Cancer erosion of the cervix treatment. Is it possible to degenerate cervical erosion into cervical cancer? Video: treatment of advanced cases of epithelial cancer

No woman is immune from various gynecological pathologies, in particular from such as cervical erosion. Cervical cancer often becomes a consequence of this pathology. Therefore, it is important to solve this problem in a timely manner. What is characterized by erosion of the uterine cervix?

The culprits of the development of the disease and its symptoms

Erosion of the reproductive organ can occur for various reasons. It is impossible to say exactly what became the reason for the development of pathology. But experts note several provoking factors, the impact of which adversely affects the reproductive organ and can cause such a disease. These include:

Hormone imbalance in women, when estrogens are produced in excess of normal.
Damage to the uterus during operations, abortions and other gynecological procedures, as well as after childbirth.
Early intimacy.
Weakened immune system.
The presence of other diseases of the uterus of an infectious and inflammatory nature.
Failure in the activity of the endocrine organs.

Among the symptoms of cervical pathology in women, vaginal discharge can be noted, which has a specific odor and has blood impurities. But these signs can be seen only at a late stage in the development of erosion. Before that, she will not manifest herself in any way, therefore she is diagnosed quite by accident.

Varieties of female ailment

There are several types of cervical erosion in women. The first variety is congenital erosion. It involves the displacement of cervical epithelial cells. This disease is observed more often in young girls, does not cause any symptoms and is eliminated on its own. Moreover, it cannot develop into cervical cancer.

The second variety is true erosion. It is acquired during life under the influence of negative factors. Basically, its development does not take much time, since it often turns into pseudo-erosion. This is the third type of pathology of the cervix.

It occurs when the squamous epithelium is replaced by columnar cells. With pseudo-erosion, tissue growth is possible, their degeneration, including into a malignant neoplasm. Therefore, doctors attribute this type of pathology to a precancerous condition.

Dangerous consequences of pathology

Erosion of the reproductive organ can trigger various negative processes in a woman's body that will lead to big health problems. But this is possible if the patient does not take timely measures to get rid of the pathology. The late stage of erosion can be the culprit of problems such as:

Infectious diseases of the genital organ. This complication is considered one of the most unfavorable. Due to the fact that during erosion the mucous membrane loses its ability to protect the uterus from pathogens, bacteria can easily penetrate there.
Benign tumor of the epithelium. When erosion takes too long, epithelial cells begin to be replaced by atypical tissues.
Problems with conceiving a child. Pathology of the cervix in combination with other diseases, for example, an infectious process in the organ, can lead to infertility.
Malignant tumor. The late stage of erosion of the uterine neck can provoke the development of cancer.

When can a degeneration into cancer occur?

Can cervical erosion turn into cancer? Yes, it can, if left untreated for a long time. Most often, the reason for this is the human papillomavirus, which was originally the culprit in the formation of erosive changes. The connection between such an infection and cancer has already been proven.

This virus can be transmitted through contact with a sick person. Most often this happens during intercourse if the partners are not protected. The papillomavirus has many varieties, most of which do not cause degeneration into cancer. However, there are types of bacteria that are highly oncogenic. They can also cause the degeneration of cervical erosion into cancer.

Symptoms of rebirth

You can suspect the development of cervical cancer only if it is already at an advanced stage. Prior to this, the disease may not manifest itself at all. A woman will feel the symptoms of erosion alone. Signs of erosion, turning into oncology, can be considered the following:

The occurrence of bleeding after sexual contact.
Unusual vaginal discharge that has an unpleasant odor.
Pain in the lower abdomen, which can radiate to the lower back and lower limbs.
Weight loss, loss of appetite.
Fast fatiguability.

The presence of these manifestations is a reason for an immediate appeal to a specialist, as this already indicates the advanced development of the disease.

Measures for diagnosing a disease

When visiting a gynecologist, a woman will have to undergo a gynecological examination, after which the doctor will decide what other diagnostic measures will be needed in this case. The most commonly used methods are:

Colposcopy. This method is usually prescribed if the result of a cytological examination of a woman's smear caused the doctor to suspect the development of cancer cells.
Biopsy. This method is just necessary in order to confirm or refute malignant degeneration and draw up the correct treatment plan.
Laboratory studies to check for the presence of infectious pathologies.
Human papillomavirus analysis. This diagnostic measure is very important, since such a virus can cause erosion to degenerate into uterine cancer.

Based on the results of these diagnostic measures, the attending physician can make a correct diagnosis and prescribe an effective treatment.

erosion therapy

The absence of clinical manifestations at an early stage of cervical erosion is not a reason to ignore the disease. Even if there are no symptoms, it develops. Therefore, refusal of therapy may lead to adverse consequences that have been described previously.

The most common way to treat erosion is to cauterize it with an electric current. But this method is unsafe for a woman and can cause side effects.

Rehabilitation after such cauterization can take a long time. It is also possible to influence the childbearing function of the patient. In this regard, doctors do not resort to such a procedure if the woman has not yet given birth and wants to have a baby in the future.

