Cervical cancer. Symptoms and signs, causes, stages, prevention of the disease. Diseases of the uterus, their causes and features What are the diseases of the cervix

Which doctors should you contact if you have cervical diseases?

What are Cervical Diseases

The frequency of background and precancerous processes of the cervix is very high and does not tend to decrease; the diseases affect a large contingent of young women and affect their reproductive health. Cervical cancer ranks third in frequency among malignant neoplasms of the genital organs. The average age of patients with cervical cancer is 52.2 years, with one peak incidence occurring at 35-39 years and another at 60-64 years.

Pathogenesis (what happens?) during Cervical Diseases

Pathological conditions of the cervix are presented in the WHO International Histological Classification (1975, 1995), the International Nomenclature of Diseases (MNS, 1992), the International Statistical Classification (ICD, 1995), the clinical and morphological classification of Ya.V. Bokhman (1976), classification by I.A. Yakovleva, B.G. Kukute (1977), etc. The following clinical and morphological classification of pathological changes in the cervix is most convenient for clinicians:

background processes (true erosion, cervical ectopia, ectropion, congenital ectopia, simple leukoplakia, erythroplakia, cervical polyps);
cervical precancer (cervical intraepithelial neoplasia);
cancer (pre-invasive, micro-invasive, invasive).

To refer to cervical precancer, the term “dysplasia”, proposed by J.W., has long been used. Reagan in 1956 and approved by WHO in 1973. Currently, the generally accepted designation is CIN (Cervical Intraepithelial Neoplasia). Recently, to designate pathological processes in stratified squamous epithelium, the term SIL (Squamous Intraepithelial Lesion) has been used, which was proposed by cytology in 1988. There are low and high degrees of damage.

Background, precancerous and malignant diseases of the cervix have different pathogenesis. The cervix of the uterus is covered with two types of epithelium. The vaginal portion of the cervix is covered with stratified squamous epithelium, and the cervical canal is lined with single-row columnar epithelium. Epithelial cells are separated from the stroma by a basement membrane containing reticulin, argyrophilic fibers, collagen, and neutral mucopolysaccharides. The stroma is represented by intertwining bundles of elastic, collagen fibers and contains blood and lymphatic vessels.

Multilayered squamous epithelium consists of cells that differ in size, shape, nuclear-cytoplasmic ratio, nucleus, and functional features. There are basal, parabasal, intermediate and superficial layers. The number of layers of intermediate cells and the activity of glycogen accumulation are estrogen-dependent and are maximally expressed in reproductive age, minimally during hypoestrogenism in the neutral period in girls and postmenopause. In postmenopause, the stratified squamous epithelium of the vagina and cervix is normally represented only by basal and parabasal cells. The processes of desquamation are most intense in the second phase of the menstrual cycle. The stratified squamous epithelium of the vaginal portion of the cervix does not keratinize, but with genital prolapse, when the mucous membrane is exposed to the drying effects of the environment, the surface cells can keratinize.

The cylindrical epithelium of the cervical canal is represented by one row of cylindrical, or goblet, cells with basally located round nuclei. Cells of the cervical canal and crypts are capable of producing mucopolysaccharides. As a result, a mucous plug forms in the cervical canal. The epithelial border has always attracted the attention of clinicians, since 90% of cervical pathology occurs in this zone (“storm zone”). At different age periods, the epithelial border can be located on different parts of the cervix: in girls and in the pubertal period (sometimes in young women) - on the vaginal portion of the cervix around the external pharynx, in reproductive age - in the area of the external pharynx, in postmenopause - on various level in the cervical canal. This must be taken into account when examining patients.

Symptoms of Cervical Diseases

Ectopic cervix implies displacement of the columnar epithelium to the vaginal portion of the cervix. The term “pseudo-erosion” has long been used to denote ectopia. There are acquired and congenital ectopia (pseudo-erosion).

Acquired ectopia is a polyetiological disease, in the genesis of which inflammatory, mechanical, and hormonal factors play a role. As a result of inflammatory changes, multilayered squamous epithelium with loosely laid, poorly cohesive layers under mechanical stress can be locally damaged and desquamated. Subsequently, columnar epithelium can be formed from reserve cells against a dishormonal background due to infectious influences, replacing multilayered squamous epithelium. In women with menstrual irregularities, ectopia occurs 5-6 times more often than in the population.

Patients with ectopia, as a rule, do not show any complaints; sometimes they may be bothered by leucorrhoea and contact bleeding, which usually happens with concomitant exo- and endocervicitis. During a gynecological examination, pseudoerosion looks like an irregularly shaped bright red area, often located asymmetrically on the anterior or posterior lip of the cervix against the background of the pale mucous membrane of the ectocervix. During colposcopy, ectopia appears as areas covered with many round or oblong red papillae, which creates the effect of a velvety surface. The bright red color is due to the vessels of the underlying stroma, visible through one row of cylindrical cells. Sometimes the picture can be complemented by a “transformation zone” - metaplastic and immature stratified squamous epithelium in the ectopic zone, open and closed gland ducts. The “transformation zone” reflects the processes of replacement of the cylindrical ectopic epithelium with multilayered squamous epithelium. Histologically, glandular, papillary pseudoerosions and with squamous metaplasia are distinguished.

The management tactics for patients with ectopia should be individual; for uncomplicated pseudo-erosion, observation with regular colposcopic and cytological monitoring is possible. When treating ectopia, cryodestruction, laser coagulation, radiosurgery (surgitron), and diathermoelectroconization are used. Chemical coagulation (solcogin) is of limited use.

The development of congenital ectopia is associated with hormonal effects of the mother’s body in the antenatal period. 50% of newborn girls have ectopic columnar epithelium. With the onset of puberty, migration of the epithelial border normally occurs; towards its end, the transition zone is located in the area of the external os of the cervix. If these processes are disrupted, columnar epithelium may remain on the ectocervix. From the point of view of histogenesis, congenital ectopia can be considered as a variant of the physiological norm.

Ectropion called eversion of the mucous membrane of the cervical canal onto the vaginal portion of the cervix as a result of ruptures of the circular muscle fibers of the cervix. Most often, ectropion occurs after childbirth, traumatic dilatation of the cervix during abortion, diagnostic curettage of the uterine mucosa and is essentially a combination of pseudo-erosion with cicatricial deformation of the cervix. The patient does not present any pathognomonic complaints. When examined on a deformed cervix with a gaping or slit-like external pharynx, red areas of columnar epithelium are visible, often with a transformation zone. Depending on the degree of cervical deformation, hypertrophy, cysts of the nabothian glands, as well as taking into account the age and state of the reproductive function of the patient, one or another method of surgical treatment is chosen (cryodestruction, laser coagulation, radiosurgical treatment - diathermoelectroconization)

Leukoplakia of the cervix(translated from Greek - “white spot”) is a local process of keratinization of stratified squamous epithelium of varying severity (parakeratosis, hyperkeratosis, acanthosis) with the formation of lymphohistiocytic infiltrates around the vessels of the underlying stroma. There are simple leukoplakia (background process) and proliferating leukoplakia with cell atypia. Leukoplakia with cell atypia is classified as cervical precancer and is classified depending on the degree of atypia. According to modern concepts, endocrine, immune, infectious (chlamydia, viruses) factors, and trauma play a role in the occurrence of leukoplakia.

