Cervical intraepithelial neoplasia is most often called cervical dysplasia among gynecologists. Such a pathology of stratified squamous epithelium is regarded as a precancerous condition, where the risk of cell changes is high. At the same time, the disease is treatable.
In most cases, the female body copes with the disease on its own in the absence of therapy. But the possibility of progression of the disease is not excluded, which, in fact, leads to the development of the oncological process.
General information
What is this type of pathology of the female body and what is the danger? Until 1975, the disease had an excellent name - dysplasia. With the development of the pathological processcharacteristics of mitosis of the cell nucleus and cytoplasm of the epithelium undergo significant changes. At the same time, the membrane and its upper layers remain intact.
Under certain circumstances, cervical intraepithelial neoplasia will transform into a malignant neoplasm. And if medical therapy is not started in a timely manner, the further development of the disease poses a serious threat to life. The precancerous condition is caused by the activation of the human papillomavirus (HPV), which is present in the body of almost every person. At the same time, experts identify several varieties of the virus, which further aggravates the situation.
Many people often confuse the two terms, calling dysplasia erosion. But this is not entirely true, since the last term does not fully convey the essence of what is happening. The fact is that erosion occurs due to damage to tissues of a mechanical nature, and dysplasia is already a violation of their cellular structure.
Each year, around 40 million women worldwide are diagnosed with cervical intraepithelial neoplasia, accounting for 15 to 18 percent of all cases of reproductive organ pathologies. At the same time, in most cases, young girls aged 25-35 are at risk. The incidence ratio is on average two people per one thousand of the population.
How the cervix works
In order to clearly understand and realize the danger of pathology, you should have a good understanding of the anatomy of the female body, inespecially the cervix. This term is called the lower part of the reproductive organ of a narrow and cylindrical shape. Partially it is located in the abdominal region and slightly extends into the vaginal area, in other words, it is located in both areas.
Gynecologists use special mirrors to examine the vaginal part. In the inner part of the neck there is a narrow cervical canal 10-15 mm long. The external os passes directly into the vagina, while the internal one faces the uterine cavity. In other words, this is a kind of small tunnel that connects the vagina to the reproductive organ. To examine the vaginal part in order to detect cervical intraepithelial neoplasia of the cervix, gynecologists use special mirrors.
The cervical canal is lined with bright red cylindrical epithelial cells. Inside them are special glands that secrete mucus, which serves as protection against various pathogens.
In the area of the external uterine os, cylindrical cells are replaced by flat ones. There are no glands here, and the shade is already pinkish. Moreover, this epithelium is formed by several layers:
- Basal-parabasal - the lowest border formed, in turn, by basal and parabasal cells. Under the basal tissue is the muscular structure, blood vessels, nerve endings. There are also young cells here that can divide.
- Intermediate.
- Superficial (functional).
He althy basal cells have roundedshape, inside them is a large nucleus. Gradually ripening, they rise to the top layer. At the same time, their shape is flattened, while the nuclei are reduced in size. As the cells get to the top layer, they become flatter with small nuclei.
With cervical intraepithelial neoplasia of 1, 2, 3 degrees, the structure of the cells is already slightly different - atypical elements appear that do not have any specific shape, and their size is very large. In addition, each such cell has several nuclei, and their division is even faster.
In the case of a pathological process, different layers of the epithelium are affected, except for the superficial one. Altered cells actively grow, and against this background, signs of nuclear atypia are formed.
Classification of pathology
Neoplasia is classified into several grades, depending on the severity of the pathology and the number of integumentary epithelial cells involved:
- I degree - mild (CIN1).
- II degree - moderate (CIN2).
- III degree - severe (CIN3).
On the territory of the Russian Federation, doctors mainly use this classification by I. A. Yakovleva and B. G. Kukute of 1977.
Mild neoplasia
This is a mild cervical intraepithelial neoplasia, in which the tissue structure is slightly changed, koilocytes are present. There is also a mild degree of proliferation of basal cells. The pathological process affects no more than a third of the thickness of the epithelium.
Moderate Dysplasia
Here it comesabout a more pronounced pathological process, which already covers up to 2/3 of the thickness of the mucous membrane of the cervix. Atypical cells are present on the lower and middle layers of the epithelium.
Severe case
This affects almost the entire thickness of the epithelium. In this case, a clear division into layers is no longer traced. In addition, pathological changes in mitosis and acanthosis can be detected.
Causes of occurrence
For HPV to lead to the development of a cancer process, a number of factors are required. It is worth noting that this virus can not provoke the appearance of cervical intraepithelial neoplasia of the 1st degree in every woman. As a rule, starting from the moment of infection with HPV or its activation and ending with the appearance of a precancerous condition, it takes about 1.5 to 5 years. The oncological process itself is formed over years or decades.
As for the development of neoplasia of the neck of the reproductive organ, the appearance of pathology is due not to one, but to several factors, as in the case of any other precancerous condition. Here we are talking about a whole combination of provocative reasons:
- Infection with a specific type of HPV.
