Tumor-like diseases of the female genital organs. Precancers of the female reproductive system. I. Background processes

Malignant diseases, as a rule, are preceded by pathological processes against which they arise. Timely diagnosis of precancerous diseases, their treatment are effective for cancer prevention. The basis of precancer is morphological changes, but when taking anamnesis and examination, it is necessary to take into account the clinical manifestations and the nature of the development of the disease.

Precancerous diseases of the vulva and vagina

The disease occurs most often in menopause and is characterized by gradually developing atrophy of the skin, mucosa, and subcutaneous tissue of the vulva. Kraurosis and leukoplakia are based on complex metabolic and neuroendocrine processes.

Crowrose. Pronounced atrophic processes are noted. Gradually, the skin of the labia wrinkles, atrophy of the mucosa occurs, the entrance to the vagina narrows. The process is accompanied by persistent itching, urination is difficult, sexual activity is impossible.

Leukoplakia. In this disease, dystrophic changes in the mucosa are accompanied by keratinization of the epithelium, which is manifested by the appearance of dry white plaques of various sizes in the area of ​​the external genital organs. In addition to the vulva, leukoplakia can be localized on the mucous membrane of the vagina and cervix. The combination of kraurosis and leukoplakia requires increased attention and timely complex treatment, since there is a high risk of malignancy. Examination of patients includes mandatory colposcopy and biopsy.

Treatment patients should be complex, use general strengthening therapy, a sparing diet, sedatives, topical application of estrogen-containing ointments, novocaine blockades, a helium-neon laser, symptomatic therapy, etc. In the absence of the effect of the treatment, they resort to surgical treatment.

Background diseases of the cervix

Background diseases include true erosion, pseudo-erosion, ectropion, leukoplakia.

true erosion

This is a condition of the cervix in which part of the stratified squamous epithelium is missing. Erosion occurs against the background of traumatic and inflammatory effects on the cervix (radiation therapy, traumatic gynecological examination, colpitis). True erosion is a short process, after 5-10 days it turns into pseudo-erosion due to the cylindrical epithelium "creeping out" of the cervical canal and covering the surface of true erosion.

pseudo-erosion

It can exist for a long time - for years, it supports the inflammatory process in the cervix due to infection of the erosive glands. If left untreated, basal cell hyperactivity appears on the erosive surface, which is sometimes complicated by atypia, which makes it possible to attribute long-term pseudo-erosion to precancer.

Clinical manifestations of erosions and pseudo-erosions are uncharacteristic, the diagnosis is made during examination followed by additional research methods - colposcopy, biopsy.

Erosion treatment is mandatory. When choosing methods of treatment, it is necessary to take into account age, prescription of erosion, the presence or absence of childbirth in history. Conservative methods of treatment are used in nulliparous, with "fresh" erosions. As therapeutic measures, it is proposed to sanitize the vagina, use ointment tampons with anti-inflammatory and regenerating properties (sea buckthorn oil, fish oil, antibacterial emulsions). In the absence of the effect of conservative therapy, with long-term erosion, with erosion in those giving birth, surgical methods are the method of choice. The essence of surgical methods is reduced to the destruction of pathological substrates of pseudo-erosion, followed by their rejection. Then the former pseudo-erosion surface is regenerated.

Surgical methods:

• diathermocoagulation. The technique and techniques of this procedure have been developed for a long time and are widely used. The efficiency of the method is about 70%. Negative sides - cicatricial deformity of the cervix with deep coagulation, menstrual irregularities, the risk of endometriosis. The method is not used in nulliparous;
• cryotherapy(cryodestruction with liquid nitrogen). In recent years, it has occupied a prominent place in the treatment of pseudo-erosions. The advantages of this method are manifold: painlessness of the intervention, its bloodless nature, no risk of scar tissue formation, rapid epithelialization of the surface of the cervix after rejection of necrotic pseudo-erosion tissue. The method can be applied to nulliparous;
• laser therapy. It is currently widely used for the treatment of pseudo-erosions. Laser radiation has a stimulating effect on regeneration processes in the absence of the risk of tissue scarring. Epithelialization occurs quickly on the 10-20th day after the procedure.

All three methods are used after extended colposcopy and biopsy to exclude the processes of severe dysplasia. After applying these methods, women are under careful dispensary observation.

Ectropion

Eversion of the mucous membrane of the cervical canal on the vaginal part of the cervix. Most often, these are the consequences of ruptures of the circular muscle fibers of the cervix. The cause of ruptures can be childbirth, traumatic expansion of the cervical canal of the cervix during abortion, diagnostic curettage of the uterine mucosa. In fact, ectropion is a combination of pseudo-erosion with cicatricial deformity of the cervix. After examination, the patient choose one or another method of surgical treatment. It is necessary to take into account age, the state of reproductive function and the degree of deformation of the cervix.

