Obstetrics And Gynecology / / April 24, 2016
Cervical Dysplasia video
Cervical Dysplasia - are pathological changes in the cells on the surface of the cervix or abnormal growth of precancerous cells on the surface of the cervix, which can be seen under a microscope.Alternative names: cervical intraepithelial neoplasia (CIN), a precancerous cervical changes.
themselves, these changes are not cancer.This condition is classified as low or high degree of malignancy, depending on the degree of abnormal cell growth.Low degree of cervical dysplasia progresses very slowly and often normalizes itself.However, it can lead to cervical cancer, without a proper treatment.Without treatment, 30 - 50% of cases of severe dysplasia progresses to invasive cervical cancer.The risk of cancer is lower in the case of moderate growth.
Cervical dysplasia is directly linked to the human papilloma virus (HPV), a sexually transmitted virus.
Signs and symptoms of cervical dysplasia
cervical dysplasia often has no symptoms, and are usually found in the smear
Sometimes the signs and symptoms may include:
- Genital warts
- Abnormal menstrual bleeding
- Slight spotting after intercourse
- Vaginal discharge between periods
- Back pain
These symptoms can also be caused by other diseasesso it's important to see a doctor for an accurate diagnosis.
Causes Cervical Dysplasia
exact cause of cervical dysplasia is not known.Studies have shown a strong association between cervical dysplasia and infections of human papillomavirus (HPV).HPV is a common virus that is transmitted through sexual contact.There are many different types of HPV.Some types lead to the development of cervical dysplasia or cancer.
Cervical dysplasia is more common in women aged 25 - 35 years old, but can occur at any age.
The following factors may increase the risk of developing cervical dysplasia:
- Start early sexual activity;
- Early birth of a child (under 16 years);
- Having multiple sexual partners;
- Having a partner whose former partner had cervical cancer
- Intake of drugs that suppress the immune
system - Smoke
- Human papillomavirus (HPV)
- Genital warts
- history of one or more sexually transmitted diseases such as genital herpes orHIV
- Using birth control pills for more than 5 years
- women whose mother applied diethylstilbestrol (DES), to become pregnant or to sustain pregnancy.This drug is used in the 60s to prevent miscarriage.
- Low levels of folic acid (vitamin B9) in red blood cells
- Lack of vitamin A, beta-carotene, selenium, vitamin E and vitamin C.
diagnosis of cervical dysplasia
for diagnosis and screeningcervical dysplasia is held annually Pap test (smear on onkotsitologiyu, Pap test) even in the absence of symptoms.
cervical dysplasia, which is visible in the results of a Pap smear are called squamous intraepithelial lesions (SIL).These changes may be:
- Low degree of squamous intraepithelial lesions (LSIL)
- High degree of squamous intraepithelial lesions (HSIL)
- Starting cancer degree (malignancies)
- atypical glandular cells (AGUS)
Gynecological examination asgenerally ineffective in the diagnosis of dysplasia, so if there are any suspicious or unclear Pap test, it requires different diagnostic measures for the study of the extent of damage and malignancy:
- Cervical biopsy
- Test HPV
DNA - Cone biopsy(cone biopsy)
grade dysplasia of the cervix
Pap smear results are based on basis of medical terminology system, called the Bethesda system (Bethesda), which was developed in the US state of Maryland National Institutes of health in 1988 and amendedin 2001.The main categories for evaluation of abnormal results of Pap smears are as follows:
Atypical squamous cells
Atypical cells of squamous epithelium of undetermined significance
word "squamous" describes a thin, flat cells that lie on the surface of the cervix.One of the two options is added to the end of the ASC:
Low grade squamous intraepitelial lesion
low degree of squamous intraepithelial lesion
This means that changes characteristic of mild dysplasia, are seen in cells of the cervix.
High grade squamous intraepitelial lesion
high degree of squamous intraepithelial lesion
cells with severe dysplasia are not visible
Carcinoma in situ
carcinoma in situ
Invasive cancer, the accumulation of histologically abnormal cells without sprouting into the underlying tissue.Characterized as a rule, small size, lack of clinical manifestations, very slow growth and the absence of metastases, it does not manifest itself and is found usually by accident.