But medicine does not stand still, and cauterization can now be done in other, less traumatic ways. These include:

Cryodestruction. It involves freezing erosion with the help of a substance such as liquid nitrogen. The point is that under the influence of low temperatures, the affected cells begin to die. The method does not cause scars on the uterus, but swelling and copious vaginal discharge may occur.
radio wave method. In this case, the treatment is carried out using high frequency waves. They first cut the affected area, and then the diseased cells are destroyed. It will not take a woman much time to recover from the operation, it will take just a few days. There will be no scarring on the reproductive organ, which allows the method to be used by women who want to have a baby in the future.
laser therapy. This method will allow you to get rid of erosion using a laser beam that cauterizes the affected area, leaving a crust. Rehabilitation after such an operation is fast - about 7 days.

After laser therapy, no scars remain on the uterine mucosa, the woman is not bothered by bleeding and pain. This method is excellent for nulliparous patients.

If cervical erosion has developed into a malignant neoplasm, then the treatment methods may be different. The most common way to fight cancer is chemotherapy. But it helps well only in the initial stages of the development of the disease. It is also possible to remove the genital organ in part or completely.

After cauterization of cervical erosion, women should adhere to the following recommendations of doctors:

Do not have sexual intercourse for one month.
Do not take a hot bath, give up baths, saunas, solariums, the beach.
Avoid hypothermia.
Don't lift weights.
Stop using tampons.
Do not overload the body with exercise.

If these rules are not followed, then the mucous membrane of the cervix may be damaged again. It is necessary to carefully monitor the state of the body after cauterization of erosion. If there is bleeding and severe pain in the abdomen, you should immediately see a doctor.

Moxibustion can affect the menstrual cycle, knocking it down. This is considered normal only for two months after surgery. If the cycle is not restored, then it is also worth informing the doctor about this.

Thus, there is a real danger of degeneration of cervical erosion into cervical cancer if it is not eliminated in time. Both of these pathologies at the initial stage do not bother the woman, which makes it difficult to detect them in a timely manner. Therefore, it is so important to be checked by a gynecologist every year, this will help to avoid many health problems.

Cervical erosion = this is a defect in the epithelial layer of the genital organ, associated with damage to some places of the inner membrane. The danger of the formation of erosive ulcers occurs in women of all age categories, and timely diagnosis prevents the formation of a malignant neoplasm. So, does erosion always turn into cancer, and what causes the transformation.

Types and causes of erosion

Pathological manifestations of the epithelial layer are divided into types depending on the causes of development:

Pseudo-erosion is associated with a hormonal imbalance in the body.
Ectropion, such a deviation occurs after eversion of the neck as a result of a surgical operation.
Dysplasia is caused by the viral disease papillomatosis.
True erosion is the result of infections after unprotected sexual contact.
The formation of ulcers on the lining of the cervix may not show signs.

Gradually, the disease makes itself felt, the following symptoms appear:

pain during sexual contact and discharge with blood;
pain syndrome in the lower abdomen grows with physical exertion or carrying weights, while the inconvenience is not associated with menstruation;
there may be discharge of a greenish-yellow color with a disgusting odor;
painful sensations are observed periodically, especially after sex and during urination.

With the spread of the inflammatory process in the area of \u200b\u200bthe uterus and appendages, the signs intensify. Menstruation fails, the discharge becomes brown, the temperature may rise. This condition occurs when an infection occurs, which is transmitted through sexual contact. In this case, the process is accompanied by curdled or foaming secretions with a bad odor, which contributes to the formation of erosion and dysbacteriosis. It is difficult to determine the disease in the initial stages, therefore, with the appearance of pain, discharge and violation of menstruation, you should visit a gynecologist.

The causes of the disease are as follows:

the beginning of an early sexual life;
mucosal damage, such as surgery and artificial termination of pregnancy in the later stages;
difficult childbirth, which led to ruptures in the mucous membrane;
chronic infectious diseases;
poor immunity;
disorder of the endocrine system;
hormonal imbalance.

Many medical professionals agree that erosion of the cervix develops into cancer, but there are not many grounds for pathology. If the damage is with a scratch on the skin, then they have similar characteristics with injuries to the epithelium of the reproductive organ. Such abrasions, scratches do not always lead to cancer. The process of development of a malignant tumor begins with the division of mutated cells, and this requires only one unit, which begins to produce its own kind.

An important factor in the fight against pathology is immunity, which suppresses the reproduction of malignant cells. The long recovery process of erosion reduces the functions of the immune system, which is unable to counteract cell division.

Cervical erosion leads to cancer under favorable conditions. At risk are women aged 20 to 40 who are sexually active or do not have a permanent sexual partner. Also included in this category are girls taking contraceptives.

When erosion turns into cancer, then a malignant neoplasm in the primary and late stages has a pronounced clinical picture:

bleeding not associated with menstruation can reach severe blood loss;
pain syndrome in the lower abdomen;
in the later stages, the lower limbs and external genitalia swell;
if the foci have spread further, then the activity of the intestinal system and urinary organs is destabilized.

Preventive measures

A defect in the epithelium of the neck of the reproductive organ requires early diagnosis and treatment in the primary stages. To avoid negative consequences, you should adhere to the following rules:

Infections of the reproductive organ often go away without obvious signs, so it is important to visit the gynecologist periodically and be tested for genital infections.
It should be protected from infection by pathological microorganisms, even a common thrush can provoke the development of erosion.
If a defect in the epithelium of the neck of the reproductive organ is detected, it is necessary to start therapy and prevent the chronic course of the disease.

Development cancer after cervical erosion depends on the nature of the violation.

pseudo-erosion does not entail negative consequences;
with true erosion, there is a possibility that infections will affect nearby organs;
with dysplasia, there is a real danger of the formation of a malignant neoplasm.