Leukoplakia of the cervix

It has no symptoms and is detected when examining the cervix with the help of mirrors. White spots are visible, which are local processes of keratinization of the stratified squamous epithelium. The cause may be immune disorders, dyshormonal changes and inflammatory processes. After the examination, individually selected treatment is carried out, which depends on the age, reproductive function of the patient. With simple leukoplakia in young women, cryodestruction and laser vaporization of the cervix are used. With leukoplakia with atypia, diathermoconization or amputation of the cervix is ​​​​used, taking into account the age of the patient.

Dysplasia of the cervix.

The basis of dysplasia are the processes of proliferation. Depending on the degree of proliferation, the presence of atypical cells and the localization of the process in different layers of the epithelium, dysplasia is divided into mild, moderate and severe. Cervical dysplasia does not have typical clinical manifestations. Diagnosis of dysplasia includes examination with mirrors, swabs for atypical cells, colposcopy with targeted biopsy. The most accurate diagnosis is made by histological examination of the biopsy material.

Treatment dysplasia is carried out taking into account all diagnostic indicators and concomitant diseases.

Precancerous diseases of the endometrium

These include recurrent hyperplastic processes, adenomatosis, atypical endometrial hyperplasia. Increased proliferation of glandular tissue occurs as a result of dyshormonal disorders and can be established during a histological examination of the material obtained during hysteroscopy or diagnostic curettage of the mucous membrane of the uterine cavity. The leading role in the pathogenesis of hyperplastic processes belongs to hormonal disorders in the form of hyperestrogenism. However, hyperplastic processes in the endometrium can also occur in violation of tissue reception. The main clinical manifestations of hyperplastic processes are various kinds of uterine bleeding. The final diagnosis can be made with a comprehensive examination with a mandatory histological examination of the endometrium. You can get the material with diagnostic curettage of the uterine mucosa, with hysteroscopy or aspiration from the uterine cavity. Treatment of patients can be conservative - it is a normalizing hormone therapy, or operative - in the presence of organic diseases such as uterine fibroids, endometriosis, ovarian cysts, etc.

Precancerous diseases of the ovary

In 80-85% of cases of malignant ovarian tumors, cancer occurs a second time with malignancy (malignancy) of benign ovarian tumors. Therefore, all cystomas are precancer. Patients are subject to surgical treatment. The volume of surgical intervention depends on the age of the patient and the nature of the tumor.

Timely detection of precancerous diseases of the female genital organs, examination of patients, treatment of precancerous diseases is a reliable prevention of cancer of the female genital organs. Early detection of precancerous diseases is possible only during mass preventive examinations. To this end, it is necessary to use all measures of explanatory work with the population - conversations, lectures, speeches in the media.

No one knows the unambiguous cause of oncological disease with one or another localization. But, there are a number of pathologies that are considered precancerous and, without proper timely treatment, can provoke the development of a malignant tumor. So, cervical cancer can have causes not only in the form of the human papillomavirus or exposure to carcinogens, but also chronic pathologies that have not been treated for years.

Most pathologies of the female genital organs, which are considered precancerous diseases, respond well to treatment. And with timely therapy, they do not give a single chance to develop an oncological process, but in the case of a negligent attitude to health and lack of treatment, the disease will sooner or later degenerate into a cancerous tumor.

Cervical cancer

Oncology can be formed as a result of the lack of treatment of the following pathologies:

• cervical erosion;
• polyps;
• leukoplakia;
• cervical dysplasia, its deformation, etc.

Erosion

Erosion is a common pathology in women. It occurs in both very young girls and older women. The disease consists in violation of the integrity of the epithelium of the cervix, in the occurrence of an ulcer. Pathology may not manifest itself for a long time, but without therapy, cervical erosion can develop into cancer. In order to exclude this possibility, it is necessary to undergo a preventive examination by a gynecologist at least once every six months. If there is erosion, the doctor will prescribe treatment, as a rule, it consists in cauterizing the ulcer with liquid nitrogen or current.

The procedure is performed without hospitalization, without the use of anesthesia and takes no more than 10-20 minutes. The only prerequisite before cauterization is to take a sample of erosive tissue for histological analysis, in order to exclude the fact that cervical erosion has developed into cancer.

Informative video: E rosia - precancerous disease of the cervix

Erosion can occur for a number of reasons:

• hormonal imbalance;
• weakened immune system;
• inflammatory processes in the genitals of a woman;
• mechanical damage to the cervical mucosa.

Erosion has no characteristic symptoms. Basically, women do not feel discomfort, pain or other manifestations and learn about the presence of a problem after examining a gynecologist. In rare cases, when there are significant mucosal lesions, bloody or bloody discharge may appear after or during intercourse. In this case, you should immediately contact a specialist.