This pathology is not accompanied by any symptoms. Upon examination, leukoplakia may have clinically pronounced forms, visible to the naked eye as raised white plaques on the ectocervix, or detected only by colposcopic examination. The colposcopic picture of leukoplakia may look like an iodine-negative zone in the form of a whitish shiny film with a smooth or bumpy surface due to the development of the stratum corneum of the epithelium. Multiple red dots at the base of leukoplakia (punctuation) and lines forming polygons in the fields of leukoplakia (mosaic) are caused by blood vessels in the connective tissue papillae and processes protruding into the epithelial layers of leukoplakia. In areas of leukoplakia there are no intermediate cells accumulating glycogen, which causes a negative Siller test. Cells accumulate keratin. Cytological examination does not reliably differentiate simple leukoplakia and leukoplakia with atypia, since cells taken from the surface of the epithelium do not reflect the processes occurring in the basal layers; a cervical biopsy with histological examination is required.

Treatment is carried out individually depending on the type of leukoplakia, its size, as well as the age and reproductive function of the patient. For leukoplakia with atypia, methods with histological control of the removed part of the cervix are preferred - diathermo-electroconization, radiosurgical conization. In young women with simple leukoplakia, in order to avoid cicatricial changes on the cervix, cryodestruction, laser vaporization, and radiosurgical treatment are used.

Erythroplakia(translated from Greek - “red spot”) implies the processes of local atrophy and dyskeratosis of the stratified squamous epithelium with a sharp thinning to several layers (there are no intermediate cells) with the preservation of normal epithelial cover in the adjacent areas of the ectocervix. Areas of erythroplakia are defined as reddish spots on the ectocervix, which is caused by the transillumination of stromal vessels through the thinned epithelium. To date, the etiology, pathogenesis and prognosis of this rare pathology have not been clearly studied. Treatment of erythroplakia involves destruction of the lesion by diathermocoagulation, conization, and cryodestruction.

P polyps of the mucous membrane of the cervical canal They are connective tissue outgrowths covered with epithelium. There are glandular (covered with single-row columnar epithelium) and epidermalized (covered with metaplastic stratified epithelium) polyps. Polyps appear as bright pink, oblong or leaf-shaped growths hanging from the external os of the cervix. Differential diagnosis is necessary with large endometrial polyps or with polyps arising from the lower third of the uterine cavity, therefore polypectomy is carried out under the control of hysterocervicoscopy. Modern ultrasound equipment with high resolution makes it possible to diagnose small polyps that do not extend beyond the external pharynx. They look like inclusions of increased or moderate echogenicity in the cervical canal. After the diagnosis of a polyp of the mucous membrane of the cervical canal is established, regardless of the patient’s age, polypectomy with careful removal of the polyp stalk or its coagulation under endoscopic control is indicated.

Precancer and cervical cancer have common etiology and pathogenesis. It is believed that carcinogens reach the cervix through sexual intercourse. Many traditional carcinogens and infectious agents are now assigned a very modest role (Trichomonas, chlamydia, herpes virus, sperm, smegma, etc.). Only the human papillomavirus is currently considered the real cause of precancer and cervical cancer. The virus is detected in 90% of cases of moderate, severe dysplasia and cervical cancer. More than 60 types of human papillomavirus are known, 20 of them can affect the genitals; serotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 have oncogenic properties. The most common are serotypes 16 and 18 ( more than 70%), other serotypes are detected in less than 30% of observations.

Human papillomavirus infection can be latent (carriage), subclinical (cytological changes) and clinically pronounced (endophytic, exophytic condylomas). In most cases, infection with the human papillomavirus goes undetected, the infection is asymptomatic and the virus is eliminated. In some patients who have a hereditary predisposition or a history of cervical cancer, cervical dysplasia occurs. Among patients in whom the virus of serotypes 16 and 18 is not removed, the virus infects a cell, integrates into the genome, replication begins, and subsequently dysplasia and cancer develop in 80% of cases. It is believed that hereditary defects in defense mechanisms and epithelial susceptibility may play a role in the occurrence of dysplasia and cervical cancer.

Cervical intraepithelial neoplasia (CIN) refers to processes of structural and cellular atypia (impaired cell differentiation) with impaired epithelial layering without involvement of the basal membrane. According to the WHO classification (1995), mild, moderate and severe CIN are distinguished. If a violation of the structure of the epithelium, cell polymorphism, an increase in mitoses, and dyskaryosis of nuclei are observed in the lower third of the epithelial layer, then they speak of CIN I, in the lower and middle thirds - of CIN II, if the above changes cover the entire layer - of CIN III. The conventional boundary between severe dysplasia and pre-invasive cancer is the involvement of the surface layer of the epithelium in the process. All these conditions are successive stages in the development of one rather long malignant process. The transition from dysplasia to cancer in situ takes an average of 2-10 years, and the onset of invasive cancer also takes an average of 10-15 years. Therefore, there is enough time to identify the precancerous process and the initial stages of cervical cancer.

Dysplasia remains asymptomatic and can occur with a visually unchanged cervix (10%) and with background processes (90%). The colposcopic picture of dysplasia may include pathological vessels (dilated, irregularly branched) in the area of transformation, punctation, mosaics, and a whitish color of the epithelium. Dysplasia causes local whitening of the epithelium with the acetoacetic test and iodine-negative areas with the Siller test. Cytological examination turns out to be informative in 60-90% of cases. However, neither colposcopy nor cytology can determine the degree of dysplasia and exclude preinvasive and microinvasive cancer. The final diagnosis is made on the basis of histological findings. A targeted knife biopsy of the cervix with curettage of the cervical canal allows one to obtain material for histological examination. It is not recommended to perform a biopsy with a conchotome (special forceps), since this technique does not allow assessment of the underlying stroma. Electroloop biopsy is also not recommended, since coagulation tissue damage obscures pathological changes. It is necessary to avoid unnecessary biopsy of the cervix and strive for complete removal of the pathological focus followed by histological examination, since biopsy disrupts the integrity of the basement membrane of the epithelium and the cancer can progress to the next stage.

When determining the management tactics for a patient with dysplasia, the severity of changes, age, and reproductive function are taken into account. Mild dysplasia in 50-60% of cases undergoes reverse development on its own, and in other cases it stabilizes or progresses. For mild dysplasia, dynamic observation and specific treatment are indicated when urogenital infections are detected. If within 1 - 2 years the pathology does not regress or worsens, conization is performed. For moderate and severe dysplasia, conization of the cervix (knife, laser, electroconization) is indicated. For cancer in situ in a woman of reproductive age, a cone-shaped conization of the cervix is performed with layer-by-layer intraoperative histological examination, which makes it possible to accurately determine the stage of the process and preserve the cervix as much as possible. In postmenopausal patients with in situ cancer located in the transition zone of the cervical canal, the treatment of choice is hysterectomy.

Diagnosis of Cervical Diseases

Gynecological examination remains an accessible and fairly informative method for assessing the condition of the cervix, but does not allow diagnosing minimally expressed pathological processes and examining the cervical canal.

Siller's test involves staining the vaginal portion of the cervix (and vaginal vaults) with iodine-containing preparations (Lugol's solution). Healthy areas of stratified squamous epithelium are stained brown (iodine-positive) due to the accumulated glycogen of intermediate cells; in iodine-negative areas, the epithelium that remains unstained has pathological changes. In hypoestrogenism and postmenopause, thinned squamous epithelium, depleted of glycogen, is not stained with iodine-containing substances.