When talking about the dangers and consequences of cervical erosion, they first of all mention the risk of its degeneration into a malignant tumor. But the relationship between these two states is not always clear. Will erosion necessarily become cervical cancer or not? What other factors can influence this? How to protect yourself from this? Let's try to figure it out.

Types of erosion

First of all, once again we draw attention to the fact that erosion can be different. Most often, these terms are understood as ectopia - partial replacement of the squamous epithelium with a cylindrical one. Real erosion is the death of part of the epithelium on the cervix, but this condition is much less common. But also the concept of "cervical erosion" includes such conditions as ectopia (eversion of the cervical canal after childbirth), leukoplakia (keratinization of epithelial areas) and so on.

The reason for this ambiguity of the term was the tradition to call any area of change in the mucous membrane of the cervix of red color erosion ....

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Malignant erosion is one of the types of early stage cervical cancer.

Despite modern advances in the treatment of uterine cancer, thanks to the development of methods and techniques of surgical assistance, despite the spread and improvement of methods of radiation therapy for uterine cancer, the diagnosis of the disease and the fate of the patient primarily depend on how early the diagnosis was made. It can be argued that almost every case of uterine cancer is curable if it is treated radically at the onset of the disease. And if, nevertheless, a large percentage of patients with uterine cancer still die in all countries of the world, this is due to the fact that patients often turn to specialists already in the advanced stage of the disease.

Early recognition of uterine cancer is hampered primarily by the fact that at the very initial stage of the disease, accurate diagnosis using conventional methods of gynecological examination - examination and palpation - cannot be made. But if you have symptoms that...

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Malignant erosion of the cervix is the initial stage of cervical cancer.

21st century medicine has made great strides in the treatment of cervical cancer, thanks to the development of techniques and methods of surgical assistance, as well as the modernization of methods of radiation therapy, however, the continued successful elimination of cervical cancer depends on how early the diagnosis was made. Today we can cure almost every case of cervical cancer if it was subjected to radical treatment in the initial stages of the disease. And all there is a sad statistic that many women in the later stages of cervical cancer die because patients seek medical help too late.
The problem of diagnosing cervical cancer is also that the disease is not recognizable during the use of traditional gynecological methods such as palpation and examination.

With the formation of symptoms, which we will discuss later, the gynecologist should suspect ...

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How to identify cervical cancer by symptoms?

Have you noticed whitish, bloody vaginal discharge? Do you experience frequent pain during intercourse? Pain in the pelvic area, lower back, sacrum? Do you have trouble urinating? Has the nature of menstruation changed - duration, volume of discharge?

Urgently contact a specialized specialist - a gynecologist!

What is cervical cancer?

Cervical cancer is a malignant tumor that occurs in the area of the cervix. The disease ranks second in prevalence in female oncology, giving way to breast cancer. Basically, two histological types of the disease occur: squamous cell carcinoma (in about 85% of cases) and adenocarcinoma (15%).

With timely treatment to the doctor, the prognosis of treatment is favorable. Therefore, it is important to seek help from a specialist in time!

I want to consult a gynecologist

Causes of cervical cancer...

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The cervix is the lower part of the uterus that connects to the vagina. In the cervix, the vaginal and supravaginal parts are distinguished. Inside the cervix passes the cervical canal, which is usually clogged with mucus. In the middle of the menstrual cycle, the mucus becomes thinner, and sperm can enter the uterus. During childbirth, the cervix can stretch up to 10 cm in diameter. The opening leading from the vagina to the cervical canal is called the cervical os.

Diseases and treatment of the cervix
Cervical erosion

During a gynecological examination, only the vaginal part of the cervix is available for examination. Normally, its surface, like the surface of the vagina, is lined with stratified squamous epithelium, while in the cervical canal the epithelium is cylindrical. Between different types of epithelium is the so-called transition zone. If the cylindrical epithelium goes beyond this border and shifts to the vaginal part of the cervix, then they speak of erosion or ectopia of the cervix. Previously this...

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Cervical erosion is a reddish-colored wound on the walls of the cervix or vagina. During the disease, the epithelium is damaged on the surface of the walls of the cervix, as a result of which the mucous membrane bleeds in the form of spotting. During a gynecological examination, erosion looks like a bright red spot on the walls of the uterus.

Symptoms of the disease

Usually the disease goes without any symptoms. It can only be detected during a routine examination by a gynecologist. However,

understand that the absence of symptoms can only be with mechanical damage that caused erosion. During inflammatory processes, certain changes in the patient's well-being may be observed. A woman can detect erosion on her own.

The discharge should not embarrass you, as soon as they become different from usual - go to the doctor describing all the symptoms. You can sound the alarm with: yellowish discharge, greenish, foul-smelling, ...

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Can cervical erosion cause cancer?

No, cervical erosion itself cannot provoke cancer. Unfortunately, in recent years, very often gynecologists scare women with the fact that erosion can eventually "grow" into cervical cancer. However, such a statement is fundamentally wrong and, moreover, completely absurd. Let us consider in more detail what the relationship can be between erosion and cervical cancer in fact.

