Mild cervical dysplasia

Mild cervical dysplasia is the most common cause of oncopathology, which can be diagnosed at early stages due to screening of this pathology. Today, cervical pathology ranks first among the most common diseases of the female reproductive system. Cervical dysplasia is a precancerous disease that requires early diagnosis and adequate, correct and timely treatment. Therefore, it is necessary to know the main clinical manifestations and complications of this pathology, because the first degree of cervical metaplasia has a good prognosis in case of timely diagnosis.

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Causes mild cervical dysplasia

Mild cervical dysplasia develops gradually under the influence of certain factors, but it is very important to identify the main risk factors and etiological causes of this process. Risk factors can be divided into general and local. General ones include bad habits, smoking, alcohol consumption, poor diet and consumption of carcinogenic products, and the influence of environmental factors. All these changes are accompanied primarily by a decrease in the reactivity of the entire body, and against this background, functional and then morphological changes in organs and systems develop. At the same time, all the conditions are created for the development of mild dysplasia first, and then the second and third degrees of metaplasia. Among the local risk factors for the development of mild cervical dysplasia are: untimely onset of sexual activity, violation of the rules of hygiene of sexual activity with frequent change of partners, as well as infectious and inflammatory diseases of the internal female genital organs, frequent surgical interventions - abortions, hormonal imbalances, traumatic injuries.

Among the etiological factors, infectious agents are in the first place. Among the possible pathogens, there may be both viruses and bacteria. Among the viral agents, this is most often a woman's infection with the human papilloma virus. This virus has a tropism for the female genital organs and causes the development of another disease - condylomas or papillomas of the cervix. But the infection may not make itself known for a long time, and its course may be asymptomatic, and in some cases, cervical dysplasia may develop. Other possible agents are herpes viruses of all types. These viruses also have a tropism for the epithelium of the cervix and a fairly high oncogenicity, so they can be a trigger for the development of dysplastic processes in the cell. Different strains of these viruses are distinguished, and each strain has its own degree of oncogenicity, which determines the possibility of malignancy of mild dysplasia in the future.

Bacteria play a lesser role in the development of this disease, since they do not penetrate the nuclear apparatus of the cell and do not induce changes in the genetic material. But among possible bacterial infections, only intracellular ones are of greater importance - these are ureaplasmas, toxoplasmas, chlamydia, gonococci. These microorganisms penetrate the cell and remain there for a very long time, while protecting themselves from immune cells and maintaining a chronic focus of inflammation. This is not the true cause of dysplasia, but similar changes can develop against its background, which will further lead to dysplasia. This also reduces local immune defense mechanisms and further contributes to the disruption of metabolism in the cell.

The causes of cervical metaplasia are quite difficult to establish accurately, but today, one of the proven etiological factors is infection with the human papillomavirus, which plays a key role in the further progression of changes inside the cell. Therefore, this condition must be treated and the diagnosis of mild dysplasia is associated with the papillomavirus, which is often confirmed by additional methods, that is, this viral agent can be considered the priority cause of the development of mild cervical dysplasia.

As for the pathogenesis of mild dysplasia, it is necessary to know some normal anatomical features of the structure of the cervix in order to know when to talk about dysplasia. The histological structure of the cervix in a healthy woman is an alternation of epithelial cells:

• flat multilayered non-keratinizing epithelium - located in the endocervix closer to the vaginal canal and is a continuation of it;
• the intermediate zone is located further and is the border on the way to the cervix; both types of epithelium are absent here;
• Columnar epithelium – lines the cavity of the cervix and the cervical canal.

Normally, these balls do not mix and there is a clear boundary between them. In mild dysplasia, there is a violation of the normal anatomical structure and alternation of these zones, in which the epithelium of one zone can move to another, for example, the cylindrical epithelium is located among the cells of the squamous epithelium. This occurs when some etiological factor disrupts the normal life cycle of the cell, the process of its normal division is disrupted and abnormal cells appear in numerical quantities in the area where they should not normally be. The genetic apparatus of the cell is disrupted in such a way that cell atypia is formed, that is, the process of cell division can stop at a certain phase of mitosis, and then the development of numerical cells with an incorrect set of chromosomes can be initiated. Such cells cannot ensure normal metabolism in the cytoplasm, which is the cause of dysplasia. Such changes are especially dangerous in terms of the fact that these cells already pose a potential threat due to the disruption of their normal division and at any moment their uncontrolled reproduction can occur. In this case, a dysplasia process is observed that does not reach the basal layer of the cell, but makes up only one third of the epithelial cover of the cervix.