Colposcopy is an examination of the cervix with tens of times magnification using a colposcope, which can be simple (survey colposcopy) and extended (using additional tests and dyes). Treatment of the cervix with a 3% acetic acid solution allows you to evaluate the characteristics of the blood supply to pathological areas. Normally, the vessels of the underlying stroma react to the influence of acetic acid with a spasm and become empty, temporarily disappearing from the field of view of the researcher. Pathologically dilated vessels with a morphologically altered wall (lack of smooth muscle elements, collagen, elastic fibers) remain gaping and look full of blood. The acetoacetic test allows you to evaluate the condition of the epithelium, which swells and becomes opaque, acquiring a whitish color due to coagulation of proteins with acid. The thicker the white staining of the spots on the cervix, the more pronounced the damage to the epithelium.

Microcolposcopy is an examination of the cervix with an optical system that provides hundreds of times magnification and allows one to evaluate the morphology of the cell. This method is sometimes called "intravital histological examination."

Cervicoscopy is an examination of the cervical canal using fiber optics (hysteroscope), in most cases combined with curettage of the cervical canal mucosa.

Cytological examination of cervical smears under a microscope is used as a screening method, but has insufficient sensitivity (60-70%). Until now, there are various systems for assessing cytological results. In Russia, institutions often use a descriptive conclusion; in the world, the most common assessment is the Papanicolaou scale; the Maryland system is also used (Bethesda, SSA).

Morphological research methods allow us to establish a final diagnosis. However, resorting to them using targeted knife biopsy of the cervix is advisable only if it is impossible to clarify the diagnosis during a comprehensive examination of the patient (colposcopy, cytology, echography).

At the present stage, when determining the etiology of pathological changes in the cervix, viruses and infectious agents can be identified using polymerase chain reaction (PCR). The most important thing is to determine the human papillomavirus and, if necessary, its serotyping.

Ultrasound can be an additional method when examining patients with cervical pathology, which allows one to assess the thickness and structure of the mucous membrane of the cervical canal and identify inclusions that are pathognomonic for a cervical polyp. In addition, echography provides additional information about the size, structure of the cervix, characteristics of the blood supply (with digital Doppler mapping and pulse Doppler), the condition of the parametrium, and sometimes the pelvic lymph nodes.

In gynecological oncology for cervical cancer, MRI, CT, angio- and lymphography are used to clarify the stage of the process.

True erosion is a defect in the stratified squamous epithelium on the vaginal portion of the cervix. It is believed that true erosion occurs as a result of inflammatory processes leading to necrobiosis of the stratified squamous epithelium in the acidic environment of the vagina, which, as a result of mechanical trauma, is desquamated from the underlying membrane. At the same time, the basal layer of cells and thereby the potential for healing is at least partially preserved. True erosion does not have a specific clinic and very often the patient does not see a doctor. Leucorrhoea or other pathological discharge, itching, as a rule, are caused by exocervicitis, colpitis. True erosion lasts from 2-3 days to 1 - 2 weeks and looks like a bright red, irregularly shaped area of ectocervix, not covered with epithelium, diagnosed by colposcopy.

Treatment of Cervical Diseases

Treatment should be aimed at eliminating contamination (antibacterial therapy, ointment swabs and suppositories with antibiotics) and normalizing the vaginal microflora (use of eubiotics - lactobacterin, etc.), stimulating regeneration (solcoseryl, sea buckthorn oil). In case of hormonal disorders and lack of proper treatment, epithelization of erosion with the formation of columnar epithelium (ectopia) of the cervix is possible.

Cervical diseases in the modern world they are common among women. At the same time, there is no tendency to reduce their number. Basically, such diseases are typical for young women of reproductive age.

Features of cervical diseases

Cervical diseases are usually divided into several different groups: precancerous , malignant , inflammatory And background diseases.

Background illnesses , which include cervical ectopia , congenital ectopia , have different pathogenesis. Two different types of epithelium cover the cervix. The vaginal part of the cervix is formed by squamous stratified epithelium, and the cervical canal is lined by single-layer cylindrical epithelium. Between these layers there is a part of the neck, which is called the transformation zone. This is where pathological conditions most often develop.

This type of cervical disease can occur not only in women of reproductive age, since significant changes in the female body that occur both during adolescence and menopause sometimes cause pathologies.

Background diseases very rarely develop into a malignant form. But still, constant medical supervision and treatment of such ailments must be practiced.

Precancerous illnesses cervix are pathological processes that over time can lead to the development of a malignant disease. All of these diseases are considered to be of some degree . There are no specific symptoms for such diseases: all symptoms are caused by concomitant pathologies of the reproductive system.

Cancerous illnesses cervix is diagnosed as a consequence of changes in the cervical epithelium. A malignant disease is always preceded by precancerous diseases. Oncological pathology develops mainly in the zone of epithelial transformation. The increase in the number of cases is directly related to irregular preventive visits to the gynecologist.

Inflammatory illnesses cervical infections are certain types of sexually transmitted infections that occur as a result of infection with pathogens of such diseases.

Ectopic cervix

With the development of this disease in a woman, the cylindrical epithelium moves to the vaginal area of the cervix. Sometimes this disease is also called pseudo-erosion. The acquired and congenital type of the disease is determined. Several times more often cervical ectopia detected in women with disrupted menstrual cycles.

There are no particularly pronounced symptoms of ectopia in patients: in some cases the amount increases, and spotting appears after sexual intercourse. During the examination, the doctor determines the presence of a bright red area with an irregular shape. The doctor selects treatment on an individual basis. If there is uncomplicated pseudoerosion, then the specialist can limit himself to regular observation and conducting the necessary research.

Cervical ectropion

In this condition, due to ruptures of muscle fibers, a woman experiences an inversion of the mucous membrane of the cervical canal onto the vaginal area of the cervix. Most often, this pathology manifests itself in women after diagnostic procedures. In this case, we are talking about a combination of scars and pseudo-erosion. Women with this disease do not complain about severe symptoms of the disease. Treatment, if necessary, is carried out surgically.

Leukoplakia of the cervix

This disease is characterized by the occurrence of local processes of keratinization of multilayer epithelium. They can have varying degrees of severity. In addition, it varies simple And proliferating leukoplakia . In the latter case, cell atypia also occurs. This condition already refers to precancerous diseases of the cervix.

Leukoplakia develops in women as a consequence of immune and endocrine factors, exposure to infections, and also becomes a consequence of injuries. There are no clear symptoms for this pathology. In the process of diagnosing the disease, not only a cytological examination is carried out, but also followed by a histological examination.

Erythroplakia of the cervix

This disease is characterized by local atrophy of the stratified squamous epithelium, as a result of which it becomes thinner. With erythroplakia, red spots appear on the ectocervix. To this day, there is no exact data on the etiology and pathogenesis of this disease. For treatment, various methods are used to destroy the source of the disease.

Cervical polyps

They develop on the mucous membrane of the cervical canal. These outgrowths, covered with epithelium, are divided into glandular And epidermalized . They have a bright pink color, leaf-shaped or oblong shape. When diagnosing this disease, it is important to differentiate it from large endometrial polyps. Polyps can be diagnosed using ultrasound. Polyps are removed using a method that is selected individually.

Cervical endometriosis

When treating precancerous conditions of the cervix, it is important to ensure intake of fiber, enzymes, selenium, and Omega-3 fatty acid. The deficiency of these substances can be compensated not only by treatment with medications, but also by adjusting the diet. However, such treatment methods cannot effectively influence the condition of women diagnosed with moderate or severe dysplasia.