So, cervical erosion is, simply put, a small defect on the mucous membrane, which in its structure is completely similar to an abrasion on the skin. It is hard to imagine that an abrasion that does not heal for a long time due to the fact that it is constantly “renewed” will develop into skin cancer. Similarly, it is impossible to imagine how an abrasion (erosion) on the mucous membrane of the cervix can grow into cancer. From the analogy of skin abrasions, the absurdity of claims that cervical erosion can cause cancer is quite clear.

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CIN, dysplasia, CIN are different names for the same condition, in which pathological changes occur in cells, leading over time to cancer.

Most often in our country, cervical cell dysplasia is detected. The rectum, anus and oropharynx are less commonly affected. In countries where great results have been achieved in preventive screening activities for the early detection of cervical pathology, for example, in some countries in Europe and the USA, slightly different statistics.

There they faced the fact that the defeat of the anus and oropharynx comes to the fore. That is, they have practically defeated cervical cancer and are now looking for ways to deal with previously atypical localization.

CIN is erosion?

No, erosion is, roughly speaking, a scratch on the cervix, in which the integumentary epithelium that protects the underlying tissues is damaged, it is perfectly visible when examined by a gynecologist or during colposcopy.

Dysplasia may not be determined at first glance and not ...

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Female doctor:

Hello Polina!
The cervix is lined externally with stratified squamous epithelium (SSE). It has no glands and practically does not change during the menstrual cycle. The cervical canal is lined with columnar epithelium (CE), which has many recesses - glands that produce mucus, the properties of which change depending on the woman's age and the phase of the menstrual cycle.

The border between the two types of epithelium is most often located in the area of the external uterine os and is called the transformation zone. This boundary is not the same throughout a woman's life.

In all girls, before puberty, the border passes outwards from the external pharynx, and then gradually shifts to the cervical canal. In postmenopausal women, the transformation zone is located approximately on the border of the middle and lower thirds of the cervical canal. At reproductive age, due to individual characteristics, about a quarter of young women have a zone shift ...

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Most women do not know much about cervical diseases. More precisely, almost nothing. Lack of awareness often leads to extremes, from questions on the Internet like: “Found erosion - is it cancer ?!” to the denial of really serious diagnoses. Every gynecologist knows more than one patient who could have been saved with timely treatment, if the woman had not stalled in the hope that she would resolve herself, or had not resorted to dubious methods of self-treatment. Obstetrician-gynecologist of the Center for Healthy Motherhood Victoria Zhuravleva answered the most popular questions about cervical diseases.

1. Why is there so much talk about cancer?

Cervical cancer is the most common oncological disease of the female genital organs, one of the main causes of female mortality in the world. This disease may not manifest itself for a long time, although it is effectively treated in the early stages - which means that systematic and regular visits to the gynecologist, special ...

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Diseases of the cervix, as a rule, do not have any special symptoms. They are found most often when a woman has ailments due to concomitant inflammatory processes or when she comes to the doctor to check for pregnancy. If the doctor tells her that there is cervical dysplasia, and besides, he warns that this is a precancerous condition, the woman begins to panic. You can and should be treated. Of course, this is best done at an early stage of the disease.

Dysplasia and other pathological conditions of the cervix

The cervix is a canal at the bottom of the uterus that opens into the vagina. From the inside, just like the uterine cavity, it is lined with a single layer of cylindrical epithelial cells. They contain glands that produce mucus that forms a protective plug. This mucus prevents the penetration of pathogens from the vagina into the uterine cavity and appendages.

Cervical dysplasia...

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Pathology of the cervix is one of the most common diseases in the world. Today we will tell you what symptoms you should pay special attention to in time, who is at risk, and what consequences even small pathologies lead to.

Currently, various diseases of the cervix affect a large number of women. First of all, such pathologies affect reproductive health. However, their main danger is that even background diseases can lead to malignant tumors. In terms of the frequency of cancers of the reproductive system, cervical cancer is in third place. And while the average age of the woman most at risk for cervical cancer is thought to be 52.2, other age groups are also at risk. Thus, the peaks of the disease also occur at 35-39 years and at 60-64 years.

Types of pathologies

First of all, you should know that there are three main types of cervical pathologies. These are background diseases, precancerous and ...

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You came for a scheduled examination to the gynecologist. Nothing bothers you, you feel absolutely healthy. And suddenly, like a bolt from the blue, the doctor's verdict: “You have cervical erosion. If not removed, it can develop into cancer." Before you panic, figure out what erosion is, because it is successfully treated.

In most cases, erosion proceeds painlessly, and this is their insidiousness. By letting things take their course and postponing a visit to the doctor, you run the risk of “earning” dysplasia, and this, unlike erosion, which, in fact, is a background disease, is already a precancerous condition. “Perhaps, there is no other disease in gynecology that would give rise to so many rumors and idle conjectures as the so-called erosion of the cervix,” says Vadim Vasilievich Semenov, obstetrician-gynecologist, director of the Healthy Motherland diagnostic and treatment center. What kind of folk recipes are passed from mouth to mouth by those who have already encountered a problem from their own experience! But few people know...

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Inspired by many posts such as this one:
http://www.baby.ru/community/view/22621/forum/post/483354785/ Comments with illiterate recommendations to the author are amazing ...

In general, the actual topic on the baby.

A little theory about what it is and what it is with - erosion, they eat it ...

Cervical erosion occurs when small erosions, ulcers, begin to form on the cervical mucosa. It is very important to diagnose this disease in time, because it can eventually develop into cervical cancer. The cervix is a cylindrical mucus-filled cavity that is responsible for connecting the vagina and uterus. If erosion appears on it, many problems arise.