In addition to cauterization with electric current or freezing with liquid nitrogen, other methods can be proposed in the treatment of erosion, such as radio waves or a laser. The latest therapies are the most modern, and have a limited number of side effects.

Leukoplakia

In addition to uterine erosion, cervical treatment can also occur due to other diseases, one of which is leukoplakia. The disease consists in the defeat of the mucous membrane of the lower genital tract of a woman. Visually, such changes are characterized by compaction and keratinization of the epithelium layer, on which a white or dirty gray coating appears.

Leukoplakia can be of several types:

• erosive- in this case, cracks or small sores form on the surface of the white plaque;
• flat- the most asymptomatic form, as a rule, does not show any signs of its existence. With the course of the disease, whitish foci appear that do not rise above the epithelium and do not cause pain. Basically, this form is found on examination by a doctor;
• warty- the foci in this case rise above the epithelium in the form of small growths. They can overlap one another, thus, the walls of the cervix become tuberous. This form is considered the most dangerous and most often degenerates into a cancerous tumor.

If a pathology is detected, the affected tissue is always taken for histological analysis using. The exact causes of the development of leukoplakia have not yet been studied reliably.

Informative video: Leukoplakia of the cervix

The symptomatology of the disease depends on its form. So, for example, the warty form often brings discomfort, pain and a burning sensation. In the erosive form, patients notice sanious discharge, especially after intercourse, and sometimes itching. The flat form rarely manifests itself, except for the presence of a white coating, which can only be seen by a doctor during examination.

For the treatment of pathology, the following methods can be proposed:

• chemical coagulation;
• cryodestruction;
• radio wave surgery;
• electrocoagulation;
• laser application.

polyps

Benign formations in the form of polyps can be transformed into the development of a cancerous tumor without timely therapy. Polyps are pear-shaped or villous growths. They can be attached to the mucous membrane on a wide base or a thin leg. They can be single or multiple.

Cancer development

By themselves, polyps do not harm the body, but they can cause the development of oncology or uterine bleeding, and therefore require timely treatment. Therapy consists in the removal of these growths, most often a radical method is used for this - a polypectomy.

Fibromyoma of the uterus

A common disease among women, characterized by the formation of a benign tumor in the uterus from its muscular layer. For a long time, fibromyoma does not manifest itself until it reaches a significant size. With large nodes, the tumor can be palpated by the doctor even through the abdominal cavity. This form is dangerous with bleeding and degeneration into cancer. Of the symptoms, pain is noted in the back, buttocks and lower abdomen. The pain appears as a result of the large weight of the fibromyoma and its pressure on the nerve endings. Bowel and bladder disorders can also be diagnosed.

Informative video: Fibromyoma - tumor of the uterus

Therapy depends on the size of the fibromyoma and individual indicators. As a rule, they resort to the surgical method.

Each of the described pathologies with timely diagnosis responds well to treatment. But, without therapy, there is a high probability of developing cancer, and it will be much more difficult to cope with this pathology. For prevention purposes, doctors recommend systematic visits to profile examinations by a gynecologist. Don't be indifferent to your health!

Practical gynecology

Guide for doctors

Medical News Agency

UDC 618.1 BBK 57.1 L65

Reviewers:

G.K. Stepankovskaya, Corresponding Member of the National Academy of Sciences and the Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor, Department of Obstetrics and Gynecology No. 1, National Medical University named after. AA. Bogomolets;

AND I. Senchuk, doctor of medical sciences, professor, head. Department of Obstetrics and Gynecology of the Medical Institute of the Ukrainian Association of Traditional Medicine;

B. F. Mazorchuk, doctor of medical sciences, professor, head. Department of Obstetrics and Gynecology No. 1, Vinnitsa National Medical University. M.I. Pirogov.

Likhachev VC.

L65 Practical gynecology: A guide for doctors / V.K. Dashing-

chev. - M .: LLC "Medical Information Agency", 2007. - 664 p.: ill.

ISBN 5-89481-526-6

The practical guide provides modern ideas about the etiology and pathogenesis of the most common gynecological diseases, algorithms for their diagnosis and treatment, based on the principles of evidence-based medicine. The issues of inflammatory diseases of the female genital organs are described in detail with the characteristics of sexually transmitted infections; the problem of infertility and the use of modern reproductive technologies; all aspects of menstrual disorders, the course of menopause and postmenopause; background conditions, precancerous diseases and tumors of the female genital area; problems of endometriosis and trophoblastic disease; family planning methods; clinic, diagnostics and tactics of treatment in cases of "acute abdomen". The appendices provide information about modern pharmacological preparations, methods of herbal medicine, gynecological massage and therapeutic exercises.

