Cervical dysplasia is a condition characterized by the appearance on the mucous areas with atypical cells. This pathology in most cases does not have any symptoms, but it is revealed during preventive examinations at the gynecologist, if the material is taken from the cervical canal. There are three degrees of dysplasia: mild, moderate and severe. The synonym of the concept is CIN( cervical intraepithelial neoplasia) 1, 2 and 3, respectively. Dysplasia is a precancerous condition: the higher the degree, the higher the risk of cervical cancer over the next ten years. It is the early diagnosis and timely treatment of CIN that lead to a decrease in the detection of malignant pathology of this part of the body in the later stages. Which treatments for dysplasia are most effective for each degree and how does the body recover after?
Diagnosis of pathology
Today, there are reliable and highly informative ways of detecting cervical intraepithelial dysplasia. But, unfortunately, many methods require expensive equipment and services, which often can not afford budgetary health care.
Publicly available methods of
Traditionally, throughout the post-Soviet space, the diagnosis of cervical pathology is performed by sampling the material with a cytoplasm( cytoplate, sponge or spoon of Volkmann).Immediately the resulting cellular composition is applied by the doctor to the slide and sent to the laboratory, where the staining and further research is carried out. There are two methods - according to Romanovsky-Giemsa and Pappanikolaou. Most often as a free survey is given the coloring of the first method. The use of the Pappanikolau method is more informative in terms of pathology detection, but it requires more financial investments. Therefore, this type of research is not generally accepted in Russia and nearby countries.
As a result, most women after a standard examination at a gynecologist have a result of cytological examination of smears from the cervical canal using Romanovsky-Giemsa staining. The detection of pathology is 40 - 60%.In order to be able to carry out the removal of cervical dysplasia in an operative way, including cauterization, this study is not enough.
The most informative methods of
As a rule, only private clinics use the rest of the survey spectrum, in which the probability of finding a pathology is 95 - 98%.These include:
- Liquid thin-layer cytology. The essential difference of the method lies in the special form of material storage. Also, this method eliminates many of the errors that often occur with normal staining, even in Pappanikolaou. Cells from the surface of the cervix are stored in the laboratory for some time. You can take them at any time, for example, if a dysplasia is detected to identify HPV and HSV.
- PCR detection of the presence of human papillomavirus , especially of oncogenic strains - 16, 18, 31, and also of herpes 1 and 2. Often this examination is prescribed when erosion or suspected sexual infection is detected.
- Colposcopy study. Is an additional method of confirming dysplasia. All the signs and symptoms obtained in this case are approximate and can be present immediately with several pathologies. Colposcopy - a fairly subjective study, depends on the quality of equipment and the professionalism of the doctor.
- Biopsy of the cervical region followed by a histological examination. Often, this requires local anesthesia. Histological examination is the last instance for confirming or refuting dysplasia. But the problem is that CIN can be localized in some specific area of the cervix without affecting the entire surface. To increase the percentage hit precisely in the affected area on the eve of a biopsy, a coloscopy is performed and the area where the greatest changes are noted is excised. If dysplasia is detected, surgical treatment is performed only after a histological confirmation of the diagnosis.
Treatment options
Treatment of cervical dysplasia of any degree complex, includes conservative therapy and various surgical methods.
Conservative therapy
CIN occurs both on the background of active inflammation, and without it. An obligatory stage of the examination in the presence of this pathology is the determination of the presence of sexually transmitted infections. Often there is a mixed pathogenic flora, which causes similar changes on the cervix.
With regard to a moderate degree, adequate conservative therapy can translate the disease from CIN 2 to 1. The pronounced form of dysplasia initially entails more radical therapies, since it involves serious changes in the epithelium of the cervical mucosa.
It is noteworthy that a combination of forms is often found. For example, with biopsy from different sites on the cervix of the uterus, it is determined both an easy and moderate degree of dysplasia. Treatment and diagnosis is based on a more severe form.
Numerous studies have shown the relationship between the deficit of certain vitamins in a woman's body and the appearance of this pathology. Proceeding from this, not only preventive measures, but also in the course of treatment, the diet should be healthy, diverse and enriched with useful substances.