Types of cervical erosion
Gynecology distinguishes 3 types of erosion - true erosion and pseudo-erosion, congenital erosion.

In childhood or adolescence, the doctor may notice that the girl has a displaced cylindrical epithelium. After colposcopy, it can be seen that the epithelium is stained bright red ...

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Any woman can face the problem of cervical erosion. This disease is very common and is caused by a complex of various causes. Erosion can be congenital or acquired, true or false. When it comes to cervical erosion, in most cases they talk about pseudo-erosion, in which there is no violation of the integrity of the mucous membrane. Fortunately, erosion is fairly easy to treat. However, the insidiousness of this disease is that most often it is asymptomatic, and it can only be determined during a routine gynecological examination. It is important to know that neglected erosion can develop into cancer.

As soon as the patient found out that she had found erosion, she should immediately begin treatment - for this you can use effective folk remedies (our website has special articles on this topic). This will help restore women's health and avoid the serious consequences of the disease.

What is erosion? Is it dangerous...

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Diseases and treatment of the cervix

Cervical erosion

Erosion of the cervix is congenital and acquired. Inflammatory diseases, hormonal disorders and mechanical factors contribute to its appearance. In women with menstrual irregularities, erosion occurs five to six times more often. Erosion does not cause any discomfort, except perhaps for whiteness and bloody discharge during sexual intercourse.

When viewed with the help of vaginal mirrors, the site of erosion looks like a red spot of irregular shape. Red - the color of the cylindrical epithelium, the stratified squamous epithelium of the vagina and the outer part of the cervix is normally gray-pink. To clarify the diagnosis, a test with acetic acid is used, which causes the cervical vessels to narrow and the epithelium to swell, and colposcopy, which allows you to examine the changes in more detail. Also, all women undergo a Pap smear (a study with Papanicolaou staining) during the examination. A smear allows you to identify changes in cells and pathological microorganisms on the mucous membrane of the cervix.

For the treatment of the cervix with erosion, methods such as cryodestruction, laser coagulation, diathermoelectroconization are used, in some cases chemical coagulation is used.

Ectropion and leukoplakia

Ectropion of the cervix is an eversion of the mucous membrane of the cervical canal on the vaginal part of the cervix. This condition occurs after childbirth, due to abortion, when the uterus is scraped. On examination, it also looks like red areas against the background of normal epithelium.

Treatment of the cervix with ectropion is performed by the same methods as with erosion. The doctor chooses a specific method based on the age and reproductive function of the patient. Leukoplakia of the cervix occurs when the keratinization of its epithelium. Like ectropion, leukoplakia does not cause any inconvenience to a woman. Doctors distinguish between simple leukoplakia and proliferating (that is, growing) leukoplakia with cell atypia. The degree of cell atypia may vary. This type of leukoplakia is referred to as precancerous conditions. It develops with injuries, as well as under the influence of immune, infectious and endocrine factors.

A simple cytological examination does not distinguish the two types of leukoplakia from each other. Therefore, a biopsy and histological examination of the obtained sample is carried out. As a treatment for leukoplakia, radiosurgical methods are preferred, that is, diathermoelectroconization. It is also possible to treat the cervix with a laser and cryodestruction. They are used in young women with simple leukoplakia.

Erythroplakia of the cervix

On examination, leukoplakia looks like white spots on the cervix, which is reflected in the name of the disease (leuko - “white”). Unlike leukoplakia, with erythroplakia of the cervix, thinning and atrophy of the squamous epithelium occurs. The affected areas look like red spots (erythro - "red"). The exact origin of this rare condition is still unclear. For treatment, cryodestruction or diathermoelectroconization is used, with the help of these methods, diseased areas of the cervix are destroyed.

Inflammation of the cervix: cervicitis

Cervicitis is an inflammation of the vaginal part of the cervix, accompanied by mucous or purulent discharge, pain in the lower abdomen, and sometimes pain during urination and during intercourse. Untreated cervicitis can lead to ectopia, hypertrophy (enlargement) of the cervix, the spread of infection to the overlying genitals. Cervicitis can be caused by opportunistic pathogens, such as strepto- and staphylococcus, fungi, E. coli, or specific microorganisms, including mycoplasmas, gonococci, chlamydia.

Cervicitis can be provoked by trauma during childbirth, abortion, curettage, installation and removal of the spiral, other diseases of the cervix, immunodeficiencies. The severity of symptoms of cervicitis depends on the type of pathogen. For diagnosis, in addition to conventional methods (examination in the mirrors, colposcopy, smear), a polymerase chain reaction is used. It helps to accurately identify the pathogen. Antibiotics are used for treatment, depending on the sensitivity and type of pathogen. Estrogens are also used, they accelerate the restoration of normal cervical epithelium and natural microflora.

Polyps in the uterus and in the cervix

Polyps are outgrowths on the mucous membrane of the cervix, consisting of connective tissue covered with a cylindrical or altered squamous epithelium. Polyps look like pink drop-shaped or leaf-shaped growths protruding from the cervix. The source of polyps can be both the cervix and the uterus. It is important to distinguish cervical polyps from polyps in the uterus, so the removal of polyps is performed under the control of a special method - hysterocervicoscopy. Modern ultrasound can detect small polyps in the uterus that do not extend beyond the cervix. Both cervical polyps and polyps in the uterus are removed under careful endoscopic control.

