Cervical dysplasia grade 3

According to statistics, the number of diagnosed cases of pre-cancerous pathologies related to the field of gynecology, is growing steadily. Precancerous cervical condition is quite dangerous, because without timely detection and adequate treatment may develop cancer as a forecast. Serious attitude on the part of patients and gynecologists deserves cervical dysplasia grade 3. It is predicted that within a year it is a precancerous condition may progress to cancer.

Cervical dysplasia 1, 2, 3 are often determined by the degree young women in a phase of the reproductive cycle, which are in the age period from 25 to 35 years.

Many women are faced with a diagnosis of "dysplasia grade 3", want to know what it means. In gynecology under dysplasia understand the disease process, which means a change in the structure of skin cells. Changes relate to the differentiation, maturation of epithelial cells. With the development of cell pathology, form a lining of the cervix become abnormal symptoms that interfere with functioning of the reproductive system.

Cervical dysplasia is a few degrees. All grade dysplasia are precancerous lesions. But, in terms of prognosis, the most dangerous was the third degree. If the first degree may regress on their own, the forecast at 3 degrees less favorable. Grade 3 dysplasia implies serious treatment as this actually severe stage coincides with a non-invasive cancer.

To understand what dysplasia, cervical need to consider the structure. It is known that the neck is the lower part of the uterus. Located within the cervical canal, providing a compound of the vagina and the uterine cavity.

Cervical canal anatomically narrow. His glands continuously produce a special secret to protect the sterile uterus from infection of the vagina. The surface of the cervical canal has some creaminess and red. Exterior cylindrical surface attached monolayer cells.

The cervical canal is small. In its upper part opens cervical canal into the uterine cavity, forming an internal throat. The lower part opens into the vagina. This important section is called the outer shed. Inside the external os is the transformation zone, meaning joint epithelium of cervical canal and vaginal part of the cervix.

Region adjacent to the vagina, is visible. This is a small portion of the cervix, as its main part, supravaginal, available for inspection. Vaginal part is lined with flat stratified epithelium, which gives the mucous pink color and a smooth texture.

Squamous epithelium of the vaginal portion of the cervix has 3 layers.

1. Basal parabasal. This is the deepest layer, which borders with the muscles, nerves and vessels. Here are located the young immature cells that have one big core. As it develops, the data elements are raised in more superficial layers undergoing characteristic changes. The cells become flat, and their nucleus is reduced in size.
2. Intermediate. This layer further cell maturation occurs.
3. Superficial or functional. This layer contains old cells that die, and then exfoliated. Thus, there is tissue renewal.

In cervical dysplasia observed pathological change of cells and the structure of layers. The cells lose their shape, becoming larger and differs in several nuclei. Physiological division into layers is lost. This process is called atypia or dysplasia. With the transition to the next degree of pathology, pathological changes have become more pronounced. A difference from the cancer is dysplasia that such abnormal cells are within the basal layer. Once on microscopic examination of the biopsy expert detects cells out of the stroma - exhibited histological diagnosis of "cancer in situ» - carcinoma in situ. Between cancer and dysplasia of the third degree is a fine line. Accordingly, prediction can be disadvantageous.

Gynecologists are three degrees of dysplasia.

1. Easy. Atypia is observed in the lower third of the cervical epithelium.
2. Moderate. Atypical elements detected in the lower and middle part of the epithelial tissue.
3. Heavy. Identify signs of dysplasia occurs in all layers of the epithelium. That is why the level of 3 is also called noninvasive cancer. However, the disease process does not affect the surrounding tissue.

The third degree of dysplasia and invasive carcinoma classification grouped together. This is due to the difficulties of differentiation of pathological processes. Especially their treatment of different identities.

Causes of

The prognosis of dysplasia can be advantageous if the abnormality is detected at an early stage. More than 90% of atypia 1 degree regress on their own. The prognosis for second and third degree unpredictable.

It is believed that the development of cervical cancer at a dysplasia of the first degree requires five years. At the second degree malignant tumor develops in three years. From heavy to the third degree of atypia of cervical cancer need only one year. However, accurate prediction can be done.

