Cervical dysplasia 1, 2, 3 degrees: symptoms, treatment, photo
What is it? The main cause of cervical dysplasia is infection with the human papillomavirus.
It promotes the transformation of human body tissues from benign to malignant. Timely analysis of the papillomavirus allows you to assess the likelihood of developing cervical cancer.
It is very relevant, because according to statistical data, about 90% of the world's population are infected with this virus.
The beginning of such a degeneration of tissues is the presence of their dysplasia, which is the onset of cancer.
Its essence lies in the pathological changes in epithelial cells and the relationships between them. In modern medicine, the term "dysplasia" is replaced with "cervical intraepithelial neoplasia."
Cervical dysplasia in most cases develops due to papillomavirus infection. The latter acquires a more aggressive course, if combined with the presence of the herpes virus in the body( especially the second type).It acts as a concomitant factor that triggers carcinogenesis processes, which leads to the development of persistent dysplasia. As a rule, it does not regress on its own.
Papillomavirus has many variations in the structure, on the basis of which the strains of this virus are isolated( there are currently about 70 of them).At the same time, some may cause certain clinical manifestations, while others may not. The virus is characterized by tropism to the epithelial cells of the skin and mucous membranes.
The degree of oncogenic risk will depend on the strain that caused the infection. Therefore, strains are distinguished with low risk, medium and high oncogenic risk.
There are three main types of dysplasia of cervical epithelium that determine the risk of malignant degeneration.
The first degree of dysplasia, or mild dysplasia, is characterized by the fact that cells that do not have differentiation are defined in a 1/3 section of the entire thickness of the epithelial layer from the basal membrane to the surface. If this is a moderate dysplasia, then they are found on a site in 2/3 of the entire thickness of the epithelium. In severe dysplasia, they permeate more than 2/3 of the thickness of the epithelial layer.
The same category includes preinvasive cancer. It is not possible to distinguish between them. But because of the same high risk for a woman, the tactics of treatment should be the same.
Cervical intraepithelial neoplasia, or dysplasia, can be combined with condylomata and papillomas. They can be localized on the genitals, soles, the mucous membrane of the respiratory tract, etc.
This combination of symptoms and should prompt the doctor to think about finding a precancerous process.
In general, dysplasia of the cervix is asymptomatic. During the inspection, the mirrors may show areas of erosion or keratinization. In this case, it is necessary to conduct more targeted diagnostic search.
Depending on the severity of the changes occurring in the epithelium, dysplasia of the cervix is classified into three degrees:
In addition to koylocytes,
So, in 30% of cases false-negative results can be obtained, that is, if there is dysplasia, it is not diagnosed. Therefore, when revealing pathological changes in the cytological smear, a histological examination is performed, which allows to assess the degree of dysplasia.
It includes a biopsy from pathologically altered cervical sites and / or a separate diagnostic curettage of the cervical canal. The main histological signs of dysplasia are considered to be the following:
Basically, surgical and destructive treatment of cervical dysplasia is used. Let's see in detail which method is better to use.
The effectiveness of the method ranges from 70 to 97% in the treatment of ectocervical epithelial dysplasia. A significant disadvantage of this type of treatment is the inability to control the depth of the effect on the tissues. In addition, complications can often develop:
Laser vaporization is a modern destructive method of treating cervical epithelial dysplasia, based on the use of laser energy. Its main advantage is the complete removal of the pathologically altered site, as well as the control of the depth of impact. It does not cause development of scars, therefore it is used in the treatment of nulliparous women. Its efficiency reaches almost 100%, but sometimes it can be 70%.
Excision is the removal of a patch of altered epithelium. It is produced when the pathological process affects endocervix, and also when there is severe dysplasia. In the case of pronounced cicatricial deformity of the cervix without this procedure also not do.
The outcomes of cervical dysplasia can be:
It promotes the transformation of human body tissues from benign to malignant. Timely analysis of the papillomavirus allows you to assess the likelihood of developing cervical cancer.
It is very relevant, because according to statistical data, about 90% of the world's population are infected with this virus.
The beginning of such a degeneration of tissues is the presence of their dysplasia, which is the onset of cancer.
Its essence lies in the pathological changes in epithelial cells and the relationships between them. In modern medicine, the term "dysplasia" is replaced with "cervical intraepithelial neoplasia."
Causes of cervical dysplasia
Cervical dysplasia in most cases develops due to papillomavirus infection. The latter acquires a more aggressive course, if combined with the presence of the herpes virus in the body( especially the second type).It acts as a concomitant factor that triggers carcinogenesis processes, which leads to the development of persistent dysplasia. As a rule, it does not regress on its own.
Papillomavirus has many variations in the structure, on the basis of which the strains of this virus are isolated( there are currently about 70 of them).At the same time, some may cause certain clinical manifestations, while others may not. The virus is characterized by tropism to the epithelial cells of the skin and mucous membranes.
