Cervical Dysplasia - is pathological structural changes of the vaginal epithelial layer of the cervix.At the core processes in the cervical dysplasia are atypical for this localization process proliferation (proliferation) and restructuring (metaplasia) of epithelial cells, as well as the disruption of normal processes of exclusion and maturation.
atypical nature of the changes in the epithelium dysplasia when pointing to the affiliation of the disease to precancerous pathologies that deserves the attention of all professionals.
Cervical dysplasia sometimes develops on the background of erosion, both diseases have some similarities in the methods of diagnosis and therapy, but to talk about the identity of these pathologies is incorrect.Erosion is the result of trauma to the cervix and does not affect its structure.When dysplasia is always going structural deformation fabric.For cervical erosion, unlike dysplasia, atypia cells of the mucous layer is uncommon.
Cervical dysplasia is diagnosed in women of all ages from the young 20-year-old girls to women in the menopausal period.The largest number of dysplasia between the ages 24 - 35 years.Pregnancy does not interfere with the development of dysplastic processes in the cervix.
early symptoms of the disease has not.The most common epithelial dysplasia of the cervix detected at routine inspection or when visiting a gynecologist on the other (or related) diseases.Companions dysplasia are often the background processes in the cervix, inflammatory diseases, sexually transmitted infections.
In the initial stage all the pathological processes in the dysplasia are reversible, and the disease respond well to treatment.However scanty symptoms of early forms may complicate treatment because of late diagnosis.In the later stages of the disease only applies surgical treatment.
on time detection and elimination of the pathological process is a guarantee of complete cure and eliminate cancer risk.
Causes cervical dysplasia
uterus and vagina are connected through the cervix.It is separated from the body of the uterus isthmus.The cervix secrete two parts: the upper (inner) supravaginal located above the vagina, and the lower (outer) vaginal.The lower part of the cervix is located directly in the vagina and can be viewed in the mirrors gynecologist.Dysplasia of the cervix develops in her vaginal area (outer).The cervix opens into the vagina outside the hole, which is called the outer end wrench.A similar hole in the uterus is called the inner throat.
extends inside the cervix the cervical canal, its length corresponds to the length of the cervix and the diameter of the lumen of less than 4 mm.The cervix are muscle and connective elements.To during childbirth cervix may change its settings, and after childbirth to restore its original appearance and size, connective tissue contains collagen and elastin fibers, which create a strong frame and provide good elasticity.The cervix is well supplied with blood, it has lymphatic vessels and nerve fibers.
vaginal mucosa of the uterus presented elements of stratified squamous epithelium, which is able to be updated and to resist infectious agents.Inside the cervical canal of the cervix is a single layer of cylindrical cells.Mucous secretion glands columnar epithelium prevents the contents of the vagina into the uterus, protecting against infection.The junction of the epithelium of the cervical canal with epithelium surface of the cervix called a "zone of transformation" and is located in the external os.
cervical mucus has several layers: basal (deepest layer), intermediate (middle) and functional (surface).Each layer has a specific function.The basal layer is updated elements of stratified squamous epithelium due to the division and multiplication of cells.As the deepest, the layer borders downstream muscle tissue, and blood vessels and nerve fibers.The intermediate layer helps "young" cells to complete the process of forming.The mature cells of the surface layer functioning as intended, so called functional layer.
Violation of division and maturation of cells in the basal layer leads to changes in the structure of the elements of the mucosa and distorts the normal operation, that is dysplasia.The modified cells of the basal layer become large, lose their clear outline and expand.Such cells are called atypical because they are not like the rest of the cells in this zone and should not be there.Risk of such elements in the mucous is that over time they can acquire the ability to multiply and aggressive infiltrative growth into the surrounding tissue and blood vessels (malignancy) that can be attributed to epithelial dysplasia of the cervix to precancer.Incorrect to say that every woman with dysplasia certainly develop malignancy.It is only the probability of an undesirable outcome of the disease and the adverse factors that may contribute to this.