Papilloma of the cervix

Currently, human papillomavirus infection is considered the main cause of precancer and cervical cancer. The human papillomavirus is detected in 90% of cases, while the role of microorganisms, sperm and other carcinogens is not so significant. Of the 60 known human papillomaviruses, 20 can infect the genital tract, and numerous subtypes of the virus have oncogenic properties. In the area of tissue damage, dysplasia and cervical cancer itself can develop.

Cervical cancer

cervical dysplasia

Cervical cancer is a very common disease, second only to breast cancer in frequency. The factors of its development include early onset of sexual activity, genital infections, smoking, immunodeficiencies, poor hygiene, and infection with the papillomavirus.

It is believed that a violation of the protection and increased susceptibility of the epithelium play a role in the development of cervical cancer. Allocate the so-called cervical intraepithelial neoplasia (CIN) of varying severity. The border between severe dysplasia and cervical cancer is the defeat of the outer layer of the stratified epithelium. Before the development of cancer from cervical dysplasia, 10-15 years pass. If a woman regularly visits a gynecologist, then this time is more than enough for the early detection and destruction of cervical cancer.

Dysplasia may go unnoticed on routine examination, but is visible on colposcopy, and the acetic acid test causes the lesions to turn white. The Schiller test with iodine is also used. Areas of dysplasia do not absorb iodine, so this test result is called iodine-negative. The final diagnosis is established after biopsy and histological examination. Mild dysplasia usually does not require treatment and regresses in 50-60% of cases. However, such women need to be constantly monitored by a gynecologist. If dysplasia does not go away, conization of the cervix (knife, laser, electric) is performed. In case of in situ cancer (at the initial stages of tumor development) in the transition zone in postmenopausal women, the uterus and cervix are removed.

Symptoms of cervical cancer

Unlike dysplasia, cervical cancer has a very clear symptomatology. It includes spotting from the genital tract outside of menstruation. They can be minor, and can reach bleeding. There are pains in the lower abdomen, at a later stage, swelling of the legs and external genital organs, disruption of the intestines and bladder (cancer can grow into adjacent organs) are possible. General symptoms are also characteristic: weakness, malaise, weight loss, dizziness, fever for no apparent reason.

For diagnosis, a general gynecological examination, staining with iodine solution, colposcopy, Pap smear and biopsy are used. The prevalence of the process and damage to neighboring organs can be assessed using ultrasound or computed tomography. In addition, various studies are carried out aimed at finding metastases distant from the original focus.

In the treatment of cervical cancer at an early stage, organ-preserving operations are possible, that is, the removal of only the tumor with the capture of healthy tissues. Removal by laser, liquid nitrogen (cryodestruction) or ultrasound is possible. In later stages, both the cervix and the uterus itself are removed. At the same time, the ovaries are left in women of childbearing age, and in postmenopausal women, both the uterus and appendages are removed, and often nearby lymph nodes. The operation is usually supplemented with radiation and chemotherapy.

Prevention of cervical cancer

Prevention of cervical cancer is, first of all, regular visits to the gynecologist, so as not to miss the beginning of the process, especially if cases of cervical cancer were noted in the woman's family. Hygiene of sexual life, timely treatment of infectious diseases is important. In recent years, human papillomavirus vaccines have been developed. They are administered to girls who have already begun puberty, but have not yet had sexual intercourse (on average, this is between the ages of ten and 25 years). In addition, as in the case of many other diseases, no one has canceled the strengthening of the body's defenses, proper nutrition, maintaining a healthy lifestyle, and fighting bad habits.

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Malignant erosion is one of the types of early stage cervical cancer.

What are the symptoms caused by uterine cancer and especially cervical cancer?

Signs and recognition. Symptoms of incipient cancer are bleeding and leucorrhoea. Pain in cervical cancer appears only in the late stage of the disease, when a cure is hardly possible.

In the initial stage, a cancerous lesion of the cervix does not cause pain, so the presence of pain in a doubtful case may speak more against cancer than for it.

Bleeding in cervical cancer may have the character of increased or prolonged menstruation, as well as spotting that appears in the intermenstrual period or independently of menstruation, especially in menopause. The amount of blood released varies. Abundant bleeding is usually observed in the later stages of the disease, at the beginning of the bleeding are moderate or insignificant, but are characterized by their continuity and frequent recurrence. Of particular great diagnostic importance is the appearance of bleeding or spotting after a minor injury: sexual intercourse, gynecological examination, vaginal douching, passage of solid feces through the adjacent rectum, etc. (“contact” bleeding). This kind of bleeding should raise the suspicion of cancer, especially when the woman is in menopause.

At the onset of the disease, leucorrhoea does not have that fetid character that they acquire in the later stages of uterine cancer. In the early stage of the disease, leucorrhea is often odorless, not abundant, serous or serous-bloody. In this they differ from the secretions arising from inflammatory diseases and having a mucopurulent character with endocervicitis and unclear serous-purulent with colpitis. Not being a reliable symptom of incipient cancer, leucorrhea that appears suddenly in old age for no apparent reason should attract special attention. Occasionally, there are cases of cancer in which neither bleeding nor leucorrhoea is observed in the early stage of the disease.