The degree of oncogenic risk will depend on the strain that caused the infection. Therefore, strains are distinguished with low risk, medium and high oncogenic risk.
Cervical dysplasia of 1, 2, 3 degrees
There are three main types of dysplasia of cervical epithelium that determine the risk of malignant degeneration.
The first degree of dysplasia, or mild dysplasia, is characterized by the fact that cells that do not have differentiation are defined in a 1/3 section of the entire thickness of the epithelial layer from the basal membrane to the surface. If this is a moderate dysplasia, then they are found on a site in 2/3 of the entire thickness of the epithelium. In severe dysplasia, they permeate more than 2/3 of the thickness of the epithelial layer.
The same category includes preinvasive cancer. It is not possible to distinguish between them. But because of the same high risk for a woman, the tactics of treatment should be the same.
Symptoms of cervical dysplasia
Cervical intraepithelial neoplasia, or dysplasia, can be combined with condylomata and papillomas. They can be localized on the genitals, soles, the mucous membrane of the respiratory tract, etc.
This combination of symptoms and should prompt the doctor to think about finding a precancerous process.
In general, dysplasia of the cervix is asymptomatic. During the inspection, the mirrors may show areas of erosion or keratinization. In this case, it is necessary to conduct more targeted diagnostic search.
Diagnosis of dysplasia
Depending on the severity of the changes occurring in the epithelium, dysplasia of the cervix is classified into three degrees:
- , the light
- , the average
- is heavy.
- colposcopy with a detailed study of the pathologically altered site
- a cytological examination of the smears taken
- a histological examination that puts an end to the establishment of the correct diagnosis.
In addition to koylocytes,
- keratinized and keratinizing epithelial cells of
- cells with two
- acanthosis nuclei can also be detected.
So, in 30% of cases false-negative results can be obtained, that is, if there is dysplasia, it is not diagnosed. Therefore, when revealing pathological changes in the cytological smear, a histological examination is performed, which allows to assess the degree of dysplasia.
It includes a biopsy from pathologically altered cervical sites and / or a separate diagnostic curettage of the cervical canal. The main histological signs of dysplasia are considered to be the following:
- cell nucleus becomes large
- its shape becomes incorrect
- more intense staining of the nucleus
- different variants of the structure of nuclei in one material
- large number of mitotically dividing cells
- abnormal mitosis
- disrupted or missing maturation of cells.
- 1) Polymerase chain reaction, which allows to evaluate a specific strain and the degree of its cancer risk.
- 2) A serological test that identifies antibodies to these viruses.
Treatment of cervical dysplasia
Basically, surgical and destructive treatment of cervical dysplasia is used. Let's see in detail which method is better to use.
- 1) Destructive, in which the abnormal cervical epithelium is destroyed( laser application, cryodestruction, diathermocoagulation)
- 2) Surgical, involving the removal of this tissue. This includes all types of excisions.
The effectiveness of the method ranges from 70 to 97% in the treatment of ectocervical epithelial dysplasia. A significant disadvantage of this type of treatment is the inability to control the depth of the effect on the tissues. In addition, complications can often develop:
- bleeding
- formation of scars, including deforming cervical canal( this may affect the process of opening the cervix in childbirth, therefore, nullifying diathermocoagulation is not recommended)
- persistent pain throughout the healing period
- endometriosis
- the possibility of developing relapses
- violations of the ovarian-menstrual cycle
- exacerbation of chronic inflammatory processes of the genital organs.
- 1) Weak penetrating ability in
- tissue 2) The necessity of recurrence of
- freezing 3) Lymphorea - prolonged discharge of watery discharge from the genital tract
- 4) Possibility of recurrence.
Laser vaporization is a modern destructive method of treating cervical epithelial dysplasia, based on the use of laser energy. Its main advantage is the complete removal of the pathologically altered site, as well as the control of the depth of impact. It does not cause development of scars, therefore it is used in the treatment of nulliparous women. Its efficiency reaches almost 100%, but sometimes it can be 70%.
Excision is the removal of a patch of altered epithelium. It is produced when the pathological process affects endocervix, and also when there is severe dysplasia. In the case of pronounced cicatricial deformity of the cervix without this procedure also not do.
Prognosis and prevention of
The outcomes of cervical dysplasia can be:
- spontaneous regression
- regression as a result of the treatment
- degeneration into squamous cell carcinoma( cervical cancer).
- 1) Timely detection of infection with papilloma viruses and treatment of
- 2) Exclusion of casual sexual relations
- 3) Using a condom when having sex with an unexplored partner
- 4) Carrying out specific prevention byvaccination. Currently in the pharmaceutical market there are two main vaccines "Cervarix" and "Gardasil", which are able to initiate an immune response against papillomavirus. The optimal time for their introduction is the age before the sexual life is started. However, the upper age limit is 26-30 years.