders, infections or inflammatory processes). That should stop the development of dysplasia in non-running forms and contribute to tissue scarring. In other cases, the patient is recommended surgical treatment.

Common treatment for dysplasia is the electric knife, which excised the affected tissue. Healing after such surgery is three months, but the formation of scars and bleeding, creating the risk of unfavorable pregnancy.

Also cervical dysplasia treated with laser surgery. Depending on the extent of the pathological process of healing may last for about two months, but thisthe treatment is safe and takes little or no consequences.

Another method of surgical treatment of dysplasia is cryotherapy. The affected tissue is frozen using liquid nitrogen. In addition, there is another chemical method of treatment consisting in applying to the foci of dysplasia, a special chemical compound, a cauterizing tissue. A few days later they disappear in thin crust.

On tactics of treatment is influenced by the severity of the pathological process:

1 degree

Because there are scientifically proven evidence that in most cases, cervical dysplasia 1 degree spontaneously in 1-2 years provided the liberation of the body from HPV, that modern doctors do not recommend to apply any treatment at this stage.

Therapeutic tactics is:

• dynamic monitoring up to 2 years after diagnosis;
• analysis for Cytology and colposcopy every year;

• treatment of diseases of the reproductive system (of vaginitis, sexually transmitted infections);

• struggle with bad habits (quitting Smoking);
• the selection of alternative methods of contraception;
• correction of disorders of the endocrine system.

As dosage of antiviral drugs for the treatment of HPV has not yet been created, most in the body fight the virus is having proper nutrition and vitamin support. Recommended taking multivitamin complexes, containing vitamins E, B₁₂, B₆, A, C, folic acid, selenium.

If during the examination to be performed 2 years after diagnosis, not marked inclination dysplasia 1 degree K or less, there are signs of its transformation in the 2nd degree, there is a need for more aggressive treatments.

Small areas of cervical dysplasia 1 degree successfully treated by processing their product for chemical coagulation such as salagen, wegoted.

2 and 3 degree

For treatment 2 and 3 degrees of cervical dysplasia surgical methods are used:

• Moxibustion

• Cryosurgery

• Laser treatment

• Radiowave treatment

• Electroconization (excision)

• Photodynamic therapy

Surgical treatment should be carried out immediately after the menses, it prevents the development of endometriosis and improves the healing process. Beforethe procedure must take smears for Cytology, colposcopy and biopsy.

1. Moxibustion:

   • The principle of action of moxibustion is based on the fact that diseased cells are destroyed by the action of a current of low voltage. The procedure is performed using a special apparatus with electrodes in the form of a loop.
   • The advantages of the method is its cheapness, availability of equipment, technical ease of implementation.

   • The disadvantages of the method: the impossibility to control the depth of exposure, severe scarring after healing, high risk of complications such as endometriosis.

2. Cryosurgery:

   • In this method, the removal of the modified epithelial cells produced by the instant freezing with liquid nitrogen. The temperature of liquid nitrogen -196 C%, the water contained in the skin cells, instantly turns into ice, therefore the changed areas of tissue are dying.
   • Advantages of the method is that it does not leave scars, therefore, can be recommended for nulliparous women when it is impossible to use more sophisticated techniques.
   • The disadvantages include copious clear discharge after the procedure of freezing, which may bother the woman up to 1 month, the need to abstain from sex for up to 2 months from the date of treatment, the inability to adequately control the depth of treatment.

3. Laser treatment:

   • The basis of this method is the "evaporation" of the affected tissues under the action of laser energy.
   • Advantages: leaves no scars, the modern equipment allows to control the depth of penetration of the laser beam, which allows you to completely remove all pathological tissue.
   • Disadvantages: may cause burns adjacent healthy areas of the cervix, you may need a short-term anesthesia, as the efficiency depends on the immobility of the patient.

4. Raudiovolume treatment: Refers to a relatively new methods, it is based on removing the source of dysplasia under the influence of high-frequency waves. Is performed on the unit Surgitron.

   Advantages of the method are:

   • low invasiveness;
   • the ability to control the deptheffects;
   • painless;
   • a short period of rehabilitation;
   • the lack of scars after healing period;
   • a small percentage of re-occurrence of areas of dysplasia;
   • the opportunity to apply in nulliparous women.

   Disadvantages: very expensive method, which is only available in private clinics.

5. Excision (cone biopsy): removal of areas of dysplasia with scalpel or Surgitron machine. Because of the large trauma and many complications after the procedure is not used in women of childbearing age. Currently, instead of conization with a scalpel cone biopsy uses a laser beam. With such an operation reduced the risk of bleeding both during the procedure and the rehabilitation period that is associated with the cauterizing action of the laser.

   • Read more: electro coagulation of cervix with dysplasia

6. Photodynamic therapy: is one of the newest methods of treatment of oncological diseases. Its essence is reduced to selective accumulation of the photosensitizer by the tumor after intravenous or local injection. In the future, the cancer is irradiated by a light source (laser or laser). In the end, in the affected tissues reaction occurs with the release of singlet oxygen. This leads to the death of cancer cells.

   • Read more: Photodynamic therapy of the cervix

With any method of treatment in the postoperative period it is necessary to follow a certain regime in the first month:

• Sexual rest;
• Not to lift weights;
• No sport;
• Not to use the pool, sauna, beach;
• Not to sunbathe and not go to the Solarium, especially in women, infected with HPV;
• Do not take a bath-only shower;
• Not to enter into any vaginal medications, solutions, other than prescribed by a physician;
• Be sure to conduct routine gynecological examination after the next after the treatment of the menstrual cycle.

Many women, afraid to hear the diagnosis, delay the visit to the gynecologist, but this is a false fear. Cervical dysplasia can be effectively treated if you have the time and proper method.

Medication

If the diagnosis of cervical dysplasia was conducted in the early stages, then getting rid of the disease in most cases is successful. Taking medications prescribed as therapeutical activities and basic method of treatment is considered surgery. In the course of the inspection and remove abnormal areas. However, pharmacological correction. First and foremost, it is necessary for the neutralization of HPV, which often leads to the development of dysplasia. The choice of drugs should be based on the individual characteristics of the disease, you should also consider the age of the patient and her wishes in the future to have children.

Objectives of therapy the following:

• Reduce inflammation (anti-inflammatories).
• To restore the function of epithelial tissue (hormonal medication).
• To increase the body's resistance (immune modulators).
• To restore the vaginal flora.

So, at the stage of medicamentous correction appoint immunomodulators, vitamins and minerals (vitamins a, C, E, folic acid).

Drugs for the treatment of cervical dysplasia

Preparations for stimulation of immunity	Prodigiozan The isoprinosine Interferon-alpha 2	Strengthens the immune system in General Protects against viruses and bacteria Activates the production of immune cells that effectively fight infection
Vitamins and minerals	Folic acid Vitamin A Vitamin E and vitamin C Selenium	Gives epithelial tissue to break down Normalizes the process of cell division Vitamin E is a powerful antioxidant, while vitamin C strengthens the body's defenses Promotes regeneration of cells of the endocervix after cauterization and other influences.

Read more: the HPV vaccine, why is it necessary?

Doctors try to delay surgery onas long a period. However, to cope with cervical dysplasia is not always possible with the help of medication. Therefore, in 65-70% of cases still have to resort to surgery. Later assigned to drug correction.

Antibiotics and antivirals prescribed only when the dysplasia is severe. In General, drug therapy for neoplastic processes is ineffective.