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Severe cervical dysplasia
Last reviewed: 23.04.2024
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As a result of histological examination of pathologically altered cervical epithelium, severe dysplasia of the cervix can be diagnosed, which according to the international classification is called cervical intraepithelial dysplasia of the third degree (from the existing four).
The disease is considered to be a precancerous condition of the cervical tissue and has more than one code for the ICD 10, but two: class XIV (diseases of the genitourinary system), N87 - Dysplasia of cervix uteri, and class II (neoplasms), D06 - Carcinoma in situ of cervix uteri .
[Causes of severe cervical dysplasia
In oncology precancerous (precancerous) it is customary to call changes in the state of the cervix, which make them more sensitive to the action of the human papillomavirus (HPV or HPV). Perhaps this is somewhat contrary to the definition of carcinoma as a cancer of epithelial tissues.
To date, according to numerous epidemiological studies, the causes of severe dysplasia of the cervix in 62% of the diagnosed cases of infection with this persistent viral infection. Although most genital HPV infections do not cause oncology.
Pathological changes in the form of atypical cells of the cervical epithelium are noted in the so-called transformation zone - where one type of mucosa consisting of glandular and cylindrical cells constantly (in connection with the menstrual cycle) changes into another type of squamous epithelium.
The pathogenesis of any, including severe dysplasia of the cervix, is due to the fact that HPV damages the cells that line the cervix (there is an increase and the chromatography of nuclei, changes in the shape of cells, etc.). Sometimes the virus damages the gene of healthy cells (introsomal type of lesion), which causes not only anomalies in the cell morphology of almost the entire layer of flat epithelium, but also their intensive proliferation.
Gynecologists note that factors that increase the risk of developing severe dysplasia should be attributed to unprotected sex; lowered immune reactivity of the organism (including due to deficiency of vitamins supporting vitamins - ascorbic acid and retinol); disrupting homeostasis (in particular, increasing the acidity of the internal environment of the body, which in no small measure contributes to smoking); repeated pregnancies in the anamnesis; hereditary predisposition to the appearance of gynecological malignant neoplasms, as well as long-term contraception with the ingestion of hormone-containing tablets.
Symptoms of severe cervical dysplasia
Pre-cancerous changes in the cervix often take place without obvious manifestations. And the first signs of the disease are the abnormal result of a cervical smear (Pap test, rar-test or Pap smear).
Explicit symptoms of severe dysplasia of the cervix can be manifested as:
- discomfort and painful sensations during coition;
- suprarenal vaginal discharge or bleeding after coition;
- prurit (pruritus) in the genital area;
- the appearance of other atypical vaginal discharge;
- pain aching and pulling in the lower abdomen and the pelvic area.
Cervical neoplasia of the third degree (CIN III) or severe dysplasia of the cervix affects only the flat epithelium and has complications in the presence of concomitant infections (chlamydia, vaginosis, vulvitis, colpitis). The consequences of severe dysplasia are its further development with all the signs of oncology. Either spontaneous disappearance (50 to 50), but predict the "behavior" of the disease is extremely difficult.
Diagnosis of severe cervical dysplasia
A standard scheme for diagnosing severe cervical dysplasia has been developed.
After examining the cervix on the armchair, the doctor prescribes tests:
- cytological smear of the cervical mucosa (Pap test according to the Pap test);
- a smear for the presence / absence of human papillomavirus (HPV) with the clarification of its serotype;
- taking a sample of the cervical tissue (by scraping) on the papillomavirus DNA.
Also instrumental diagnostics is used: colposcopy (vaginal endoscopy), which allows to visualize the tissues of the cervix with repeated magnification with the help of a special endoscopic device (kolkoscope).
Differential diagnosis of cervical dysplasia of severe degree (from ectopia, cervicitis, retreatment cystosis, etc.) is performed on the basis of a biopsy, which is often performed during the colposcopy, and histological examination of the resulting sample of modified tissues.
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Treatment of severe cervical dysplasia
Now drugs in the therapy of this pathology (by chemical destruction of abnormal cells) do not apply: they are all recognized as ineffective.
Therefore, operative treatment of severe dysplasia of the cervix by such excision methods as:
- diathermy or loop electric excision procedure - LEEP (Loop Electrosurgical Excision Procedure);
- cryocoagulation (freezing with liquefied nitrogen);
- laser ablation (used on clearly localized pathological areas of the cervical tissue or when a whole layer of tissue on its surface is affected);
- resection of the pathological site with a scalpel;
- ectomy or removal of the entire cervix (used when abnormal cells are found in the cervical canal).
To restore healthy cells, vitamin therapy is used (vitamins A, C, group B), taking zinc and selenium.
Stimulate the body's defenses against HPV called for alternative treatment with turmeric, pineapple juice, green tea. Herbal treatment uses inward decoctions of plants with an immunostimulating effect - echinacea of the umbilical and especially astragalus, which activates the synthesis of interleukin-2, capable of destroying the papilloma virus and mutant cells.
Homeopathy in its preparations for HPV control uses aloe juice and western thuia extract, as well as a topical agent based on the essential oil Melaleuca alternifolia - tea tree.
Prophylaxis and prognosis
Prophylaxis of this pathology is possible if all women after the age of 18 will annually give a smear and carry out a screening pap test. If the negative result is twice detected within 6-12 months, then it is enough to be examined every three years.
In the absence of treatment, the forecast of this pathology is given by physicians based on statistics: according to one data, in 20-30% of cases, 30-50% in others, and 12% in others, severe cervical dysplasia progresses into squamous cell carcinoma.