For practicing doctors - obstetrician-gynecologists, family doctors, senior students, interns.

UDC 618.1 BBK 57.1

ISBN 5-89481-526-6 © Likhachev V.K., 2007

© Design. OOO "Medical Information Agency", 2007

List of abbreviations................................................... .......................................... 12

Chapter 1. Methods of examination of gynecological patients.......................... 16

1.1. Anamnesis................................................. ......................................... 17

1.2. Objective examination .............................................................. ..... 17

1.3. Special laboratory research methods ........ 22

1.3.1. Cytological diagnostics ............................................... 22

1.3.2. Tests of functional diagnostics of ovarian activity 22

1.3.3. Hormonal studies............................................... 25

1.3.4. Genetic research............................................... 27

1.4. Instrumental research methods .......................... 30

1.4.1. Probing the uterus .................................................................. ....... thirty

1.4.2. Diagnostic fractional curettage of the cervical canal and uterine cavity 30

1.4.3. Puncture of the abdominal cavity through the posterior

vaginal fornix.................................................................. ................ 31

1.4.4. Aspiration biopsy .................................................................. 31

1.4.5. Endoscopic research methods .......... 32

1.4.6. Ultrasound ........................................................ 35

1.4.7. X-ray methods of research ............... 37

1.5. Features of the examination of girls and adolescents ............ 39

Chapter 2............... 43

2.1. Mechanisms of development of inflammatory diseases

female reproductive organs .................................................................. ........ 43

2.1.1. Factors of occurrence of inflammatory diseases of the female genital organs 43

2.1.2. Mechanisms of biological protection of the female reproductive system from infection 44

2.1.3. Conditions that violate the barrier mechanisms of protection of the female reproductive system 45

2.1.4. The main links in the pathogenesis of inflammatory diseases of the female reproductive system 46

2.2. Characteristics of infections transmitted

sexually .............................................................. ......................... 48

2.2.1. Trichomoniasis .................................................. ................. 48

2.2.2. Gonorrhea................................................. ............................ fifty

2.2.3. Urogenital candidiasis .............................................. 54

2.2.4. Chlamydia ................................................................ ....................... 56

2.2.5. Mycoplasmosis and ureaplasmosis...................................... 60

2.2.6. Bacterial vaginosis.............................................................. 63

2.2.7 Infections caused by the herpesvirus family 66

2.2.8. Papillomavirus infection .............................................. 73

2.3. Clinic, diagnosis and treatment of individual forms
inflammatory diseases

female reproductive organs .................................................................. ...... 76

2.3.1. Vulvitis................................................. .............................. 76

2.3.2. Bartholinitis ............................................................ ................... 80

2.3.3. Colpitis................................................. ....................... 83

2.3.4. Cervicitis .................................................. ......................... 95

2.3.5. Endometritis .................................................. ................... 98

2.3.6. Salpingo-oophoritis .................................................. ......... 102

2.3.7. Parametritis................................................. ................... 118

2.3.8. Pelvioperitonitis .................................................. ........ 119

Chapter 3.................................................. 123

3.1. Neurohumoral regulation of reproductive

functions of a woman .................................................. ................... 123

3.1.1. Physiology of the female reproductive system.. 123

3.1.2. Neurohumoral regulation

menstrual cycle .................................................................. .. 135

3.1.3. The role of prostaglandins in the regulation of the female reproductive system 136

3.1.4. Anatomical and physiological features of the functioning of the female genital organs

in different age periods .............................. 137

3.2. Hypomenstrual syndrome and amenorrhea .............................. 141

3.2.1. General principles of examination and treatment of patients

with hypomenstrual syndrome and amenorrhea.... 145

3.2.2. General principles for the treatment of patients

with hypomenstrual syndrome and amenorrhea .... 146

3.2.3. Features of clinical manifestations, diagnosis and treatment of primary amenorrhea 151

3.2.4. Features of clinical manifestations, diagnosis and treatment of secondary amenorrhea 160

3.3. Dysfunctional uterine bleeding .............................. 173

3.3.1. Clinical and pathophysiological characteristics of dysfunctional uterine bleeding 175

3.3.2. General principles of examination of patients with DMC. 178

3.3.3. General principles for the treatment of patients with DMK .............. 179

3.3.4. Features of DMC in different age periods .... 181

3.4. Algodysmenorrhea .............................................. .................... 194

Chapter 4.......................................................... 199

4.1. Physiology and pathophysiology of perimenopausal

and postmenopausal periods....................................... 202

4.2. Pathology of the peri- and postmenopausal periods ...... 206

4.2.1. Psychoemotional and neurovegetative disorders 207

4.2.2. Urogenital disorders and trophic skin changes 211

4.2.3. Cardiovascular disorders

and osteoporosis .............................................................. .................... 213