long (more than 1 year) the presence of a woman's human papillomavirus (oncogenic types 18 and 16) in combination with predisposing factors have an adverse effect on the body and can cause the appearance of atypical processes in the cervix.In 90% of patients with cervical dysplasia detected human papilloma virus (HPV).The presence of a patient with dysplasia of the herpes virus (type 7), exacerbating the disease.In healthy women with good condition of the immune system eliminated the human papilloma virus (leaves the organism) on its own within 1 year, and only prolonged its presence in the body can be considered as causes of cervical dysplasia.
predisposing risk factors in the development of dysplasia may be:
- early sexual debut and early childbirth;
- immunodeficiency states;
- chronic gynecological diseases;
- disorders in the hormonal regulation;
- specific (venereal) reproductive tract infections;
- traumatic lesions of the cervix (multiple births, abortion, surgical and diagnostic manipulations, and so on.);
- deficiency of vitamins A, B and C;
- frequent change of sexual partners;
- the presence of cancer pathology of the cervix in the immediate family;
- long-term use of combined oral contraceptives (COCs).
immediate cause of the disease the presence of these factors can not be, however, their presence may increase the chances of developing the disease.For example, the risk of cervical dysplasia is increased 4 times smoking women, and women after 5 - COC year application it increases by 2 times.Hormonal contraceptives based only on the risk of dysplasia progestin do not increase.Not established a causal link hormone replacement therapy (HRT) with the appearance of epithelial dysplasia of the cervix.
as background diseases for dysplasia treated ectopia, leukoplakia, ectropion, erosion, and others.
thus fair to say that any situation that caused the disruption of the normal functioning of the basal layer, is a condition (background process) for the appearance of dysplasia.All pathological changes in the cervix during the early stages of dysplasias disease are reversible.
uniqueness of this disease is that it can go both on their own and have serious consequences (cancerous changes in the cervix).
correct tactics of treatment of patients with cervical dysplasia (among other factors) should depend on an adequate assessment of the possible causes and conditions of its origin.
symptoms of cervical dysplasia
disease develops long with full independent recourse or further progression.
Cervical dysplasia has no specific symptoms.Patients in most cases, no complaints.If dysplasia is formed with the participation of existing pathological conditions of the woman, or it joins the local inflammation, the patient may complain inherent in these states.Often, patients with dysplasia detected genital warts and chlamydia.
Occasionally patients concerned about prolonged unusual discharge, itching or burning.Character of discharge determines a local accompanying inflammatory or infectious process that affects their color, smell and volume.When intimacy, using vaginal tampons or douche, secretions may be present in the blood as a consequence of traumatization of the cervix, and the allocation of purchase sukrovichny or bloody form ("contact bleeding").For cervical dysplasia uncharacteristic any pain, discomfort or change in the overall well-being.
severe symptoms may occur only in severe dysplasia or accession of secondary infection - colpitis and cervicitis.
combination of dysplasia and pregnancy is rare.Structural and functional deformation of the epithelial layer with dysplasia provoke complications.Damaged cervix is unable to maintain its former elasticity and can rupture during childbirth, and concomitant dysplasia inflammation can cause subsequent postnatal inflammatory diseases.
As with any asymptomatic disease, regular annual preventive gynecological examinations are the only way for early detection of asymptomatic cervical dysplasia.
diagnosis of cervical dysplasia is reduced to the consistent application of a variety of survey methods, the choice of method is determined by the subsequent results of the previous.The starting point is a regular survey of the gynecologist.During the inspection in the mirror revealed discoloration cervical mucus, stains or rough on its surface.
Regardless of the results of the inspection, all the women taken smear cytology to exclude (or confirm) the presence of atypical cells.Using special tools is taken and applied to the glass material with several sections: from the surface of the cervix, the transition from the site of a single layer of columnar epithelium to stratified squamous and from the cervical canal.Then in the lab made a special painting material and study it under a microscope.