Since the cervical epithelium has several types of cells, dysplasia can also be different. This concerns the degree of maturity of the cells and their morphological features. There are several types of dysplasia:

1. immature metaplasia of the cervix;
2. squamous cell metaplasia of the cervix with dyskaryosis;
3. squamous cell metaplasia of the cervix.

The higher the degree of cell differentiation, the lower the probability of malignancy.

Such pathogenetic features of the course of the process make it possible to determine treatment tactics, since it is necessary to eliminate this process before the progression of atypical changes begins.

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Symptoms mild cervical dysplasia

Cervical dysplasia is one of the diseases of the female reproductive system, which is characterized by the fact that often the morphological changes that develop are much ahead of the development of at least minimal clinical symptoms. At the same time, it is mild cervical dysplasia, as an initial process, that has an asymptomatic course. This requires as much attention as possible for timely diagnosis.

Symptoms of mild cervical metaplasia may most often appear with some provoking factor. This may be with concomitant condylomas, erosions, infectious lesions, as well as during pregnancy or pregnancy planning. Less often, the clinical picture occurs without such conditions and is characterized by pain during intercourse, disruption of the normal menstrual cycle, if there are hormonal disruptions, vaginal discharge. Discharge may be in the form of leucorrhoea - cheesy, abundant, white or milky discharge with an unpleasant odor, as well as in the form of bloody discharge before menstruation, after it or after intercourse. Local pain with metaplasia is not typical if it is a purely dysplastic process. Menstrual irregularities with mild cervical dysplasia may be with concomitant hormonal pathologies, cysts, which often occurs with dysplasia. Therefore, in this case, dysplasia can be diagnosed by chance.

The first signs that appear most often and are not specific, but should alert - this is painful sexual intercourse. Unpleasant sensations arise due to injury to the dysplastic epithelium, which can also be accompanied by bloody discharge. This discharge is contact and appears only after a provoking factor. This does not happen so often, but can be one of the first manifestations. As for older women, they often have the first symptoms of mild dysplasia may not be expressed due to involutional processes in the uterus and cervix, which suggests premenopausal changes. So, the symptoms that appear in a woman, she explains by the onset of menopause and does not consult a doctor. Sometimes mild dysplasia of the cervix in women of reproductive age can be asymptomatic and when planning a pregnancy can be an accidental finding, then there is an opportunity to successfully treat this condition. If mild dysplasia is not diagnosed before pregnancy, then in the future this condition has no clinical symptoms until the very moment of childbirth, then the first signs may appear. These may be traumatic injuries at the site of dysplasia, cervical ruptures, bleeding, the development of concomitant pathology in the form of infection and the formation of condylomas and papillomas.

Sometimes the only clinical sign of mild cervical dysplasia may be the inability to carry a pregnancy normally with a tendency to “habitual” miscarriages.

Considering the fact that mild cervical dysplasia is asymptomatic in 90% of cases, this condition must be diagnosed in time by screening women. This reduces the percentage of possible malignancy of dysplasia.

Diagnostics mild cervical dysplasia

Mild cervical dysplasia is the initial stage of further changes and aggravation of the process, so it should be diagnosed as early as possible. Since the course of this pathology is often asymptomatic, an important element of timely diagnosis and prevention of complications is preventive examinations by a gynecologist, which a woman should undergo annually. During the examination, the doctor examines the woman's cervix in mirrors, which makes it possible to see changes that can be seen without additional methods. Several cells of metaplastic epithelium among the normal cover are usually not visible, so a mandatory stage of the examination is taking a smear with a special brush for histological examination and detection of dysplasia. This is a screening method of examination, which is carried out on all women specifically for timely diagnosis. In addition to a smear for cytology, another smear is taken for pathological flora, which helps to identify additional concomitant infectious lesions of the cervix or to identify a possible pathogen. A smear for flora is taken from the posterior vaginal fornix, and a smear for cytology is taken directly from the cervix. The correct technology must be followed - a smear is taken from three zones of the cervix - the endocervix, the intermediate zone and the cervical canal, i.e. all three types of epithelium must be present. This is where the objective examination ends. Then all smears are sent to the laboratory for cytology and histology.