4.3. Diagnosis of climacteric syndrome .................... 217

4.4. Drug therapy for the pathology of peri-

and postmenopausal periods....................................... 221

4.4.1. Hormone Replacement Therapy .................................. 224

4.4.2. Selective estrogen receptor

modulators ................................................. .................... 231

4.4.3. Tissue-selective regulator of estrogenic activity - STEAR 232

4.4.4. Phytoestrogens and phytohormones .............................. 233

4.4.5. Androgens ................................................................ ....................... 234

4.4.6. Systemic and local HRT for urogenital disorders 234

4.4.7. Prevention and treatment of osteoporosis .............................................. 235

4.5. Physiotherapy of the pathology of peri-

and postmenopausal periods....................................... 238

4.6. Phytotherapy of pathology of peri-

and postmenopausal periods....................................... 240

Chapter 5................................................................... 243

5.1. Characteristics of various forms

polycystic ovaries .............................................................. ...... 243

5.1.1. Polycystic ovary disease............................................... 243

5.1.2. Polycystic Ovary Syndrome .............................. 245

5.2. Diagnosis of PCOS .............................................. .................... 248

5.3 Treatment of PCOS............................................... ............................... 252

5.3.1. Conservative methods of treatment............................... 252

5.3.2. Surgical methods of treatment .............................. 256

5.3.3. Physiotherapy................................................. ................. 258

Chapter 6............................................................................................. 260

6.1. Features of clinical manifestations,

diagnostics and treatment of various forms of infertility............. 262

6.1.1. Endocrine infertility............................................... 262

6.1.2. Tubal and tubal-peritoneal infertility..... 276

6.1.3. Uterine and cervical forms of infertility .................. 282

6.1.4. Immunological infertility .................................... 283

6.1.5. Psychogenic infertility .............................................. 285

6.2. Algorithm for diagnosing infertility....................................... 285

6.3. Algorithm for the treatment of various forms of infertility....................... 287

6.4. Modern Reproductive Technologies ...................... 290

6.4.1. In vitro fertilization.............................. 291

6.4.2. Other Reproductive Technologies .................................. 294

6.4.3. Ovarian Hyperstimulation Syndrome....................... 296

Chapter 7

genitals................................................................................. 300

7.1. Background and precancerous diseases of the cervix

uterus ................................................. ...................................... 300

7.1.1. Etiopathogenesis of diseases of the cervix ............... 301

7.1.2. Classification of diseases of the cervix .............. 303

7.1.3. Clinic of diseases of the cervix .......................... 305

7.1.4. Diagnosis of background and precancerous diseases of the cervix 316

7.1.5. Treatment of background and precancerous

diseases of the cervix .............................................. 321

7.1.6. Clinical management of patients

with various forms of background and precancerous
diseases of the cervix .............................................. 328

7.2. Hyperplastic processes of the endometrium (HPE) .......... 331

7.2.1. Etiopathogenesis of HPE .............................................. ...... 331

7.2.2. GGE classification .............................................................. ...... 333

7.2.3. GPE clinic .................................................. ................... 339

7.2.4. Diagnosis of HPE .............................................. ........... 340

7.2.5. Treatment of HPE .............................................................. .................... 344

7.3. Hyperplastic and dysplastic processes
mammary gland (mastopathy) .............................................. 359

Chapter 8............................ 375

8.1. Uterine fibromyoma (FM) .............................................. .......... 375

8.1.1. Etiology and pathogenesis of FM .............................................. 375

8.1.2. FM classification .................................................................. ...... 379

8.1.3. Clinic FM .............................................. .................... 381

8.1.4. FM diagnostics .................................................. ............ 386

8.1.5. Treatment of FM ....................................................... .................... 391

8.2. Benign tumors of the ovaries .............................. 399

8.2.1. Epithelial benign

ovarian tumors ................................................................ .......... 404

8.2.2 Sex cord stromal tumors (hormonally active) 409

8.2.3. Germinogenic tumors.............................................. 411

8.2.4. Secondary (metastatic) tumors .................. 414

8.2.5. Tumor-like processes.............................................. 415

Chapter 9......................................................................................... 418

9.1. Etiopathogenesis of endometriosis............................................... 418

9.2. Morphological characteristic

endometriosis ............................................................ ........................... 422

9.3. Classification of endometriosis............................................... 422

9.4. Clinic of genital endometriosis.............................. 425

9.5. Diagnosis of endometriosis.................................................... ... 431

9.6. Treatment of endometriosis .............................................................. ............ 438

9.6.1. Conservative treatment............................................. 438

9.6.2. Surgery................................................ 445

9.6.3. Combined treatment .................................................. 447

9.6.4. Algorithms for managing patients with various forms of endometriosis 449

9.7. Prevention of endometriosis............................................... 452

Chapter 10........................................... 453

10.1 Acute bleeding from the internal genitalia

organs................................................. ................................... 454