- Hormonal contraceptive use for a long period of time (5 years or more).
- Begin early sexual activity (14-15 years).
- Intimacy with many partners.
- The presence of bad habits (smoking, not only active, but also passive).
- Weak immunity.
- Surgicalinterventions and abortions, more than once.
- Hormonal imbalance.
- Sexual diseases of an infectious nature.
- Hereditary predisposition.
But as noted above, it is often the papillomavirus that provokes the appearance of cervical intraepithelial neoplasia. Moreover, the disease can begin to develop with no symptoms and, as a rule, it takes up to 10 years from the onset of dysplasia to the onset of an oncological neoplasm.
Every person is susceptible to this virus, but especially those women who have an active sex life with several partners. Neglect of contraceptives, as well as ignoring the treatment of inflammatory processes in the organs of the reproductive system - all this only increases the risk of developing pathology. In addition, frequent births or abortions lead to cervical injuries.
Symptomatics
The danger of cervical intraepithelial neoplasia of grade 2 or more severe is that in most cases a woman simply does not feel the characteristic signs of the onset of pathological changes in the epithelium. At the same time, the woman does not feel pain, there is no increase in body temperature either, as well as deterioration.
Symptoms, if they appear, it will already indicate the presence of an associated infection, which leads to the development of a number of diseases:
- Inflammation of the cervix (cervicitis).
- Inflammatory process of the genitourinary system due to exposure to Trichomonas(trichomoniasis).
- Inflammation of the vagina (colpitis).
In this case, the woman will feel itching and burning in the vagina, spotting after intercourse, douching or using tampons. Leucorrhea may also change in texture, odor, and color (thick, copious, and foul-smelling). With severe cervical intraepithelial neoplasia, pain may appear in the uterus of a pulling nature.
Regular gynecological examination of women using instrumental, laboratory and clinical studies will allow timely detection of pathology and start treatment.
Diagnosis
As we now know, neoplasia, under certain circumstances, threatens to move to the development of a cancerous tumor. For this reason, early diagnosis will avoid serious complications. Any woman over the age of 21 should visit the gynecologist for a routine check-up every year, and undergo a cytological examination every three years.
Effective diagnostic techniques:
- Gynecological examination.
- Colposcopy.
- Targeted biopsy.
- Histology of the biopsy.
- Pap smear cytology.
The purpose of a gynecological examination is to identify visually visible changes in the mucous membrane. At the same time, in rare cases (3-4%), such an examination does not give the proper result. But mostly in women (20-24%), signs of cervical intraepithelial neoplasia of the 1st degree inthe face of a retention cyst, focal or diffuse hyperemia of the cervical mucosa. In a severe form of pathology, characteristic signs are often (64-73%) revealed: erosion, pseudo-erosion, leukoplakia of varying degrees of keratinization, exophytic growths of the epithelium.
Colposcopy is carried out with a special optical device (colposcope), which is capable of magnifying objects 10 times or more. With its help, you can not only carry out diagnostics, but also perform tests. That is, treat the neck of the genital organ with Lugol's solution or acetic acid.
A targeted biopsy is done during a colposcopy procedure. In this case, a sample is taken by cutting off a piece of tissue in the problem area.
Histology of a biopsy specimen is a histological examination of a sample taken during a biopsy. This technique is considered the most effective in detecting pathology.
A Pap smear is examined under a microscope, where atypical cells can be detected, as well as HPV markers, indicating grade 2 cervical intraepithelial neoplasia.
In addition, an ultrasound scan of the woman's genitals is mandatory. And as additional measures, a PCR study and a blood test for immune status are proposed.
Treatments
The choice of treatment method largely depends on several factors:
- age of patient;
- severity of pathology;
- what is the affected area;
- are there any comorbidities;
- presence of allergic manifestations to medications.
If the pathology is weakexpressed, then dynamic observations are carried out, and if any infection is detected, special therapy is prescribed. It is worth noting that the treatment of the initial stage of neoplasia is carried out using medications, however, when diagnosing cervical intraepithelial neoplasia of severity 2 and 3, only surgical intervention is indicated.
Medicine use
Because the treatment of neoplasia is carried out mainly through surgery, the use of drugs is being used as adjuvant therapy.
This is mainly due to the fact that at the initial stage of the development of pathology, there are no characteristic signs. The task of medicines in this case is as follows:
- Increase immunity power.
- Normalize the vaginal microflora.
- Elimination of hormonal imbalance.
- Suppression of HPV activity in the body.
- Therapy for sexually transmitted infections (STIs).
As for the medications themselves, the doctor usually prescribes "Interferon", "Prodigiosan", "Cycloferon", "Groprinosin", "Kagocel", "Genferon" and a number of other drugs. Given one feature of HPV, which is to suppress the production of its own interferon by leukocytes, and significantly, then the choice of these medications for the treatment of cervical intraepithelial neoplasia (CIN 1) is quite justified.