The tests that the doctor receives from the laboratory allow one to suspect dysplastic changes. There are six main types of smears:

1. histological picture of a healthy woman;
2. inflammatory and benign changes in the smear;
3. cervical intraepithelial neoplasia

• mild metaplasia (CIN-I) – altered dysplastic cells extend into no more than one third of the epithelial layer;
• moderate metaplasia (CIN-II) - altered dysplastic cells extend in depth by no more than two-thirds;
• severe metaplasia (CIN-III) - altered dysplastic cells extend into the tissue by two-thirds or more, but without invasion of the basement membrane;

1. suspected cancer;
2. Cancer;
3. uninformative smear (not all types of epithelium are represented).

The result of mild dysplasia or CIN-I is a reason for which the woman is necessarily called for a repeat examination and additional instrumental methods are carried out to confirm the diagnosis and determine the treatment tactics.

Colposcopy is a diagnostic test for various pathological conditions of the cervix using a special device that has a magnifying power of 2 to 32 times, depending on the power. This magnification allows you to see those areas of metaplasia that are not determined during a normal examination in mirrors. In addition to simple colposcopy, extended colposcopy is also performed. In this case, the area of the examined cervical epithelium is stained with trichloroacetic acid, iodine or Lugol's solution, and the degree of staining is looked at. Areas of metaplastic epithelium will be pale against the background of normally stained epithelium. Such diagnostics allow you to confirm the presence of metaplasia, even if nothing can be detected visually. Often, to confirm the degree of changes, colposcopy with a repeated biopsy is performed. In this case, a repeated histological examination allows you to determine the morphological features of the puncture and clarify the prognosis and treatment tactics.

Immature mild dysplasia is characterized by the appearance of cells in the smear that are small in size, have unclear, uneven boundaries, and are also located chaotically in the smear itself. As for the internal structure of the cells, the cytoplasm is changed with a violation of the location and structure of the structural elements of the cell. Various changes in mitoses are observed in the nucleus. Sometimes it is difficult to classify such cells as a type of epithelium, since they do not have characteristic distinctive features. This type of metaplasia requires immediate surgical treatment.

Squamous cell metaplasia of the cervix with dyskaryosis is a more differentiated type, compared to immature forms. Such cells already have a certain shape, the same size and sufficient size. Inside the cell, the cytoplasm is not changed, and the structural elements are located correctly, in sufficient quantity, which characterizes the cytoplasm of a normal epithelial cell.

Squamous cell metaplasia of the cervix is the most differentiated variant, since the epithelium has all the characteristics of normal cells, except for the location. Thus, in squamous cell metaplasia of the cervix, the flat multilayered epithelium is determined beyond the intermediate zone in the cervical canal among the columnar epithelium. These types of mild dysplasia are necessarily determined by cytological examination of the smear.

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Differential diagnosis

Mild cervical dysplasia must be differentiated from other precancerous conditions and benign formations of the cervix: polyps or condylomas, with adenomatosis, with leukoplakia without atypia, with erosions.

Cervical polyps are benign neoplasms of viral etiology. The cause of the development of cervical polyps, as in some cases of metaplasia, is the human papilloma virus. This neoplasm is characterized, as well as metaplasia, by the proliferation and growth of cells. But with polyps, these formations are visible to the naked eye and rise above the surface of the epithelial cover. With mild dysplasia, such changes are not determined visually, and histologically have a different type of structure.

Leukoplakia is the appearance of keratinized epithelium in areas where it should not be. This is a form of dysplasia, but in this case, it is not intraepithelial neoplasia. These areas look like whitish islands among the epithelial cover. Histological examination allows us to establish the presence of cellular atypia and accurately distinguish leukoplakia from neoplasia.

Cervical erosions have a characteristic appearance during colposcopy - this is a defect of the mucous membrane. There are also pseudo-erosions, which occur in girls under 25 years old, as a result of hormonal imbalance. In any case, they are bright red, slightly swollen due to the inflammatory component. Such a defect is visible on the mucous membrane of the cervix, and in case of mild dysplasia, the decisive factor is the result of the histological examination.