If a woman has minor erosion, chemical coagulation may be used. This process involves treating the erosion site with special means. About five such procedures are necessary. However, this method cannot always be the key to a woman’s complete recovery.

Surgical treatment methods are used taking into account a number of features. They should be carried out in the first two weeks of the monthly cycle, since the tissue healing process is more active under the influence. During surgery, local anesthesia is predominantly used. However, in some cases general anesthesia is also used. If the patient wishes, on the recommendation of the doctor, you can take sedatives for some time.

The diathermocoagulation method involves cauterization of the cervix. It is now used quite often, since this operation is easy to perform. But there is also a disadvantage of this treatment: during the procedure it is very difficult to determine the required depth of tissue coagulation. Also, if there is a blood or lymphatic vessel near the site of coagulation due to necrosis, scar formation may occur on the cervix over time.

Cryodestruction of the cervix is performed using liquid nitrogen. In this case, regulation of the depth of influence on tissue is also carried out only approximately. After this procedure, the woman experiences prolonged discharge. It is important to take into account all the individual characteristics of the patient’s body before carrying out such a procedure. In particular, the doctor must make sure that the woman does not have a cold allergy.

Laser treatment allows you to work in two directions. Using a powerful laser, evaporation is carried out, and low-intensity radiation allows for laser conization of the cervix. Sometimes a side effect of such treatment is tissue burns or overheating. However, laser treatment involves stopping immediately after the procedure. During the procedure, only short-term anesthesia is used. The method is quite painful.

The radio wave surgery method is non-contact. The affected area is exposed to a radio wave, which promotes the destruction and evaporation of the cell. This procedure is quick and painless. After such an operation, it does not appear due to the absence of muscle damage, however, discharge of a bloody nature may still appear. The tissues are completely restored after using this method, while the postoperative period is reduced compared to other methods. This method of treating cervical diseases is recommended for women who have not given birth before.

Previously, knife conization was considered a fairly popular method of treating cervical pathologies. But today this technique is used only for the treatment of women who have been diagnosed with columnar epithelial dysplasia, pathological ectropion, and large cervical ruptures. When using this method, patients experience bleeding due to severe trauma. Accordingly, healing takes a relatively long time.

cervical surgery is performed exclusively in the operating room, since this surgical intervention involves a cone-shaped excision of cervical tissue. Anesthesia can be either epidural or general. This operation is practiced in the initial stages of cervical cancer.

It is important to take into account several important requirements when choosing a method of treating cervical diseases: it must be as safe as possible, not provoke complications in the future, and provide treatment and recovery in the shortest possible time.

Postoperative period

During the period after surgical treatment, the patient may experience certain unpleasant symptoms: pain in the lower abdomen, which has a pulling nature, which may stop after 2-4 weeks. To relieve pain, women are prescribed painkillers. The patient is prohibited from lifting weights, using tampons, douching, and having sex for a month.

They are not prescribed after surgery. If severe bleeding, pain, deterioration in general condition, or increased temperature occur, you should immediately contact a specialist.

After surgery, some complications may develop over time. Sometimes scars form on the tissue of the cervix, resulting in its deformation. Menstrual function may be disrupted or develop as a consequence of cervical canal stenosis and other changes. In the presence of inflammation of the genitourinary organs, their exacerbation is possible.

Due to the use of certain methods of treating cervical diseases, women may experience premature birth, as the cervix, which has previously undergone surgery, does not dilate in a timely manner. Rupture of the membranes is also possible. Therefore, for previously nulliparous women, it is necessary to choose methods of treatment for cervical diseases especially carefully.

Covered with stratified squamous epithelial cells. It consists of three layers: basal, intermediate and superficial. Doctors may call any change in the maturation or differentiation of epithelial cells dysplasia. This term is often used to describe all precancerous conditions of the cervix.

Possible diseases

Doctors identify several pathological conditions that must be paid attention to. Thus, the so-called background processes are combined into a separate group. These include true erosion, simple leukoplakia, polyps, ectopia, erythroplakia of the cervix. A separate precancerous condition is identified, which is called cervical intraepithelial neoplasia or dysplasia. It is important to understand that background and precarceral conditions have different pathogenesis.

But the origin and manifestation of precancerous conditions and cancer are similar. Many people call HPV one of the reasons. Thus, the presence of human papillomavirus in the body is not a guarantee that there will definitely be cancer. But those women who were diagnosed with precancerous conditions of the cervix were still diagnosed with HPV in 90% of cases. But it is necessary to understand that out of more than 60 types of this virus, about 20 affect the genitals, and 11 serotypes are considered highly oncogenic.

Papillomavirus

Most often, people do not even suspect that they have HPV in their bodies. For some, the disease occurs in a latent form. This means that people are carriers of the virus, but they do not have any manifestations. In the subclinical form, cytological changes are diagnosed. Clinically expressed HPV is determined when exophytic and endophytic condylomas are visible.

The most common are the 16th and 18th serotypes of papillomavirus. Infection, as a rule, goes completely unnoticed and is not accompanied by the appearance of any symptoms. But at the same time, the virus infects cells, it is integrated into their genetic code, and the replication of infected elements begins. This ultimately leads to their degeneration and causes the appearance of dysplasia or cancer.

But it is believed that the individual susceptibility of the epithelium and congenital defects in defense mechanisms play an important role in the development of diseases.

Characteristics of background processes

Gynecologists can diagnose a number of cervical diseases that are characterized by specific changes. So, doctors distinguish true, congenital and false erosion.

Even in teenage girls, the gynecologist can see displacement of the columnar epithelium during examination. After colposcopy, it becomes clear that it is bright red in color. However, it is impossible to paint it with Lugol's solution. This condition is often called pseudoerosion or ectopia. It can be congenital or acquired. But these are not yet precancerous conditions of the cervix, so such erosions do not require treatment. You just need to monitor them regularly.

If the patient's mucous membrane of the cervical canal everts onto the vaginal part of the cervix, then this condition is called ectropion. This is a combination of scar deformation of cervical tissue and pseudo-erosion. Upon examination, the doctor may see a deformed neck with a slit-like or gaping pharynx with red areas of columnar epithelium. Often they can have a transformation zone.

Another background process is leukoplakia, the name of the disease is translated as “white spot”. With this disease, the stratified epithelium becomes locally keratinized. In this case, infiltrates form around the stromal vessels. Leukoplakia can be simple, then it is classified as a background process. If this disease appears, then we are talking about precancer.

Another disease is erythroplakia, but it is quite rare. This name literally translates as “red spot”. In this condition, the stratified epithelium atrophies and thins down to several layers. Intermediate cells disappear. Vessels are visible through the thinned epithelium, so the areas look like red spots.

Also, during examination, the doctor can see growths covered with epithelium. They are called polyps. These are bright pink formations that can be leaf-shaped or oblong. They hang from the throat of the cervix.

Causes of erosions

Problems can often be detected during a routine examination or colposcopy. If the doctor sees changes, he can explain what causes cervical erosion. So, the most common reasons are:

Infectious diseases, among which the most common are chlamydia, trichomoniasis, gonorrhea, ureaplasmosis, genital herpes, papillomavirus;

Inflammatory diseases of the female genital organs;

Mechanical damage to the mucous membrane;

Hormonal changes.