10.1.1. Ectopic pregnancy .................................. 454

10.1.2. Apoplexy of the ovary .................................................... 469

10.2. Acute circulatory disorders in tumors
and tumor-like formations of internal

sexual organs .................................................................. ................. 472

10.2.1. Torsion of the pedicle of an ovarian tumor .............................. 472

10.2.2. malnutrition

fibromatous node .............................................................. 474

10.3. Acute purulent diseases of the internal

sexual organs .................................................................. ................. 476

10.3.1. Pyosalpinx and pyovar, tubo-ovarian purulent tumor 476

10.3.2. Pelvioperitonitis .................................................. .. 486

10.3.3. Widespread peritonitis.............................. 486

Chapter 11................... 490

11.1. Anatomical and physiological features

position of the internal genital organs ........................ 490

11.2. Anomalies in the position of the internal genitalia

organs................................................. ................................... 491

11.3. Omission and prolapse of internal

sexual organs .................................................................. ................. 495

Chapter 12............................................. 504

12.1. Methods of natural family planning ............................... 505

12.2. Barrier methods of contraception.............................. 509

12.3. Spermicides ................................................................ ......................... 512

12.4. Hormonal contraception................................................... 513

12.4.1 Principles of prescribing oral hormonal contraceptives 514

12.4.2 Combined oral contraceptives. 519

12.4.3. "Pure" gestagens ............................................... ......... 525

12.4.4. Injectable contraceptives .............................. 527

12.4.5. Implantation methods................................................... 530

12.5. Intrauterine contraceptives ................................................... 530

12.6. Voluntary surgical contraception (sterilization) 533

12.7. Emergency contraception .................................................................. 536

12.8. Principles for choosing a method of contraception .............................. 538

Chapter 13.................................... 543

13.1. Etiopathogenesis of gestational trophoblastic disease 544

13.2 Nosological forms of gestational trophoblastic disease 546

13.2.1. Bubble skid .............................................................. ...... 546

13.2.2. Chorionepithelioma (chorioncarcinoma) ........... 553

13.2.3. Other forms of trophoblastic

illness ................................................. ...................... 560

13.3.............................................. ................................................. Prevention of recurrence of gestational
trophoblastic disease .............................................. 561

Attachment 1. Antibacterial agents .................................................................. ... 562

1.1. Classification and brief description

antibacterial drugs .............................................. 562

1.2. Antimicrobial agents effective against individual microorganisms 572

1.3. Doses and routes of administration of some antibiotics. 578

1.4. Combination of antimicrobials .............................. 583

1.5. The use of antibacterial drugs

during pregnancy and lactation .................................. 584

Appendix 2 Antivirals of direct action .............................. 589

Appendix 3 Immunoactive drugs .................................................................. ........ 592

Appendix 4 Phytotherapy in complex treatment

gynecological diseases .................................................................. ... 598

4.1. Menstrual irregularities.............................................. 598

4.2. Pathological climacteric period .............................. 606

4.3. Inflammatory diseases of the female genital

organs................................................. ............................................... 608

4.4. Collections that improve blood circulation in small
pelvis and having antiseptic

and desensitizing properties .............................................. 613

4.5. Kraurosis of the vulva .............................................. ......................... 615

Appendix 5 Gynecological massage .............................................................. ........ 616

5.1. Mechanism of action of GM .............................................................. ........... 616

5.2. Indications, contraindications and conditions

GM. General methodology of GM .............................................. ........ 618

5.3. Features of GM techniques depending on

from testimonies .................................................. ............................... 624

Appendix 6 Therapeutic exercises for gynecological

diseases ................................................................ ................................... 637

6.1. Therapeutic exercises for non-fixed retroflexion of the uterus 637

6.2. Therapeutic exercises for the prolapse of the genital organs. 640

6.3. Therapeutic exercises for chronic inflammatory diseases of the female genital organs 641

6.4. Therapeutic exercises for dysmenorrhea ....................................... 644

6.5. Therapeutic exercises for functional urinary incontinence 645

6.6. Therapeutic exercises in the preoperative period.... 646

6.7. Therapeutic exercises for pathological menopause ........ 648

Appendix 7 Normal microflora of the vagina .............................................. 650

Literature................................................. ................................................. .... 655

Leukoplakia of the vagina

The disease manifests itself in the form of slightly raised plaques or white spots of various sizes in the area of ​​the labia, clitoris or perineum.