Thus, the main and more informative method of diagnosis and differential diagnosis of mild cervical dysplasia is histological examination, which is carried out on all women for the purpose of early diagnosis of the pathology.

Treatment mild cervical dysplasia

Treatment of mild cervical dysplasia is mandatory due to possible serious complications. Conservative and surgical treatment are distinguished, depending on the degree of dysplasia and the nature of the histological smear.

With the second type of smear, the woman undergoes etiologic therapy, symptomatic anti-inflammatory therapy. With the third type of smear (CIN-I), when dysplastic cells occupy up to one third of the epithelial cover, treatment can be conservative with the use of medications and local drugs. Sometimes mild dysplasia is treated surgically, for which there are special indications.

Conservative treatment of mild cervical dysplasia includes:

1. The regime for this disease is general, dietary recommendations are unremarkable, healthy eating is recommended.
2. During the treatment period, it is necessary to abstain from sexual activity.
3. Use of medications.

As for medications, to conduct etiological treatment it is necessary to identify the human papilloma virus, which is most often found in metaplasia, and to use antiviral drugs. Today, there are two main drugs that are used to influence the virus - "Genferon" and "Panovir". These drugs inhibit the activity of the virus by influencing the nucleic acid and disrupt the process of reproduction of viral particles.

If concomitant bacterial flora is detected in the smear, antibacterial therapy is mandatory. Preference is given to complex drugs that contain not only an antibiotic, but also a corticosteroid and an antifungal drug. It is necessary to conduct systemic antibiotic therapy in parallel. Among antibiotics, preference is given to broad-spectrum cephalosporin drugs.

Cefepime is a beta-lactam antibiotic from the 4th generation cephalosporin group, which has a pronounced bactericidal effect on gram-positive and gram-negative microorganisms. The drug is used in a dose of 1 gram per day, administered intramuscularly or intravenously at intervals of 12 hours. The course of treatment is 7-10 days.

Contraindications for use are allergic reactions to penicillins or other beta-lactam antibiotics. No negative effects on the fetus during pregnancy have been identified. Side effects are possible from the gastrointestinal tract, allergic manifestations, nervous system reactions in the form of headache, drowsiness, dizziness.

It is also necessary to use local therapy, especially before planning a surgical intervention or when a pathology is detected that is concomitant with dysplasia. In this case, the chances of a complete recovery from dysplasia increase. I use anti-inflammatory suppositories that have an anti-inflammatory, anti-edematous, antimicrobial effect on the vaginal microflora.

This comprehensive treatment can cure mild dysplasia and modify risk factors to prevent it in the future.

Surgical treatment of cervical epithelial metaplasia is performed for CIN-II and CIN-III. In case of mild dysplasia, surgical treatment is not used as a starting therapy, but there are special cases when this is not followed. There are special indications: if mild dysplasia is characterized by the presence of immature cells, then surgical treatment must be performed, since this guarantees the complete disappearance of dysplastic areas. This tactic is due to the fact that conservative treatment is ineffective at a low level of differentiation, and malignancy is possible during this time.

There are several methods of surgical treatment: laser vaporization, cone excision, scraping of the cervical canal, electrocoagulation. In case of mild dysplasia, less invasive methods are used, which are less traumatic.

Cone excision is the excision of the cervical epithelium in the form of a cone, depending on the depth of the lesion. This method has its advantages, since the risk that any cells will remain deeper is minimal, since the area is excised to the basement membrane or even deeper if necessary. But this method is more invasive and traumatic than others. After excision, the material is sent for histological examination and it is possible to exclude cell atypia once again.

Electrocoagulation is the use of an electrical charge to create high temperatures that can coagulate protein and thus destroy dysplastic cells.

Laser vaporization works on the same principle as electrocoagulation, but laser energy is used here. This is an electrosurgical method of treatment, which consists of the targeted action of a laser beam on the pathological focus of cells, and under the influence of this beam, mechanical energy is converted into thermal energy and strongly heats the cells. As a result of this process, the evaporation of pathological cells occurs - vaporization.

Scraping of the cervical canal is the most "rough" method and can be used if there are no technological possibilities for other treatment methods or there are concomitant conditions that require such a method. In case of mild dysplasia, such a method is not justified.