As a result of the changes, the multilayered epithelium, the layers of which are poorly cohesive and loosely laid, is damaged in places and sloughs off. It has been observed that this occurs 5 times more often in women with menstrual irregularities, they may even have greater cervical erosion. Instead of the desquamated layer, columnar epithelium is formed.

Provoking factors include disruptions in the cycle, frequent changes of partners, early onset of sexual activity and reduced immunity. Many of those who have discovered these problems are interested in whether there are any restrictions if cervical erosion has been diagnosed. What cannot be done with this disease? There are no strict restrictions. It is important to simply see a gynecologist regularly, undergo all the necessary examinations and not refuse the prescribed treatment.

Diagnostics of background processes

As a rule, women with an affected cervix do not complain of anything. There are no symptoms of erosion. True, some people experience whitish discharge, which does not cause any discomfort. After sexual intercourse, bloody discharge or ichor may appear. In this case, you should see a doctor as soon as possible. He is able to assess the condition and determine whether there is cervical erosion. The name of the disease in such a situation is more important for the doctor. Further treatment tactics will depend on the identified problem.

On examination, pseudo-erosion looks like a red spot of irregular shape. It stands out against the background of pale mucous membrane. When performing a colposcopy, it becomes clear that the problem areas are covered with red papillae of a round or oblong shape, because of which the surface looks like velvet. You shouldn’t be afraid of colposcopy, it’s just an examination using a special device that can enlarge the area 30-40 times.

Diagnosis of a disease such as leukoplakia is also not difficult. In some patients, the keratinized layers of cells are visible to the naked eye; they appear as white plaques that rise on the ectocervix (the part of the cervix that protrudes into the vagina). In others, they can only be detected during colposcopy. To clarify the diagnosis, cervical tissue can be treated with iodine solution. The affected keratinized areas do not turn brown; they look like a surface covered with a whitish film. To determine the nature of leukoplakia (simple or with atypical cells), a biopsy is necessary.

Also, during examination, the gynecologist may see cysts on the cervix. The reasons for their appearance are as follows:

Sexual infections that provoke the development of inflammatory diseases;

Injury to the cervix during childbirth, abortion,;

Hormonal disorders.

Cysts look like sacs filled with mucus. They arise from the nabothian glands, which appear as small white swellings. If there are malfunctions in their work, the ducts close. In the case when only one sac is visible upon examination, it is called an endometriotic cyst. But there are times when there are several of them. In such situations, the doctor says that these are Nabothian cysts on the cervix. It is advisable to find out the reasons for their occurrence. After all, their appearance can be caused by infections that need to be treated. As a rule, doctors recommend only one treatment method - removal of cysts. This is done by puncturing the sac, removing viscous mucus and treating the place where it appears.

Treatment tactics

In cases where the doctor discovers problems with the cervix, he should tell you what needs to be done next. So, first of all, the specialist will perform a colposcopy, take material for cytological examination and, if necessary, offer a biopsy. A complete examination allows you to determine what causes cervical erosion. It is also important to do microflora smears to determine if there are any infectious diseases. It is mandatory to find out whether the patient has HIV, syphilis or viral hepatitis. In addition, the gynecologist can give a referral for examination for the presence of trichomonas, ureaplasma, HPV, chlamydia, mycoplasma, and gardnerella.

After this, you can begin treatment. Depending on the size, causes of appearance and other factors, the gynecologist will suggest cauterizing the cervix with electric current, performing cryodestruction, laser coagulation or using the radio wave method.

In some cases, simply observing the erosion is sufficient. This tactic is chosen in cases where it is detected in young nulliparous girls. Most often, their appearance is caused by hormonal changes.

Description of treatment methods

Cauterization is one of the most common methods. However, the procedure has many side effects. As a result of cauterization, rough scars may form and the throat of the cervical canal may narrow. In addition, healing after the procedure takes quite a long time. But, despite all the shortcomings, they often use evidence that the procedure is unpleasant, but it cannot be called too painful. Many women simply talk about a feeling of discomfort in the lower abdomen. In addition, there may be vaginal discharge after the procedure.

The doctor must also warn about a number of restrictions. It must be done at least a month after the procedure. There are also restrictions on lifting weights - you can carry no more than 2 kg. A ban is imposed on visiting saunas, baths, taking baths, and engaging in intense physical activity.

Cryodestruction often leads to shortening of the cervix. In addition, as a result of the procedure, the cervical pharynx may narrow. Cryodestruction cannot be called excessively painful; patients are more embarrassed by the accompanying unpleasant odor.

Many people prefer to use more modern methods, for example, the radio wave method for treating cervical erosion. It is carried out with a special device “Surgitron”. The electrode located in it emits high-frequency waves, they generate heat when they meet tissues. In this case, the cells seem to evaporate.

Laser treatment is also considered highly effective. Exposure to a beam of waves leads to the fact that pathologically altered cells are removed. In this case, the surrounding tissues are slightly affected. This method is considered the least traumatic.

Characteristics of dysplasia

Most often, precancerous conditions develop with traumatic lesions of the cervix. Those who have cervical erosion need to be especially careful. Cancer is unlikely to begin to develop against this background, but fields of dysplasia in some cases are detected precisely against the background of pseudo-erosions.

Experts distinguish 3 stages of this disease. The first degree is called mild. With it, the deep layers are affected - the basal and parabasal. The upper layers remain normal. There are no external signs of the disease. It can only be detected by cytology, and the scraping must be taken deeply.

In the second degree - moderate dysplasia - changes can affect up to 2/3 of the epithelial cells. At this stage there should be no atypical cells.

In the third degree, maturation and differentiation of cells occurs only in the superficial layer. The remaining layers are affected. More detailed examinations show the presence of cells with atypia.

Diagnosing dysplasia is not so easy. The disease occurs without any obvious signs and has no characteristic symptoms. During the examination, the gynecologist can determine ectopia, leukoplakia, and see papillomas. Sometimes with dysplasia it happens that the cervix is not changed.

The diagnosis can be made with a smear taken from the cervix. If during the research it was established that the taken material contains cells with dikaryosis (changes in the nuclei), then histology is necessary. It is made from materials taken during a biopsy.

Reasons for the development of dysplasia

In most cases, it is difficult to understand what became the basis for the emergence of problems with a woman’s reproductive organs. But there are a number of factors that can trigger the onset of the disease. So, for example, if a patient has stitches on the cervix, it means that there is a malnutrition of her tissues. And this can become an impetus for the development of the disease.

Provoking factors also include:

Immune and hormonal disorders;

The presence of erosive foci - the transition zone between flat and columnar epithelium, located on the outer part of the cervix, is dangerous;

The presence of a highly oncogenic type of HPV in the body.

The risk factors are the following:

Early onset of sexual activity by a girl at a time when the epithelium is not yet normally formed;

Long-term use of intrauterine and hormonal contraceptives;

Multiple births;

The presence of sexually transmitted infections;

Poor nutrition with deficiency of vitamins C, A and beta-carotene.

It was also found that men’s hygiene also influences the occurrence of these female diseases. Smegma, which accumulates under the foreskin, can cause precancerous conditions of the cervix to begin to develop. This is due to the presence in it which, during sexual intercourse, ends up on the cervix.

Possible ways to get rid of the problem

Treatment tactics directly depend on the degree of dysplasia that was diagnosed. Thus, in the first stage, it is often recommended to simply observe the tissues over time and carry out conservative treatment, which is aimed at eliminating the possible cause of the disease. As a rule, antiviral or antibacterial therapy is carried out to eliminate infectious agents. In the absence of positive dynamics, as well as in cases where dysplasia of the 2nd or 3rd degree was immediately diagnosed, surgical treatment is recommended.