Cervical intraepithelial neoplasia grade 1
dysplasia of the cervix 1 degree
Cervical intraepithelial neoplasia 1 degree
presence of dysplasia in the lower third of the cervix, or in the epithelium (formerly lightdysplasia).It is considered a low degree of defeat.
Cervical intraepithelial neoplasia grade 2
dysplasia of the cervix 2 degrees
cervical intraepithelial neoplasia grade 2
A complete defeat when dysplastic cellular changes have covered two-thirds of the mucous tissue (formerlymoderate dysplasia).
Cervical intraepithelial neoplasia grade 3
cervical dysplasia grade 3
cervical intraepithelial neoplasia grade 3
high degree of defeat, when pre-cancerous changes in the cells have covered more than two cervical thirdsfull-thickness mucosal tissue (previously called severe dysplasia and carcinoma.)
treatment of cervical dysplasia
Choice of treatment depends on the degree of dysplasia.Light dysplasia (LSIL or CIN I) may disappear without treatment.Patients only need careful medical monitoring with repeat Pap smears every 3 - 6 months.If the changes persist or worsen, treatment is necessary.
Treatment of moderate and severe dysplasia, as well as mild dysplasia that does not go over time may include surgical removal of the abnormal tissue, which is the most common treatment for cervical dysplasia.Ninety percent of these procedures can be done on an outpatient basis.These procedures include:
- Cryosurgery (cryotherapy). This method uses extreme cold, which would destroy the abnormal cervical tissue.This is a simple and safe procedure, and typically consumes 99% of the abnormal tissue.Cryosurgery is often performed without anesthesia.The technique is used for the treatment of tumors, avoiding the pain, bleeding, and prevents damage to adjacent tissues.The probe is inserted into the cervix through which liquid nitrogen is circulated.To destroy diseased tissue, they are cooled to a temperature below -200 degrees centigrade.Frozen tissue nekroziruyutsya and replaced by healthy.It will be appreciated that this procedure is not suitable for the treatment of moderate to severe dysplasia, and cervical cancer, but is effective for the treatment of low-grade dysplasia.
- Laser therapy. Impact on the cervix high-energy laser beam, allows accurate and complete removal of tissue by its vaporization (evaporation).Lasers are able to destroy the abnormal cervical tissue with less scarring than cryotherapy.Lasers are more expensive procedure, performed under local anesthesia, and give 90% recovery.
- Loop cervical electroexcision. loop electrosurgical excision, which allows you to accurately cut the anomalous tissue thin wire loop with different forms of the cervix: a semi-circular, square, triangular (conical excision or cone biopsy).LEEP procedure is performed under local anesthesia and has a 90% cure. This procedure is most often used for the treatment of dysplasia, including severe dysplasia.
- conization. During cervical cone biopsy removes a small cone-shaped area of abnormal tissue from the cervix.cervical conization requires general anesthesia and a 70 - 98% recovery, depending on how far the cancer cells have spread beyond the cervix.
- Electrocoagulation. This method is based on a tissue cauterization electric shock.In the vagina or cervix administered ball electrode.By applying and moving, the ball is treated with the modified portion of the cervix, causing thermal necrosis, ie,abnormal tissue necrosis.As a rule, this method is used in nulliparous women, as the cervix may lose elasticity.
- Hysterectomy. Hysterectomy is the surgical removal of the uterus.This surgery is used to treat almost all cases of invasive cervical cancer.Sometimes, a hysterectomy is performed to treat severe dysplasia.It can also be used if the dysplasia is repeated after all other treatment procedures.
- Medications. Medication is not used for the treatment of cervical dysplasia, but some research suggests that the development and progression of cervical dysplasia can be associated with specific nutrient deficiencies, including folic acid, beta-carotene and vitamin C.
important factorin deciding whether a particular method of surgical treatment is the patient's desire to preserve fertility, ie,ability to bear children.To date there is no reliable research on the study of infertility after treatment.