As a good antiviral agent"Panavir" differs in efficiency. It is possible to normalize the vaginal flora with the help of probiotics with bifidus and lactobacilli. STI therapy is carried out with the use of antibiotics, based on the variety of the pathogenic microorganism. In addition, the intake of B vitamins, antioxidants, omega acids is prescribed.
At the same time, it is not always possible to completely defeat the pathology, and for this reason, in most cases, doctors still refer patients for surgery. Only before and after such a procedure is a maintenance course of therapy using medications required.
Surgery
Depending on the individual characteristics of the female body, the list of contraindications, the size of the affected area, the prescribed surgical intervention may be of different types.
- Laser excision. This technique for the treatment of grade 3 cervical intraepithelial neoplasia is carried out using a laser scalpel, which actually excised the affected tissue.
- Radio wave therapy. It is considered a new technique in which the affected area is removed by exposure to high frequency radio waves. The "Surgitron" apparatus is involved in the operation.
- Electroconization. Here the procedure is performed using a metal loop, where an electric current is supplied. In this case, the affected cone-shaped area of the affected tissue is removed with the inclusion of he althy tissue. The operation is widely used in the treatment of cervical neoplasia. It can also be performed with a laser method, which can minimize the risk of bleeding. An operation is performed after menstruation.
- Photodynamic therapy. It is also a modern way of treating neoplasia. The technique works as follows: after the introduction of a photosensitizer into the body, it begins to accumulate in the neoplasm. At the same time, singlet oxygen is released in tissues with a changed structure, which leads to the death of atypical cells.
- Diathermocoagulation and cryodestruction. These methods of temperature exposure in relation to cervical intraepithelial neoplasia of the 3rd degree are used in extremely rare cases, due to the lack of control over the depth and volume of exposure by the doctor. And so the appearance of relapse in this case can not be avoided. Usually, cauterization or freezing is applied only to background pathologies, not precancerous ones.
Based on the data obtained from the histological examination, the specialist is already making further decisions. If cancer cells are found, additional surgery or radiation therapy, chemotherapy will probably be required.
Possible consequences
Proper treatment of neoplasia of the initial degree helps to suppress the replication of HPV, resulting in recovery. However, the lack of proper treatment threatens the development of serious complications. The uncontrolled progression of the pathology only exacerbates its course, and the transition time of stage I or II of the pathology to cervical intraepithelial neoplasia of the 3rd degree of the cervix depends on the individual characteristics of the person, his local andgeneral immunity.
The moderate stage of the pathology is also still being treated, only in this case the course will be longer, and the operation can often be performed more than once. The most severe degree of neoplasia can form into an oncological neoplasm with a probability of 50%.
However, the most threatening complication is the formation of an invasive form of cancer. At the initial stage, the process looks harmless. On the mucous membrane, this manifests itself in the form of redness. And often in the course of a more detailed diagnosis, a chaotic division of epithelial cells is determined. And if this process is allowed to develop calmly, then a small tumor is formed, which then nothing prevents from growing, which leads to the spread of metastases.
This can happen after severe cervical intraepithelial neoplasia if diagnosed late or if treatment is ignored for any reason.
Pathology and pregnancy
With neoplasia of the cervix of the childbearing organ, this is not a contraindication to prolong the pregnancy, but at the same time, the course of the atypical process is noticeably aggravated. During the period of bearing a child, treatment is more important than ever, because when HPV is activated, due to a decrease in the immunity of the female body, the microorganism can reach the fetus, which leads to intrauterine infection.
In addition, almost all types of the virus subsequently contribute to the defeat of the child's larynx. During childbirth, there is a risk of HPV getting intorespiratory tract of the child, due to which a respiratory disease such as papillomatosis develops.
Alternative method
We all know how effective folk recipes are for the treatment of various diseases. Neoplasia of the cervix is no exception, but it is better to consult your doctor before carrying out such therapy. Just keep in mind that, as in the case of the use of medications, the treatment of high-grade cervical intraepithelial neoplasia is ineffective, and sometimes even pointless.
You can fight pathology with the help of an infusion from the collection of certain types of herbs. To prepare it, you should take 1 tsp. sweet clover, 2 tsp yarrow, 3 tsp. nettles, the same amount of rose hips, 4 tsp each. flowers of calendula and meadowsweet. Mix all ingredients well, then 1 tbsp. l. pour a glass of boiling water over the mixture and let it brew for 30 minutes. With the help of this infusion, douching in the mornings and evenings, and as an addition, tampons should be inserted into the vagina from 30 to 40 minutes, soaked in the same solution. Carry out manipulations for a month.
Sea buckthorn oil is no less effective. They should also be soaked in a tampon and inserted overnight for 60-90 days. You can also use aloe juice for these purposes, only in this case you need to use tampons twice a day, and the course is 1 month.