However, it can be performed in the same way as cervical surgery. Reviews indicate that this method gives very good results. Cryodestruction or laser treatment can also be used. In some cases, diathermoconization is used. This method consists in the fact that the changed tissues are excised in the shape of a cone, the apex of which is directed towards the internal pharynx. The removed tissue areas are additionally sent for histology.

It is important to know that patients with dysplasia have a 10-20 times higher risk of developing cancer than those who do not have this problem. At the first stage, there is a possibility of reverse development of the disease - this happens in approximately half of the cases. But in 40% of women it will progress, in the rest it will be in a state of stabilization.

Alternative medicine

Having heard an unpleasant diagnosis, not everyone agrees to treatment with traditional methods. Even if the doctor offers a fairly gentle and highly effective radio wave method for treating cervical erosion, there will be those who refuse the procedure.

Some are starting to look for alternative methods. The most popular are douching with a diluted infusion of calendula (1 tsp in ¼ glass of water), eucalyptus (1 tsp diluted in a glass of water), tampons with sea buckthorn oil or mummy.

But these are not all the options for how the cervix can be treated with folk remedies. Some healers recommend brewing St. John's wort for douching at the rate of 1 tbsp. l. for a half-liter jar of boiling water. The herb must be boiled for about 10 minutes and infused for at least half an hour.

If you decide to refuse qualified help and are treated with the indicated methods, then regularly visit a gynecologist in order to monitor the condition of the cervix. This is the only way to see the deterioration in time and try to correct the situation.

Problems associated with the female genital organs occur in almost 90% of women over the age of 35. Malignant formations on the uterus and its appendages occupy 3rd place in the world in terms of the frequency of cancer diseases and 1st place among cancer diseases in women. But not all diseases of the reproductive system lead to cancer. Many pathologies require only constant monitoring and do not pose a threat to life if they are detected in time and treated correctly.

Classification of diseases and causes

The classification of diseases divides them into two groups: precancerous and those that do not tend to degenerate into malignant tumors. Diseases of the uterus and appendages are divided into three main types:

Almost all diseases are preceded by inflammatory processes caused by infections, viruses and fungi. Inflammatory diseases are isolated separately from others, but they are often the cause of background pathologies.

The uterine cavity and the canal leading to it are lined with various types of epithelium. The border between these two epithelia is nicknamed by clinicians the “zone of storms.” Pathologies most often begin to develop at this junction.

The most common causes of any cervical disease are:

Sexual infections.
Injuries (after abortion or childbirth).
Hormonal imbalances.
Viruses.
Decreased local immunity.

Sexual infections cause an inflammatory process, leading to desquamation of the epithelium. Beneath it are immature cells that are susceptible to any changes. As a result, the cells take on an atypical shape and background or precancerous diseases develop.

Injuries, if left untreated, can also lead to serious dysfunction of a woman’s genital organs. Deformed tissues are susceptible to infections and other unwanted changes. Hormonal imbalances, mainly progesterone deficiency, disrupt the normal functioning of the uterus and appendages, exposing them to the risk of pathologies.

Of the viruses, the human papillomavirus is recognized as the most dangerous for the female reproductive system.

Of the 60 types of this virus, 20 types cause cancer in women. In almost 70% of all cases these are serotypes 16 and 18.

But papilloma has its destructive effect mainly on tissues previously damaged by infections and herpes.

Inflammatory diseases

Inflammatory diseases of the cervix are caused by microorganisms: chlamydia, trichomonas, cocci. They mainly affect the lower genital region of women - the vaginal part. They are transmitted sexually, less often due to non-compliance with intimate hygiene standards. Represent benign diseases of the cervix.

Symptoms depend on the severity of the disease. Sometimes mild inflammation is asymptomatic - the woman does not suspect that she is sick and needs treatment. When moving to moderate and severe degrees, symptoms such as:

The most common inflammatory diseases of the uterus and appendages:

vulvitis;
bartholinitis;
endometritis;
cervicitis.

Vulvitis can be primary and secondary. It is characterized by inflammation of the external genitalia. Primary occurs due to poor hygiene, mechanical or chemical exposure, or due to urinary tract infections. Secondary is a consequence of inflammation of the internal female organs. Can be treated quickly and effectively.

With colpitis, the vaginal mucosa becomes inflamed. Its causative agents are infections. Viruses, fungi, E. coli and other microorganisms.

Bartholinitis is a pathology of the Bartholin gland, located in the vestibule of the female vagina. This disease causes an abscess of the gland, characterized by severe inflammation and the formation of a purulent capsule. If left untreated, it leads to serious consequences.

Endometritis is damage to the upper layer of the endometrium. The infection is dangerous because it can affect the entire mucous membrane of the uterus and appendages. The disease is caused by microorganisms. Abortions, childbirth and any interventions in the uterus contribute to its manifestation.

Cervicitis is a lesion of the cervical canal leading to a woman’s uterus, caused by infection of the organ. If not treated in the acute stage, it becomes chronic and regresses. In its chronic form, the disease may manifest itself with mild symptoms. With chronic cervicitis, the cervix becomes thicker and denser. Deeper tissues are affected. Often the process is accompanied by concomitant pathologies and requires complex treatment.

Background diseases

Background pathologies develop for various reasons and are benign diseases of the cervix. They often arise as a consequence of past infectious diseases. Three processes can be distinguished that cause background diseases of the cervix: inflammatory, dyshormonal, post-traumatic.

Background pathologies include:

ectopia;
leukoplakia;
endometriosis;
erythroplakia;
condylomas.

Ectopia or pseudo-erosion develops in women due to the transition of the cylindrical epithelium to the vaginal part of the uterus. Sometimes it goes away without symptoms. The focus of this pathology is in the area of the external pharynx. Ectopia should not be confused with erosion. Erosion goes away on its own within 10-15 days. Ectopia almost never heals on its own and requires medical intervention.

Leukoplakia is keratinization of the upper layer of the epithelium, formation on the uterus in the form of a white plaque. The cause may be erosion or hormonal imbalances. In cancer pathologies, leukoplakia progresses. Not accompanied by any symptoms.

Endometriosis most often affects the vagina, sometimes the cervical canal. This is the process by which the endometrium transitions to wound tissue. Occurs due to damage resulting from childbirth, surgery or abortion. Symptoms may include slight spotting before or after menstruation.

Erythroplakia is a disease of the uterine mucosa in which the stratified epithelium becomes thinner. When touched, the affected areas bleed in the form of red-violet spots. Symptoms: bleeding after intimate intercourse.

Polyps are bright pink growths on the cervix or surface of the cervical canal, covered with a layer of epithelium. The cause is considered to be inflammatory processes or hormonal problems. Depending on the type of epithelium covering them, epidermal and glandular polyps are distinguished. Symptoms: nagging pain, bleeding during sexual intercourse, stringy leucorrhoea.

Flat condylomas are consequences of human papillomavirus infection. In places where they develop, dysplasia may appear, progressing to the oncological stage. Symptoms are similar to viral diseases.

Precancerous diseases

A precancerous condition is dysplasia, which almost always develops asymptomatically and may have almost no external manifestation. Dysplasia is expressed by pathological changes in the structure of the mucous membrane of the female organ.

It comes in three degrees:

light;
moderate;
heavy.