Expectations and prognosis of cervical dysplasia
Early diagnosis and timely treatment provide a recovery in almost all cases of cervical dysplasia.
About 90% of women were completely cured of cervical dysplasia, which means that 10% of women will have a recurrence of their disease after treatment, requiring additional treatment. Women who were treated with cervical dysplasia have a lifetime risk of recurrence of malignant cervical tumors.
Without treatment, severe cervical dysplasia can develop into invasive cancer.It may take 10 years or more.cancer risk lower in moderate growth of abnormal cells.
Cervical Dysplasia and pregnancy
cervical dysplasia may worsen during pregnancy, but treatment can usually be postponed until after delivery.
can safely do a biopsy for the diagnosis of cervical dysplasia during pregnancy.
treatment, such as a cervical cone biopsy or electrocautery can affect fertility.
prevention and prevention of cervical dysplasia
Pap test (smear on onkotsitologiyu). Pap smear is indispensable for identifying precancerous lesions and early stages of cervical cancer.Despite its value, it is not always 100% accurate.Up to 2% of women with a normal Pap smear actually have cervical dysplasia during the evaluation.In some rare cases, the Pap smear can produce "false positive" results, which means that a healthy woman can be mistakenly diagnosed with cervical dysplasia.Despite these mistakes, a Pap test is the most effective and safe method of detecting cervical dysplasia.
Prevention and control of HPV. Although there is no sure way to prevent cervical dysplasia, a regular Pap test (smear on onkotsitologiyu) is the most effective way to detect it in its early stages and prevent dysplasia from progressive cervical cancer.
barrier contraceptives, such as condoms, may offer some protection against cervical dysplasia, or rather reduce the risk of HPV infection.This contributes to the failure of t promiscuous and frequent change of sexual partners.
Girls aged 9-26 years can get HPV vaccine (Cervarix, Gardasil) that protects against HPV, the most common cause of cervical cancer.The vaccine is also approved for boys and young men aged 9 - 26 years.Although the vaccine can prevent up to 70% of cases of cervical cancer, it can not prevent all the reasons that cause cervical cancer.
Quitting smoking also reduces the chance of developing cervical cancer.
Nutrition and nutritional supplements. diet rich in beta-carotene, vitamin C and folic acid (vitamin B9) of fruits and vegetables, cruciferous vegetables such as cabbage, cauliflower and broccoli, play a particularly important role in the prevention of cancer, including cervical cancer.
These simple tips can help reduce the risk of developing cervical dysplasia.However, if you have cervical dysplasia, you should ask your doctor before making any changes in your diet or taking any supplements.
- Eat foods rich in calcium, including beans, almonds, and dark green leafy vegetables such as spinach and kale.
- Eat more cruciferous vegetables such as cabbage, broccoli and cauliflower.
- Eat foods rich in antioxidants, including fruits such as blueberries, cherries, and tomatoes, and vegetables such as squash and bell peppers.
- Avoid refined foods such as white bread, pasta and sugar.
- Eat more lean meat, fish, or beans as a source of protein.
- Use healthy oils, such as olive oil.
- Reduce or eliminate trans fatty acids contained in the finished baked goods such as cookies, crackers, cakes, French fries, donuts, processed foods and margarine.
- Avoid caffeine, alcohol and tobacco.
- Drink 6 - 8 glasses of filtered water per day.
- Moderate exercise for 30 minutes a day, 5 days a week.
Several population studies show that eating foods rich in these nutrients from fruits and vegetables may protect against the development of cervical cancer:
Beta-carotene. Some controversial clinical studies show that people who are deficient in beta-carotene may be more likely to develop cancer or precancerous lesions of the cervix.Other studies show that taking beta-carotene as a food supplement can help reduce the symptoms of cervical dysplasia.Despite these promising results, there is no evidence that the use of beta-carotene to prevent cervical dysplasia is effective.