Treatment of cervical dysplasia of 3 degrees

To date, treatment of cervical dysplasia of the third degree is carried out exclusively surgically using various methods of excision (removal) or destruction (destruction) of pathological altered tissues.

Since the destruction of a portion of the epithelium covering the cervix, it is not possible to take a tissue sample for subsequent histological examination, the requirements for the diagnosis of dysplasia, including differentiated (to eliminate squamous cell carcinoma of the cervix uteri), are increased.

Methods of treatment of grade 3 cervical dysplasia

Surgical or surgical treatment can be carried out both on an outpatient basis and in a hospital - depending on the method chosen by the doctor (removal or destruction), which provides the maximum effect with minimal invasiveness of the procedure.

The main surgical methods for treating cervical dysplasia of grade 3, used in clinical practice, include:

• cone-shaped excision (conization) of affected tissues;
• diathermocoagulation (coagulation with electric current 60-80 W);
• cryodestruction (coagulation with liquid nitrogen or cryotherapy);
• laser treatment (laser vaporization or coagulation).

Also, according to the indications (if all layers of the cervical epithelium are affected), an ectomy (resection) of the cervix with a scalpel or ultrasound may be necessary.

Surgical treatment of grade 3 cervical dysplasia by conization is usually performed during the diagnosis, combining a biopsy. It can be used as a scalpel or cold knife technology (with local or general anesthesia) and diathermic excision of the neck transformation zone with a special loop electrode (electric cautery). With this method, cure is noted in more than 90% of cases.

The remaining surgical methods of removal or destruction should be used only when the degree of dysplasia is accurately established, colposcopy with a biopsy performed, which did not reveal cervical cancer.

Specialists note that in the case of highly differentiated cervical dysplasia, grade 3 cryotherapy - because of the difficulty of subsequent evaluation of treatment results, high probability of recurrence and risk of cervical stenosis - is rarely used when excision procedure or other ablation method is not available.

When appointing any of the above procedures should take into account the phase of the menstrual cycle of patients: the most favorable for the restoration of affected areas of the cervix is the pre-ovulatory (first) phase.

Laser treatment of cervical dysplasia of 3 degrees

Laser treatment is included in the standard protocols for the surgical treatment of cervical neoplasia of the third degree.

The pulse of the laser beam destroys (denaturates) the protein structures of pathological tissues to a depth of 6-7 mm, and even at low power of the carbon dioxide laser, the diseased cells simply evaporate. This method is called laser vaporization.

The laser accurately focuses on the affected area with the help of a colposcope, which helps to prevent the destruction of normal tissue. Treatment can be performed with local infiltrative anesthesia or analgesia of the paracervical zone. Patients may feel some discomfort in the form of spasms of the musculature of the uterus.

Laser treatment can combine simultaneous laser treatment of dysplastic lesions of the vagina and vulva. In this case, the vessels are cauterized, which eliminates bleeding. Rubtsov after this procedure does not remain, and complications with subsequent pregnancy and childbirth does not occur even in nulliparous women.

However, this method has its drawbacks: the treatment lasts at least half an hour and requires anesthesia, and also does not provide an opportunity to obtain a tissue sample for histology. And with laser conization in a few days, a slight bleeding is possible.

Radio wave treatment of cervical dysplasia

In a standard clinical protocol, radio wave cervical dysplasia or radio wave coagulation is not included.

This method of surgical treatment - using an electrosurgical device (Sugitron), generating high-frequency electric waves (4 MHz) - allows you to cut and coagulate tissues in a non-contact way.

Its wide application in plastic surgery, which requires surgical accuracy, penetration control and low-temperature treatment, has led to the use of radio wave treatment in other areas of clinical medicine: dermatology, gynecology, proctology, ophthalmology, etc.

This technology allows you to simultaneously cut and coagulate surrounding tissues with a minimal change of adjacent tissues without burning and pain. Formed on the wound surface of the film about ten days after the procedure comes off, which can be accompanied by small spotting of bloody nature. At the same scar on the cervix - as with diathermocoagulation - does not remain.

Rehabilitation period after surgical treatment

On average, the rehabilitation period after surgery for severe cervical dysplasia lasts from one and half to two months. During the first month, women have vaginal discharge (sutures with an admixture of mucus); can be felt pain in the lower abdomen (as with the onset of menstruation). These doctors are considered normal. But if the allocation is too abundant and with blood, you should immediately contact your doctor.

The main recommendations for patients, regardless of the specific method of surgical treatment, include the rejection of sexual contacts (until the end of the rehabilitation period) and a complete ban on any water procedures (bathing in the pool, bath, taking baths) - except the shower.

Doctors recommend that women do not lift weights and limit as much as possible any physical loads during this period, as well as use only sanitary napkins and carefully monitor their own well-being. For example, malaise and fever - an occasion to urgently appeal to your gynecologist.

The process of restoration of the cervical tissue can last for several months, but for control (three months after removal or destruction of the neoplasia) a smear from the vagina is necessarily taken and colposcopy is performed.

The following complications are considered most often after treatment of grade 3 cervical dysplasia:

• bleeding after diathermocoagulation or laser treatment (2-7% of cases);
• scars on the cervix (especially after diathermocoagulation and diathermic excision of tissues);
• narrowing (stenosis) of the cervical canal, which causes the impossibility of pregnancy;
• abnormalities of the menstrual cycle;
• relapse of dysplasia;
• exacerbation of existing or development of new vaginal-cervical inflammatory diseases.
• possible complications of labor or their premature onset.
• development of squamous cell carcinoma of the cervix.

Conservative methods of treating cervical dysplasia of the third degree

Severe cervical intraepithelial neoplasia (CIN), that is dysplasia of the cervix of the third stage, is a potentially precancerous pathology and in some cases (on average 12-15%) passes into squamous cell carcinoma. Therefore, gynecologists categorically do not recommend the treatment of cervical dysplasia of the third degree with alternative methods.

It should be borne in mind that any intravaginal procedures (swabs, syringes), conducted at home without prescribing a doctor, can provoke inflammation or cause an uncontrolled progression of the disease.

Since specific drugs for the treatment of severe dysplasia of the cervix are not yet available, official medicine recommends taking folic acid, vitamin B12, retinol acetate (vitamin A) and, of course, antioxidant vitamins - to increase the body's defenses against the papilloma virus (HPV) C and E.

Phytotherapists advise taking decoctions of such medicinal plants as astragalus (Astragalus danicus) and Echinacea purpurea (Echinacea purpurea). Indole-3-carbinol (I3C), which contains all kinds of cabbage, can help.

Activation of the synthesis of immune cells (T-lymphocytes) under the influence of 1,3-β-d-glucans - polysaccharides of the fungus-fungus Coriolus versicolor (or Trametes versicolor). This extract produces an extract widely used by physicians of China and Japan in the immunomodulatory therapy of neoplasms, including malignant ones.

There is also scientific evidence that polyphenols in green tea, in particular epigallocatechin-3-gallate, inhibit the proliferation of altered epithelial cells, blocking the matrix enzymes and cellular receptors of the epidermal growth factor, and inducing the death of mutant cells. Many doctors recommend that their patients reinforce the treatment of grade 3 cervical dysplasia using green tea.

[1], [2], [3], [4], [5]