Mild dysplasia CIN I is a disorder in the lower third of the epithelial layer. This degree is subject to drug treatment and observation. CIN II is a moderate degree in which the lower and middle thirds of the layer are affected. It can also be treated conservatively. CIN III is a complex degree, all three parts of the layer are affected, and develops into preinvasive carcinoma. Requires surgical removal.

The degrees depend on how deeply the tissue is affected. The deeper the lesion goes, the more severe the degree of dysplasia and the more difficult it is to treat. It occurs both on the unchanged and on the pathologically damaged cervix of women. Dysplasia is determined by the presence of atypical cells, a violation of their differentiation and architectonics. This can only be revealed through a thorough examination of the uterus and appendages.

Dysplasia is preceded by hyperplasia, in which the number of cells sharply increases. This process is almost always associated with chronic inflammation or impaired cell regeneration. In most cases, dysplasia occurs due to the long stay of the oncogenic type of human papillomavirus in the uterus. If the disease is not treated, dysplasia occurs within 1-2 years. There are no symptoms.

In almost 90% of cases, the precancerous condition of the uterus and appendages does not exist without the presence of papillomas in the body. Genetic disorders in the body's defense mechanisms and the susceptibility of the epithelium may also play a special role.

Dysplasia, with proper treatment, does not always lead to cancer. A woman with such a diagnosis can live a long life and even give birth if she is constantly monitored by doctors and takes the necessary measures. The transition from dysplasia to cancer takes from 2 to 10 years. This is a sufficient period of time to have time to take action before the initial stage of cancer.

Diagnosis and treatment

Diagnosis may include a comprehensive examination, gynecological examination or certain types of research. With a simple examination by a gynecologist, most diseases are difficult to diagnose. This method allows you to fairly well assess the condition of the female organ, but does not allow you to assess the condition of the cervical canal and appendages.

Diagnosis is carried out using the following methods:

Cervical diseases are treated depending on the nature of the disease, its causes and course. Inflammatory diseases caused by microorganisms are eliminated through antibacterial and antiviral drugs in combination with immunostimulating agents.

Chemicals are used to treat the affected upper layers. Mainly for problems such as condylomas.

The electrocoagulation method is effective, but leaves scars that narrow the canal and can lead to its rupture during childbirth. Women who are planning to give birth cannot be treated with this method.

Laser treatment is considered painless and highly effective. Laser therapy can treat damaged tissue under microscope control at the desired depth. The method does not leave scars.

Cryotherapy solves the problems of affected tissues, treats condylomas, leukoplakia, polyps and other diseases. Recommended for nulliparous women. Efficiency is average.

Radio wave surgery is also a modern method that uses the “radio knife” technique. The advantage of this method is that it does not burn, but cuts off the affected part of the uterus or appendages and allows its histological analysis. One of the treatment methods is excision of the cervix and appendages, which is carried out only when an oncological diagnosis is confirmed.

Benign: cervicitis; leukoplakia; cervical polyp; flat condyloma...

Precancerous processes: dysplasia (mild, moderate, severe).

Causes:

Chronic often recurrent inflammatory processes;
Sexually transmitted infections - STIs (especially HPV types 16, 18, 31, 33, 45);
Early onset of sexual activity and first pregnancy (before 15 years);
Having a large number of sexual partners;
Frequent change of sexual partners;
Injuries to the cervix during childbirth and abortion;
Low socio-economic standard of living;
Menstrual irregularities;
Endocrine diseases;
Immunodeficiency conditions;
Disturbances of vaginal biocenosis;
Smoking (active and passive);
Occupational hazards;
“Male” factor (oncogenic sperm proteins).

Cytological classification

Currently, 3 cytological classifications of cervical smears are used: Papanicolaou, WHO (morphological term dysplasia - CIN - Cervical Intraepithelial Neoplasia) and Bethesda System.

In clinical practice, the ICD X revision (1996) is used to classify benign processes of the cervix.

Cytological classification of Papanicolaou (Pap test, Pap-smeartest, Pap smears) includes 5 classes:

I – Normal cells;

II – Inflammatory type of smear;

III – Atypia of individual cells;

IV – Single cells with signs of malignancy;

V – Complexes of cells with signs of malignancy.

WHO classification :

Cervical Intraepithelial Neoplasia:

Mild cervical dysplasia (CIN I);
Moderate cervical dysplasia (CIN II);
Severe dysplasia (CIN III). Carcinoma in situ is included in the CIN III category under this classification.

Bethesda terminological system (TB.S.) , 2001:

According to TBS, the interpretation of cervical smears involves two categories of smears: satisfactory and unsatisfactory.

Diagnostics

Stage 1 — Primary detection (screening) of cervical diseases

Taking anamnesis (identifying risk factors);
Assessment of clinical symptoms;
General examination and examination of the mammary glands;
Examination of the external genitalia, vagina and cervix in the speculum;
Cytological examination of smears from the surface of the cervix and cervical canal.

Screening for cervical cancer subject to women from 18 years of age (or from the moment of sexual activity) and then all age groups once every 3 years.

Not subject to screening women who have already been diagnosed with diseases female genital area(cervix) and registered with a gynecologist or gynecological oncologist.

Stage 2 (diagnostic screening ) – division into subgroups according to the degree of cancer risk according to additional examination data:

a) Benign disease;

b) Precancer;

c) Cancer (second-order risk group) .

Advanced diagnostic methods (if precancer or cervical cancer is suspected):

Extended colposcopy;
Targeted cytological examination of cervical smears;
Bacterioscopic and bacteriological examination of discharge from the vagina and cervical canal;
STI screening;
Targeted biopsy of the cervix;
Curettage of the cervical canal.

Stage 3 – formation of dispensary observation groups for monitoring and correction based on nosological principles.

Classification of cervical diseases (ICD-10) and treatment methods

Cervical erosion (code - N86 )

Cervical erosion is the rejection of the epithelium as a result of inflammation, chemical exposure, and diathermocoagulation. The absence of the covering epithelium is usually short-term, so this pathology is rare. The term “erosion” should be used only for lesions with the absence of the covering epithelium of the vaginal part of the cervix (former name – true erosion of the cervix).

Treatment. After eliminating the etiological cause, epithelization occurs without treatment. When reparative processes are sluggish, agents that improve epithelization are needed.

Ectropion (cipher - N86 )

Ectropion is an eversion of the mucous membrane of the cervical canal, usually occurring after childbirth. The term “ectropion” should be used for lateral ruptures of the cervix in the area of the external os, for deformities of the cervix, accompanied by eversion of the mucous membrane of the cervical canal. Ectropion is the background for inflammatory changes in the cervix.

Treatment. In the presence of concomitant urogenital infections, etiotropic therapy followed by radio wave conization of the cervix.

Cervicitis (code - N72 )

Acute cervicitis. It is observed during infection with gonococci, postpartum infection (streptococci and staphylococci), and viral infection. The early stages of the inflammatory process are characterized by vascular congestion, exudative phenomena, and infiltration of neutrophilic granulocytes. Dystrophic changes are observed in epithelial cells. Necrosis causes ulceration (cervical erosion), the presence of purulent or serous-purulent exudate on the surface of the exocervix. The reparative process is accompanied by the development of granulation tissue, the appearance on the surface of a layer of cylindrical or immature metaplastic cells, which, as they proliferate and differentiate, form multilayered squamous epithelium.