If any visual deviations from the norm colposcopy - inspection of the cervix with an optical device (colposcope) that allows several times to increase the image of the cervix and examine the changes in more detail.If the cervix doctor found "suspicious" site for more in-depth study of the structural abnormalities are special diagnostic tests - Schiller and the sample with a solution of acetic acid.In the normal state of the mucous entire surface treated with a solution looks the same.If there are abnormalities neck, they will look different.
After contact with acetic acid physician may reveal the presence of atsetobelogo epithelium (ABE) on the cervix - the mucous areas of white.Such staining inherent dysplasia and may indicate the presence of human papilloma virus.If the sample is carried out with acetic acid, colposcopy called extended.
samples with a solution of iodine (or Lugol solution) called Schiller, performed to detect iodine-negative areas on the surface of the cervix.The normal mucosa in the processing of iodine uniformly painted in a dark brown color, areas of atrophy, inflammation, leukoplakia or dysplasia badly stained or painted and look lighter.
If during extended colposcopy modified portion identified cervical mucous, biopsy is performed from this portion - fence material (in this case the fragment pieces mucosa) for histological examination, which determines the presence of atypical process.From a piece of cervical tissue sections were prepared, stained and then study their cellular structure under the microscope.Cytology allows us to see only one layer of cells, histological allows you to explore all of the layers of mucous membrane, basement membrane and subiculum.
During pregnancy, colposcopy can be carried out, but the conduct of the biopsy procedure is undesirable.If there is a need for biopsy in a pregnant patient, the procedure lay, six weeks after childbirth, a refresher simple or extended colposcopy with biopsy specimens for cytological and histological examination.
diagnosis based on data from the gynecological examination and colposcopy, is preliminary.The last word rests with the histological examination of biopsy material.
All patients with dysplasia are examined for the presence of human papilloma virus.The most reliable method is the polymerase chain reaction (PCR - method), able to determine the presence of even very small quantities of the virus in any body fluid.
all women with cervical dysplasia were mandatory bacteriological and direct microscopic examination of the vaginal flora, as during inflammatory processes exacerbate and complicate the treatment of dysplasia.
Degrees of cervical dysplasia
initially struck the basal layer of the pathological changes are gradually beginning to spread to adjacent epithelial layers.Depending on the location and extent of lesions, release of 3 degrees (type) epithelial dysplasia of the cervix:
• Cervical dysplasia 1 degree (mild) - the changes are expressed clearly and are within the lower third of the epithelial layer;
• Cervical dysplasia grade 2 (moderate) - the number of modified cells increases, the morphological changes affect the lower and middle thirds of the mucosa;
• Cervical dysplasia grade 3 (severe) - shows signs of malignancy without invasion (penetration into the surrounding tissue and areas): total defeat of the entire thickness without penetration of the process beyond the boundaries of the basal layer of the muscles and blood vessels, blurring the boundaries between the layers of mucousexpressed atypia cells.
Severe dysplasia of the cervix occurs infrequently.The popularization of medical knowledge among the population, the availability of modern methods of diagnosis, use of new therapies allow to diagnose and treat dysplasia, preventing undesired consequences.
degree of cervical dysplasia determines the nature of the disease, its considered when choosing a treatment program patients, it affects prognosis.
Treatment of cervical dysplasia
program therapy of patients with dysplasia is made for each patient and takes into account the degree of dysplasia, the size of the lesion, age of the patient and the accompanying background of the disease, as well as individual risk of atypical changes.It is important to take into account the patient plans for future pregnancy.
initial form of dysplasia (ie, if the rate is less than a second), the small size of the cervix detected at a young age, have a higher chance of self-treatment.Only 1% of women with mild degree of dysplasia, the process proceeds to the next step.The patient is invited to observe and control cytology every three months.At this time, the treatment may be carried out comorbidities, baseline disease, measures are being taken to restore the normal composition of the vaginal microflora to improve the microclimate of the vaginal environment and prevent inflammatory reactions.If two of cytological response against cervical dysplasia positive assignment is necessary surgery.