It was found that the primary cause of dysplasia and cervical cancer is HPV. Found most dangerous strains, which when exposed to adverse conditions contribute to the development of cellular atypia. In 95 cases of grade 3 dysplasia and cancer are detected in parallel High- HPV types.

When properly functioning immune system of HPV alone is derived from the female body during the year. Only in a small number of cases papillomavirus lead to dysplasia, including those with a poor prognosis. In order to develop dysplasia occurred, for example, 3 steps, it is necessary the impact of unfavorable factors:

• lack of certain vitamins;
• multiple births;
• long reception of COCs;
• active and passive smoking;
• multiple sexual partners;
• the presence of penile cancer in partner;
• failure to comply with the sexual partners of personal hygiene, as smegma different carcinogenic;
• a weakened immune system;
• early sexual debut;
• first pregnancy at a young age;
• unfavorable heredity;
• genital infections, such as herpes, chlamydia;
• hormonal fluctuations caused by pregnancy, menopause;
• chronic inflammation;
• trauma of the cervical epithelium surgical procedures;
• pseudo;
• leukoplakia;
• warts.

Often leads to the development of dysplasia combination of several precipitating factors. Before proceeding to the basic treatment, you need to fix any possible factors that may contribute to poor prognosis in terms of relapse.

clinical picture

Many patients believe that the pathological condition should exhibit characteristic symptoms and signs. Nevertheless feature of many background and precancerous cervical conditions is the lack of a clinical picture.

Unlike the inflammatory process, affect cellular structure changes with dysplasia. That is why at the initial stage, there are no symptoms. In such cases, the only way to detect abnormalities is a timely visit to a doctor and pass examinations.

Symptoms are no dysplasia. Since the pathology is usually accompanied by other gynecological diseases, a woman may notice the following symptoms:

• profuse discharge and leukorrhea different color and consistency, often malodorous;
• discomfort, such as itching, dryness;
• pain in the abdomen;
• cycle disorders toward its increase or decrease;
• acyclic and spotting;
• bleeding.

These symptoms are not evidence of dysplasia, and poor prognosisAnd indicate the presence of concomitant diseases.

With the development of the third degree dysplasia may cause regular pain abdominal pulling character at the bottom. Concomitant HPV usually causes a vaginal warts, vulva and anus.

methods of diagnosis

Illness requires early detection and treatment. Especially if the abnormal condition was detected at 3 degrees. This is due to the fact that the advanced stage has a poor prognosis as the risk of a malignant tumor.

Atypia is often diagnosed by chance, since the pathological changes of the cervical epithelium develop latent. Suspect the presence of atypia processes can be when viewed from the vaginal area of ​​the uterine cervix. However, to confirm or refute the diagnosis is necessary to pass inspection.

Diagnostics to detect cervical dysplasia, including grade 3, includes several basic methods.

1. Cytological diagnosis of smear is a simple and accurate method. A doctor with a special brushes fence produces samples with different mucosal sites. If the smear abnormal cells are detected, there is a need for colposcopy.
2. Colposcopy may be carried out as a simple and extended embodiment. In a simple study doctor examines the neck part through the colposcope. This device has a magnification and illumination system and allows us to consider in detail the mucosa. In identifying elevations, color inhomogeneities, we recommend that the expressions of the extended procedure. Plot mucosa treated with a solution of acetic acid and iodine. If there is a loss of HPV, sites acquire whitish color. Atypical areas are not stained with iodine.
3. The biopsy is carried out only when the suspicion of cancer. Gynecologist produces fence tissue samples from suspicious areas identified during a colposcopy. The resulting material was examined under a microscope in the framework of histological examination.
4. Scraping is performed in suspected premalignant or malignant process in the cervical canal when detecting atypia according to the results of cytological smears and biopsies.
5. PCR research on HPV detection is a standard method of research.

The choice of treatment depends on the results of diagnostics. Atypia at an early stage has a favorable prognosis. In connection with the patient monitor and recommended conservative treatment. The gynecologist assigns antiinflammatory and antiviral therapy aimed at eliminating genital infections, hormonal imbalance.

treatment Guidelines

In moderate to severe atypia treatment strategy also includes conservative methods, but they are necessarily combined with surgical excision of the pathological site with capture healthy tissue.