Chronic cervicitis. Characteristic manifestations are infiltration of subepithelial tissue with lymphocytes and plasma cells, vascular congestion. In the epithelium of the cervix, along with dystrophic changes, processes of proliferation and hyperplasia of cells, squamous metaplasia are observed. Such changes in the exocervix should be distinguished from cervical intraepithelial neoplasia; they disappear after anti-inflammatory therapy.

The most common cause of chronic cervicitis is infection with chlamydia, HPV, and mycoplasmas. Almost every second woman with chronic cervicitis has microbial associations, which indicates the need for mandatory bacteriological testing to determine the effectiveness of pathogenetic treatment.

Treatment exo- and endocervicitis is complex, includes etiotropic therapy, elimination of predisposing factors, treatment of concomitant diseases. After therapy, 30 days later, control of cure using PCR. After 2 months - control colposcopy. If changes in the cervix persist, destructive treatment methods are indicated: laser vaporization, argon plasma or radio wave coagulation of the cervix. When chronic cervicitis is combined with ectropion or cicatricial deformation of the cervix - radio wave conization of the cervix.

Cervical polyp (code - N84.1 )

The size and shape of the polyps are oval or round, with an average diameter of 0.2-0.4 cm, the surface is smooth, the consistency is soft. Typically, polyps are dark pink in color due to the translucency of the vessels through the integumentary columnar epithelium. If there is a circulatory disorder, they take on a dark purple color. Such polyps are not stained with Lugol's solution.

When polyps are found on the exocervix, they are covered with stratified squamous epithelium and therefore have a whitish color. Stained brown with Lugol's solution. The base of the polyps is a thin or wide stalk. More often, polyps are located around the external pharynx and are clearly visible to the naked eye, but often the base of the polyp is located in the middle or upper third of the cervical canal.

Depending on the ratio of glands and stroma, endocervical polyps are divided into fibrous, glandular-fibrous, and glandular.

Treatment consists of removing the polyp with curettage of the cervical canal and conducting a course of etiotropic anti-inflammatory therapy.

Endometriosis of the cervix (code - N80.8 )

Endometriosis of the cervix is more often observed after diathermocoagulation (carried out without taking into account the phase of the menstrual cycle), after plastic surgery on the cervix, after supravaginal amputation of the uterus and after childbirth. This is the only site of endometriosis that usually exists separately.

In some cases, the patient does not complain, and the diagnosis is established by examining the cervix in a speculum or during colposcopy. In other cases, the complaint is pre- and postmenstrual spotting. If endometriosis is localized only in the vaginal part of the cervix, pain does not occur. When endometrioid heterotopias grow into the cervical canal or when it is combined with other localizations, nagging pain in the lower abdomen occurs, changing its intensity during the cycle, pain during sexual activity (dyspareunia).

Foci of endometriosis appear as bluish cysts, or as bleeding linear or dotted areas. The release of blood from endometriotic lesions during and after menstruation is of decisive importance.

Treatment. If an infectious agent is detected, etiotropic therapy, sanitation of the vagina followed by surgical treatment: emptying of the endometriotic lesion, radio wave coagulation (laser vaporization) of the cervix. When endometriosis is combined with cicatricial deformation of the cervix - radio wave conization.

Leukoplakia of the cervix (code - N88.0 )

Leukoplakia of the cervix is a polyetiological disease, based on many predisposing factors: previous infectious diseases, disorders of the immune status, hormonal levels, traumatic effects on the cervix as a result of childbirth, abortion, incorrect and inadequate treatment of cervical pathology.

The course of the disease is asymptomatic. Sometimes patients complain of profuse leucorrhoea and contact bleeding.

In accordance with the classification of I.A. Yakovleva and B.G. Kukute (1977) classifies simple leukoplakia without atypia as a benign process, and leukoplakia with atypia as a precancerous condition. Abroad, simple leukoplakia is classified as hyper- and parakeratosis, and leukoplakia with cellular atypia is classified as cervical intraepithelial neoplasia (CIN) of varying severity.

Simple leukoplakia is a thin white film that peels off easily, or dense lumpy plaques with clear white contours. After removal of the plaque, shiny pink areas are visualized. The Schiller test is negative.

Treatment. If an infectious agent is detected, etiotropic therapy, vaginal sanitation.

Surgery ( radio wave conization) shown:

combination of leukoplakia with cicatricial deformation of the cervix;
combination of leukoplakia with cervical dysplasia.

Cervical dysplasia (code - N87 )

N87.0 – mild;

N87.1 – medium degree;

N87.2 – severe;

N87.9 – unspecified dysplasia.

Group CIN I should include flat condylomas associated with HPV infection of the cervix.

Easy (simple) dysplasia is characterized by moderate proliferation of cells in the basal and parabasal layers of the epithelial layer. The cells of the overlying sections retain their normal structure and polarity of arrangement.

For moderate dysplasia characterized by the detection of pathological changes in the epithelial layer in its entire lower half.

At severe dysplasia in addition to significant proliferation of cells of the basal and parabasal layers, hyperchromatic nuclei appear, the nuclear-cytoplasmic ratio is disrupted towards an increase in the nucleus. Mitoses occur frequently, but retain a normal appearance. Signs of cell maturation and differentiation are found only in the most superficial part of the epithelial layer.

In intraepithelial, preinvasive cervical cancer, the entire layer of epithelium is represented by cells indistinguishable from the cells of true, invasive cancer.

Treatment . For dysplasia easy degrees - treatment of genital infections. Observation for 3-6 months under colposcopy control. Possible destructive methods of treatment: in young nulliparous patients or those who gave birth without scar deformation of the cervix - laser vaporization, cryotherapy, radio wave coagulation. When combined with cicatricial deformation of the cervix, or in peri- and postmenopause - radio wave excision.

For dysplasia average degree - detection and treatment of genital infections. A scraping from the cervical canal is required to clarify the extent of the process. Observation is possible for 3 months. In the absence of regression of the pathological process - radio wave treatment, laser.

Control examinations with SIJ: after 3, 6, 9, 12 months.
Follow-up for 2 years (after treatment).

For dysplasia severe degree of treatment - see a gynecological oncologist. Etiotropic and immunocorrective therapy is carried out for up to 1 month. Scraping from the cervical canal. Mandatory surgical treatment (radio wave conization or amputation of the cervix).

Control examinations with SIJ: after 1, 2, 3, 6, 9, 12 months.
Dispensary observation – lifelong.

Cervical ectopia

Cervical ectopia is not a pathological condition of the cervix. Ectopia is the appearance of areas of columnar epithelium on the exocervix. The process is a physiological norm for girls, girls during puberty and pregnant women, which is associated with hormonal changes in these periods of life. Cervical ectopia may occur when taking oral contraceptives, especially progestins. In this case, areas of the cylindrical epithelium have smooth, clear contours and are not accompanied by inflammatory changes.

Prevention of cervical cancer

Treatment before pregnancy of all pathological conditions of the cervix;
Screening;
Identification of risk factors and groups;
Vaccination - bivalent recombinant vaccine against HPV types 16, 18

(“Cervarix”) or a quadrivalent vaccine against human papillomavirus types 6, 11, 16 and 18 (“Gardasil”). It is carried out in children and adolescents aged 9 to 17 years and in young women aged 18 to 26 years for the prevention of genital warts, precancerous dysplastic conditions, cancer of the cervix, vagina and vulva. Currently, the possibility of vaccination with Gardasil has been extended to 45 years of age.