In view of the fact that cancer occurs more often in menopausal and pre-menopausal periods, some authors require that antenatal clinics, in order to systematically combat uterine cancer, involve all women in their area who are at a specified age for periodic gynecological examination. Recently, this requirement has met with all-round support. Included in the number of surveyed and other age groups of women. It is necessary that the doctors of antenatal clinics, gynecological polyclinics, and medical districts in the countryside, in the struggle for the early detection of the initial forms of uterine cancer, pay the greatest attention to those symptoms that can cause the slightest suspicion of cancer. The second unconditional requirement is that in each case the doctor, performing a thorough gynecological examination, must examine the cervix in the mirrors without fail. True, such a study makes it possible to diagnose cervical cancer with confidence only in advanced cases. In the initial stage of the process, the examination allows the doctor to make only a presumptive diagnosis or causes him to suspect cancer. Therefore, in such cases, in addition to a gynecological examination, additional research methods should be resorted to. The appointment of any therapeutic measure against bleeding or leucorrhoea without a thorough gynecological examination is a gross omission on the part of the doctor, which can expose the woman who turned to him for advice to mortal danger.

What are the objective changes found on the cervix during gynecological examinations that can cause suspicion of incipient cancer?

In the initial stage of the development of cervical cancer that has arisen inside the cervical canal, a gynecological examination may not give any objective signs at all; in other cases, suspicion of cancer may cause the presence of some thickening and hardening of the cervix, especially if the study is accompanied by the appearance of blood from the cervical canal.

In rare cases of cancer that does not arise from the mucous membrane of the cervical canal, but in the thickness of the cervix, at the initial stage of the disease (before the neoplasm breaks into the cervical canal or onto the surface of the vaginal part of the uterus), there will be no symptom of bleeding, so in such cases it is usually recognized very late .

Cancer of the vaginal part of the uterus can be detected during a gynecological examination much earlier than cancer that occurs in the cervical canal, since the place of its localization is accessible for examination in the mirrors. In these cases, cancer can be detected in the form of a small, located on the anterior or posterior lip of the pharynx, papillary growth or induration, which slightly rises above the adjacent area and bleeds when touched, but more often there is an ulcer, initially somewhat reminiscent of inflammatory erosion in its appearance. Inflammatory erosion has a bright red color with a bluish tint, velvety in appearance, bleeds slightly when touched. The eroded area evenly rises above the mucosa and gradually passes into healthy tissue. Inflammatory erosion is often accompanied by the presence of testicles, swelling of tissues, and abundant mucopurulent discharge from the cervix.

A cancerous ulcer has a slightly different appearance: its surface is uneven and bumpy; the color of the ulcer is darker than the color of the surrounding healthy tissue. In some places, hemorrhagic and necrotic areas are observed. When palpated, the tissue of the ulcer is denser than the surrounding tissue and is extremely fragile; at the slightest mechanical damage, profuse bleeding begins; when examining, the probe easily penetrates the tissue.

A cancerous ulcer does not appear to be uniformly elevated, like a benign erosion, and on the border with healthy tissue it is sometimes separated from it, as it were, by a groove. Catarrhal phenomena, which are usually accompanied by benign erosion of the cervix, may be absent in the initial stage of cancer. This cancerous ulcer and differs mainly from benign erosion. These distinguishing features are clearly expressed, but in the initial stage of cancer, but only when the process has already gone quite far.

At the very beginning of the disease, in its clinical picture, cervical cancer differs little from a benign ulcer.

Differential diagnosis between cancer and primary syphilitic or tuberculous ulcer of the cervix can also present great difficulties. Thus, the data of palpation and examination in the mirrors in many cases can only cause a suspicion of cancer, but they cannot always bring complete clarity to the diagnosis. Meanwhile, the answer to the question of whether there is cancer in this case or not must be given immediately, since saving the patient's life can largely depend on this.

Therefore, in order to accurately diagnose a case suspected of cervical cancer, it is necessary to resort to a biopsy.

Biopsy for suspected cervical cancer. The microscopic picture of the histological section, with the correctly applied biopsy technique, can detect cancerous degeneration at the very initial stage of its development. And if we take into account that it is the initial cases of uterine cancer that provide, we repeat, the greatest opportunities for a favorable result of treatment, then it is clear that the method of microscopic diagnosis in the fight against uterine cancer is of particular importance.

Unfortunately, microscopic examination of the biopsied area does not always allow to come to an accurate and final decision. If the histological examination does not reveal cancer, while the clinical picture still causes strong suspicion, it is necessary to re-examine, since the biopsy piece could be cut incorrectly (for example, it was taken not from the cancer focus, but from the area adjacent to it, where there is only inflammation). Difficulties and errors can also arise in the interpretation of the microscopic picture. All this indicates that the data of histological examination, when they are in conflict with the clinical picture, should be treated with some caution. In such cases, a woman should be taken into special account and systematically subjected to repeated thorough gynecological and histological examination.

The II Congress of Obstetricians and Gynecologists in a resolution on the program issue of uterine cancer noted: “ The congress believes that a microscopic examination that denies a cancerous lesion in the presence of a suspicious picture should not serve as a basis for considering a patient beyond suspicion of cancer and a reason to let such a patient out of the doctor's field of vision.».

The question often arises as to whether the biopsy should be performed in a local hospital or in an institution whose working conditions do not allow, in the event of a response confirming the presence of cancer from a histologist, to carry out the necessary treatment. Perhaps the local doctor would do the right thing if he sends the patient immediately to a medical institution, where a biopsy will be performed, and, if necessary, an immediate operation?