Thus, the relationship between deficiency of vitamins A, E, C, folic acid, omega-unsaturated acids, B6 and B12, selenium, as well as bioflavonoids, probiotics and some others has been revealed.
We recommend to read an article about the treatment of cervical dysplasia folk methods. From it you will learn about non-medicamentous treatment of dysplasia, the effectiveness of folk recipes, the use of calendula, aloe, propolis and other means. Operative therapy
Surgical treatment of mild to moderate dysplasia is performed only after complex conservative therapy, as this can affect the volume of tissues to be removed.
Diatheromocougulation and radio wave removal
DEC is one of the popular methods for treating dysplasia due to the availability of this inexpensive equipment in almost all medical institutions. But this method has a number of shortcomings, and in recent years, the use is limited due to the emergence of modern, more effective and less traumatic techniques.
The essence is this. A special loop, to which an electric current is supplied, removes the affected area on the cervix. The big drawback is that the depth of immersion can only be controlled by one's own sensations. As a result, you can remove either too much or little. In the latter variant, the treatment will have to be supplemented, since dysplasia will continue to progress.
After diathermocoagulation on the cervix, cicatricial changes often remain, which in the future can affect the process of conception and childbirth. Also, the healing is long( about two months) and is accompanied by abundant pus-like secretions.
Like DEC, radio wave treatment of dysplasia is performed. The only difference is that the action is not electric current, but radio waves of a certain frequency. The healing is also less prolonged, does not leave behind cicatricial changes.
Cryodestruction
Provides exposure to liquid nitrogen. In this case, the developing scar on the cervix has a more loose structure. This is due to long-term excretion, but they are mucocutaneous by character, less often with a purulent shade.
When cold destruction is also difficult to limit the depth of the lesion. Therefore, as in the case of diathermoculation, a malignant process must be excluded before the procedure.
Laser exposure
This is one of the promising and modern techniques, sometimes called "laser knife".Indeed, in terms of accuracy, further healing, this is one of the most favorable treatments. But the procedure is dangerous because during her conduct the woman must remain completely calm, because any unplanned movement can lead to serious damage to neighboring tissues. Therefore, the treatment of dysplasia with a laser is performed under intravenous or general anesthesia under operating conditions.
Distinguish laser action of high and low intensity. The first option is preferable for several reasons. First, there are removed tissues that can be examined histologically. And this is very important, since it is on this basis that one can judge the radical nature of the treatment. Secondly, burns and overheating of tissues are markedly less often.
Knife removal
Many practitioners prefer this method of removing dysplasia. Can be performed as a knife conization, and amputation of the cervix. In the first case, the organ's tissues are removed by the usual surgical scalpel. Manipulation is performed most often under intravenous anesthesia.
Cervical amputation is a complete surgical operation. It presupposes the excision of tissues by the length of half and more of the cervical canal. This operation is more often performed with a pronounced degree of dysplasia and even the initial stages of cancer. The healing process is on average two months. Amputation of the cervix in the future during pregnancy can cause ismiko-cervical insufficiency and premature birth. Therefore, such women need to be monitored more carefully in the risk group for miscarriage and to carry out all preventive manipulations. After surgery, cervical dysplasia rarely recurs.
Restoration of the body after
After any treatment, there is an early and late recovery period. The first lasts about 1 - 2 months and includes immediate healing of the wound surface. At this time, complications may develop. Most frequent:
- bleeding,
- prolonged leucorrhoea,
- fever,
- pain in the vagina and lower abdomen,
- others.
If you have any complaints, you should consult a doctor who will additionally prescribe a therapy.
Remote consequences are also encountered quite often. Basically, these are problems with bearing and conception, as well as a high susceptibility to inflammatory diseases of the genital organs, a violation of menstrual function, the formation of foci of endometriosis, and others.
The use of any of the surgical methods does not lead to the end of therapy. Only preventive examinations several times a year for several years will make sure that the pathology has finally passed.
Cervical dysplasia is a serious pathology that, if untimely and inadequate, can lead to malignant diseases. Therapy of the disease includes both conservative schemes and operational techniques. Indications for radio wave treatment of dysplasia, the use of DEC, laser and other techniques can only be determined by a doctor after a thorough examination.