Kraurosis vulva

Vaginal papillomas

Diseases of the cervix

A special risk group are women with pathological processes in the cervical region:

Cervical erosion

Polyp of the cervix

However, the removal of a polyp is not a radical method of cure, since it is known that a focus of tumor growth can arise from externally unchanged areas of the mucous membrane of the cervix, which indicates the appearance in all its areas of common prerequisites for the occurrence of both polyps and malignant tumors. The concomitant chronic inflammation of the cervix complicates the situation and increases the risk of tumor degeneration of polyps.

Leukoplakia of the cervix

Diseases of the body of the uterus

It is necessary to take into account heredity, since it has been established that predisposition to ovulation disorders, obesity, diabetes mellitus and cancer of the uterine body can be inherited.

Predisposing factors include, first of all, a violation of ovulation, which causes primary or secondary infertility and is accompanied by the development of endometrial hyperplastic processes.

Polycystic ovaries (Stein-Leventhal syndrome)

Recurrent glandular hyperplasia of the endometrium

Endometrial polyps

Malignant degeneration of polyps is observed against the background of concomitant metabolic disorders, obesity and diabetes mellitus. Removal of a polyp is not a radical method of cure, since it is known that a focus of tumor growth can arise from externally unchanged areas of the endometrium, which indicates the appearance in all of its areas of the same prerequisites, both for the occurrence of polyps and malignant tumors of the endometrium.

uterine fibroids

The causes of the disease are frequent abortions, pathology of the cardiovascular system, liver disease, hormonal disorders. Oncological alertness is caused by growing fibroids with an increase in myomatous nodes during menopause and during menopause.

Obesity and diabetes are common precursors of uterine cancer. Therefore, the detection and treatment of not only overt, but also latent diabetes mellitus in women with any of these diseases is an important preventive anticancer measure.

Ovarian diseases

Various long-term changes and irregularities in the menstrual cycle are conditions that precede malignant changes in the ovaries.

An increased risk group includes women who have previously taken hormones for a long time in order to suppress the estrogenic function of the ovaries.

Until now, the distinction between ovarian tumors and inflammatory processes of the uterine appendages remains the most difficult. According to various clinics, 3-19% of patients with malignant ovarian tumors are under observation with an erroneous diagnosis of "chronic inflammation of the uterine appendages", and in 36% of cases, chronic inflammatory processes in the appendages are diseases associated with ovarian tumors. In addition, in some cases, these inflammatory processes play the role of a cause that provokes malignant transformations in benign ovarian tumors.

Benign tumors and tumor-like formations of the ovaries are represented by a large number of different forms. Complaints of patients and symptoms of the disease depend on the size and location of the tumor. Most often, patients complain of changes or disruption of the menstrual cycle, pain in the lower abdomen, less often in the lower back and rectum, which is often the cause of erroneous treatment "from sciatica" or "from hemorrhoids." Large tumors are manifested by the presence of palpable formations of the appendages, pain, and an increase in the abdomen. It must be remembered that any benign ovarian tumor can undergo a transition to a malignant one.

A great danger in terms of the occurrence of malignant ovarian tumors is fraught with long-term passive observation of patients with asymptomatic or asymptomatic uterine fibroids.

Finishing the description of precancerous diseases, it should be noted once again that the nature of these diseases does not lie in a local pathological change in some particular area of ​​tissue or organ. The reason for the appearance of precancerous conditions is always hidden more deeply and goes beyond the scope of a single damaged organ.

Pathological formations in organs or tissues can be compared with the tip of the iceberg, when the bulk of painful changes remain hidden, but the most significant. For this reason, surgical treatment that eliminates only visible manifestations of the pathological process is at least incomplete.

At the same time, precancerous changes in organs and tissues do not have to turn into cancer; they are completely reversible with the possibility of partial or complete restoration of the functions of all damaged organs. This is achieved by an integrated approach to the disease that has arisen, involving all organs and systems involved in the pathological process, without dividing a single disease with various organ manifestations into separate parts, which, unfortunately, occurs with traditional treatment by medical specialists.

It must be remembered that the main factors contributing to the further progression of precancerous changes in tissues include: maintaining a state of chronic inflammation in the altered organs or the pathological focus itself; chronic intoxication against the background of latent or chronic foci of infections, as well as chronic household or professional toxic effects; long-term disorders in the work of the endocrine glands with hormonal imbalance and changes in metabolism; chronic stress, exhausting the nervous and immune systems.

It becomes clear that the treatment of a precancerous disease is not an easy task, but with a correct assessment of all the changes in the patient, it is quite solvable. At the same time, the conscious participation and medical discipline of the patient himself is a necessary condition, since any, even the most effective prescriptions and useful advice from a doctor, cannot cure the patient by themselves. He needs to be actively involved. In the treatment of a precancerous disease, given its potential for transition or, conversely, not progression to cancer, the patient's intelligence often becomes a more important factor than his immunity.