In the treatment of mild cervical dysplasia, conservative treatment is carried out first, and only then, if it is ineffective, surgical treatment. But there are indications for which surgical intervention is carried out first.

Folk treatment of mild cervical dysplasia

Folk treatment of mild dysplasia is carried out in parallel with drug treatment. In this case, herbal treatment and folk methods are used, as well as homeopathic methods.

1. Treatment with celandine promotes healing of the defect due to the pronounced anti-inflammatory and healing properties of this plant. Use celandine infusion: half a glass of dry celandine leaves is poured with a liter of boiling water and taken orally two teaspoons twice a day. You can also make an alcohol tincture and take 10 drops for ten days.
2. The juice from the nettle leaves must be squeezed into a glass, then a tampon must be soaked in this juice and inserted into the vagina for several minutes, this procedure must be repeated once a day for a month.
3. Herbal infusions are widely used. Prepare a herbal infusion from mint, raspberry and currant leaves - take them in equal quantities, pour hot water and boil for another 5 minutes, then cool and drink warm, half a glass every other day for a month.
4. Pine treatment - half a glass of pine buds should be poured with hot water, infused, and then boiled for five minutes, after which the warm solution can be used for douching twice a day. This treatment can be carried out for a long time until complete recovery.
5. Burdock juice is excellent for relieving irritation, swelling and has an antiproliferative effect, which reduces the rate of growth and reproduction of abnormal dysplastic cells. To do this, squeeze the juice out of pre-washed burdock leaves and take one teaspoon three times a day for five days, and then one teaspoon twice a day for another five days.
6. Hop cones, valerian, linden, coriander, motherwort and oregano should be poured with a liter of hot water and after infusion, drink 2 teaspoons in the morning and evening. This herbal treatment has a pronounced anti-inflammatory effect and promotes wound healing after surgery, so this herbal tincture can be recommended after treatment for a more effective and rapid recovery.

Homeopathic remedies are also widely used, the main action of which is aimed at the immunostimulating effect. These drugs include "Immunovita". Also used are drugs that have an etiological focus, that is, they act on the human papilloma virus, which is the main pathogen. These drugs are Allokin-alpha and vaginal suppositories "Papillokan".

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Prevention

Prevention of dysplasia development can be specific and non-specific. Non-specific prevention is a lifestyle modification with the exclusion of risk factors. Such risk factors that are subject to modification are the exclusion of bad habits, proper nutrition, exclusion of women's work in industry with hazardous substances. It is also necessary to monitor the hygiene of sexual life, because its early onset and frequent change of partners is a risk factor not only for cervical metaplasia, but also for cervical cancer and breast cancer. Sexual life should be safe in terms of possible infections - infection with the human papilloma virus should be avoided as much as possible.

As for specific prevention, this is the use of vaccines. Since the only proven etiological factor in the development of cervical metaplasia in women can be considered HPV, timely vaccination against this virus reduces the risk of developing both metaplasia and malignant oncological pathologies of the cervix. There is a vaccine against the papilloma virus, which is used for girls aged 9-14. One of the vaccines, Gardasil, is used against types 6, 11, 16, and 18. It consists of three doses that must be administered before the onset of sexual activity. Another vaccine, Cervarix, is also aimed at types 16 and 18. These vaccines create immunity for about 5 years. Therefore, the vaccination method is not absolute in the prevention of the etiological factor of mild dysplasia, since infection can occur with another type of virus, however, this is already at least some kind of preventive measure. With mild dysplasia, there is a high probability of a favorable outcome, since these are the initial manifestations that must be treated immediately after the problem is detected.

Mild cervical dysplasia is very common, which is explained by the high percentage of detection of this pathology. Such correct diagnosis contributes to the early start of treatment of the pathology and a decrease in cases of cervical cancer. Given the asymptomatic course of this pathology, it is only necessary to undergo timely examination and follow preventive measures.

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Forecast

Mild cervical dysplasia is a precancerous condition that has the ability to rapidly become malignant, as there is a predisposition in the form of cell dysplasia. Therefore, the prognosis in the absence of treatment is unfavorable. In case of timely diagnosis, complete reduction is possible, both by conservative and surgical methods, and then the prognosis is positive. It is mild dysplasia, as the initial stage of such changes, that responds well to treatment.

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