Treatment of cervical dysplasia Grade 3 involves surgical intervention in the form of conization. This operation involves excision of cervical portion. Surgery may be performed by a scalpel, elektropetli, laser beam or by "Surgitron" apparatus. After conization the cervix is ​​retained. Undergo excision only pathological tissue. Excision with a scalpel knife almost never used in modern high gynecology due to trauma and bleeding expressed.

When the recurrence of human papillomavirus infection after conization as dysplasia shows photodynamic therapy. The method involves the use of special medicines - photosensitizers - which accumulates in abnormal cells. When exposed to light rays in such areas, the cells are selectively destroyed.

Any degree of dysplasia requires the appointment of an antiviral and immunomodulatory treatment. The virus attacks the cells of the cervix only in a reduced general and local immunity. Therefore, the restoration of normal functioning of immune cells - the mainstay of treatment. As a rule, drugs are used before and after conization. Given the fact that HPV in any intervention, implying excision of tissue, spread to the vagina and the healthy parts of the neck, it is necessary to stop the replication. For this purpose, use drugs before surgery. To consolidate the effect and prevent the recurrence of a woman taking drugs after conization for 3 - 8 months depending on the degree of dysplasia. Third degree implies the longest reception repetition rates.

Use three main blocks in the treatment of:

• antivirals (Panavir);
• immunomodulating agents (drugs and interferon inducers TSikloferon, Viferon, Kipeferon, Isoprinosine), and stimulants (polioksidony);
• interleukins (Roncoleukin).

For topical application, after the operation and use anti-healing agent (Epigenes spray, suppositories with panthenol, tamponade with tea tree oil, sea buckthorn oil).

proteolytic enzymes (Longidaza) is used to prevent the formation of scar deformation of cervix after surgery dysplasia.

Elektropetlya

The method of excision of a cone with dysplasia of the third degree with the help of elektoropetli is the most popular. This is done using the wire loop, which has a different shape, bearing in mind how much tissue must be excised. In other words, such a procedure is called excision.

In the states of operation called LEEP, and in Europe LLETZ.

Current with a high frequency appliance is generated and supplied to the wire. In turn, it is heated to 80 degrees, it acquires the ability to excise as a scalpel. Once the physician removes the cone cauterizing bleeding vessels carried spheroidal electrode.

simple, cheap and effective, but it is more suitable nulliparous women. The probability of contraction and fusion of the cervical canal after electroconization very high.

laser scalpel

The pathological section of exposure to the laser beam. This method is highly effective in surgery dysplasia due to low trauma and possible applications in young nulliparous women.

In order to impart properties scalpel laser beam is used the energy flux diameter equal to 1 mm. Larger diameters used for vaporization of pseudo. Carbon laser surgery dysplasia third degree has a number of advantages. The physician can control the depth of exposure instantly cauterize vessels, significantly reduces the degree of bleeding. Scarring after laser conization almost never formed. The only drawback is the laser excision charring cone side surfaces, which makes the histological diagnosis. The method is non-contact, and not all doctors have the experience of carrying out the operation.

radiowave surgery

Using "Surgitron" device is the best way to eliminate background and precancerous defects. Radiowave tactic involves contactless impact.

The method is effective because the side portions thereof not carbonized when the cone unit, which allows the microscopic examination to determine exactly whether the removed tissue boundaries amazed atypical cells. If experts visualize abnormal cells on the edges of the cone, a second operation.

During issekaniya radio waves occurs simultaneous coagulation and sterilization chamber. After the manipulation is no risk of bleeding, infection. Rehabilitation period characterized by slight and short-lived trend. The method can be used successfully among nulliparous women, as the probability of narrowing or fusion of the cervical canal is minimal.

Removal of the cervix

In some cases, it may require amputation of the whole of the neck part. As a rule, indications include:

• defeat the cervical canal;
• malignant tumor stage 1;
• severe strain;
• lack of effectiveness conducted after sparing surgery.

After conducted treatment The patient complies with the recommendations relating to the renunciation of sexuality, load restrictions. Control of cure is carried out in a month and a half after the procedure.

With timely detection and adequate treatment prognosis.