A group of diseases that contribute to the emergence and development of malignant neoplasms in women are precancerous diseases of the female genital organs. Some of them respond well enough to treatment, but there are those that give a woman a lot of trouble.

Leukoplakia

Leukoplakia is a degenerative disease of the mucous membrane, which is accompanied by keratinization of epithelial cells. As a rule, such an ailment affects the external genital area and is characterized by the appearance of dry light plaques, which subsequently lead to sclerosis and tissue wrinkling. Leukoplakia can also be localized on the vaginal side of the uterine cervix or in the vagina itself.

There are two types of the disease: fine leukoplakia and scaly, which rises significantly above the surface of the uterine cervix. Often the disease indicates the occurrence of disorders in the functioning of the ovaries, although it can also be the result of papillomaviruses or herpes simplex. As a rule, leukoplakia is asymptomatic, only in some cases itching may occur. The treatment of the disease is mainly reduced to cauterization with a surgical laser, which in most cases gives a positive effect.

erythroplakia

The disease is characterized by damage to the mucous membrane of the cervix from the side of the vagina and leads to atrophy of the upper layers of the epithelium. Erythroplakia is a section of the epithelium that is translucent through. Symptoms of the disease are often absent, but in some cases contact bleeding and leucorrhea may occur. Erythroplakia is often accompanied by diseases such as cervicitis and colpitis with corresponding symptoms.

This problem of the female genital organs is treated with laser therapy or a surgical electric knife, in some cases cryosurgery is possible. With timely detection and treatment, the prognosis is usually quite favorable.

Fibromyoma of the uterus

Precancerous diseases such as uterine fibroids are very common and are a benign formation that develops from muscle tissue. Many women are not even aware of their illness, discovering it only during a visit to the gynecologist.

Fibromyoma can reach a considerable size and consist of nodes that can be palpated through the abdominal wall. In advanced cases, such a node can connect to the uterine wall and be accompanied by prolonged heavy menstruation, which often provoke the development of anemia. Sometimes there is pain or pressure in the pelvis, which is caused by the significant weight or size of the fibroids. Some women may be bothered by pain in the buttocks, lower back and back, which indicates the pressure of the formation on the nerve endings. Also, fibromyoma can lead to disruption of the intestines and urethra.

Methods of treatment of the disease depend on the size of the tumor and the severity of its symptoms. Possible treatments include:

drug therapy;

Surgical intervention;

Embolization of the uterine arteries.

Dysplasia of the uterine neck

Dysplasia is often the result of another concomitant disease of the female genital organs and, as a rule, does not have its own clinical picture. The reasons for this may be hormonal disorders, prolonged treatment with progestin drugs or pregnancy. However, dysplasia can be provoked by factors such as:

Bacterial, viral and fungal chronic infections

Vaginal dysbacteriosis;

Problems in the production of sex hormones;

Abuse of alcohol, smoking and spicy spices;

Chaotic sex life.

As a rule, precancerous diseases such as cervical dysplasia are treated in a complex manner, only in severe cases is it necessary to remove the damaged tissue using a laser, radio waves, liquid nitrogen, or surgical excision.

Ovarian cyst

An ovarian cyst is a benign formation that has the shape of a rounded cavity and contains a clear liquid, jelly-like mass, fat or blood. Basically, the disease occurs in young women and can develop into a malignant tumor, therefore, after detection, the cyst must be removed.

Types of cysts:

Follicular;

Paraovarian;

Mucinous

endometrioid

Serous;

Yellow cyst.

The symptoms of the disease include unpleasant pulling pains in the lower abdomen, menstrual disorders and the appearance of arbitrary bleeding. Often, cysts lead to disruption of the intestines, frequent urination, an increase in the abdomen, infertility, and even death.

The cyst of the corpus luteum and the follicular cyst are amenable to drug treatment, all other types of cysts are subject to immediate surgical removal, after which the woman can endure and give birth to a healthy child.

Vaginal cyst

This disease is more often detected by chance, as it has a small size. The vaginal cyst is located superficially, has an elastic consistency and contains a serous mass. Such precancerous diseases of the female genital organs are often complicated by suppuration, which leads to inflammatory processes and serious health consequences.

Polyp of the uterine neck

This disease is characterized by excessive growth of the mucous membrane and is a benign process. Polyps often occur in older women, which is explained by endocrine changes and chronic inflammation of the genital organs. The disease is often asymptomatic and is detected only during a gynecological examination. In some cases, a woman may experience heavy vaginal bleeding some time after menstruation. Rarely, a polyp turns into cancer.