Of course, such a line of behavior has certain advantages already because a biopsy performed long before the operation can lead to the introduction of infection or neoplasm from the cancer focus to the nearest or distant areas.

In order to avoid this danger, in our clinic, in cases where the type of ulcer (decay; caused a strong suspicion of a malignant neoplasm), we used the following method: a biopsy was performed half an hour or an hour before the proposed operation. This time is enough to examine the biopsy piece on a freezing microtome tissue.If a histological examination revealed cancer, then a radical operation was performed immediately, and then there was no threat of infection and cancer cells from the cancerous ulcer entering and spreading through the lymphatic tract.And if there was no cancer, then the radical operation was canceled.

But if the biopsy was not carried out at all on the spot, then some women, not attaching much importance, in their opinion, to insignificant complaints, do not always go to their destination, and then cases of initial cancer can turn into neglected and inoperable. Therefore, the requirement to perform a biopsy only in an institution where the patient can receive appropriate treatment should not, in our opinion, be categorical.

It goes without saying that the production of a biopsy on the spot with the sending of a cut piece of tissue for microscopic examination to the pathological anatomical office located in the nearest center requires good organizational linkage in the work of district doctors, as well as the entire general treatment and prevention network with oncological service institutions, in of which the oncological dispensary has been and remains the organizational center.

If a gynecological examination causes a strong suspicion of cancer in a doctor, then it is better not to perform a biopsy at the site, but to immediately send the patient to one of the medical institutions of the district or region, where it will be possible to perform a biopsy and, if necessary, an operation. But the district doctor in such a case should not be limited to only an appointment, but is obliged to check whether the patient has fulfilled his appointment, and, if necessary, take all measures to ensure that the patient fulfills it without wasting time.

Biopsy technique. A biopsy, or test excision, i.e. cutting a wedge-shaped piece of tissue from a cancer-suspicious area on the cervix for histological examination, is one of the minor gynecological operations. From the technical side, it can be available to every operating doctor. But despite its simplicity, the operation can sometimes be performed insufficiently carefully, and sometimes incorrectly, resulting in a diagnostic error. So. for example, it may happen that an extensive bleeding papillary erosion on the cervix in one place begins to turn into a cancerous one. It is sometimes difficult for an inexperienced doctor to correctly select exactly the area on the eroded neck where cancer is most likely to be detected. As a result, a test piece can be cut out from a site on the neck where there is no cancer yet, although it already exists in another area of erosion.

In order to choose the right place for a biopsy, you can make a test, which was once proposed to recognize the initial stage of cancer of the vaginal part of the uterus, as an independent diagnostic method. This test consists in the fact that the vaginal part of the uterus, exposed by mirrors, is lubricated with Lugol's solution (instead of lubrication, you can make a bath from Lugol's solution). The squamous epithelium covering the healthy surface of the vaginal part of the uterus, containing glycogen in its protoplasm, stains dark brown under the influence of Lugol's solution, while cancer cells stain weakly or not at all. As a result, the area of the vaginal part of the uterus, affected by a cancerous neoplasm, after the action of Lugol's solution on it, stands out among the healthy tissue as a lighter spot. This method, however, did not fully justify the hopes placed on it. It turned out that the test was specific only for brown staining of normal surface epithelium and that areas that did not accept stains were not necessarily affected by cancer. So, for example, the surface is slightly stained, on which there is hyperkeratosis or benign (inflammatory) erosion with a detached surface layer of the epithelium. However, it is still impossible to completely deny the diagnostic value of this method, and it seems to us that this test can help a doctor inexperienced in these matters when choosing a site on the vaginal part of the uterus for biopsy.

In cases where suspicious erosion has widely captured the lips of the uterine os, test pieces must be cut from both the anterior and posterior lip.

A biopsy can also be performed incorrectly from a purely technical point of view. The most common mistake is to cut too small a piece, so that the area where there is incipient cancer may not be included in the investigational preparation. In another case, cancer can be suspected when the examined piece contains strands and nests of squamous epithelium, and since the cut piece is too small and thin, it is impossible to establish whether the squamous epithelium grows into the depth and into the adjacent tissue, which is so characteristic of cancer. Of course, microscopic examination reveals, in addition to this, other more or less characteristic features, but still the general picture of a large section, which allows one to trace the relative position of the epithelium and stroma for a sufficient length, is usually of decisive importance. In addition, too small a piece cut from the surface in the form of a plate, it is very difficult to properly position it when pasted on the block; in the removed plate it is impossible to decide by eye where the underlying tissue is located and where the integumentary epithelium is; if the preparation on the block is located incorrectly, then at the very first sections it is possible to remove the integumentary epithelium and in the following sections to have only the stroma. It is, of course, impossible to give a definite answer in such cases.

A piece taken from the surface of a tumor or ulcer is even less suitable for research, since this surface layer can, with existing cancer, give a picture of necrosis alone. A wedge-shaped piece cut out for microscopic examination from the cervix must necessarily contain not only suspicious, but also adjacent and underlying tissue. Therefore, the cut piece should go 1 cm beyond the border of the ulcer to a healthy (by eye) surface of the mucosa. In the same way, the cut piece should also go deep enough so that its rib contains a layer of tissue lying under the suspicious area of mucosa.

Usually, anesthesia is not used during trial cutting. If a biopsy is performed on an outpatient basis, then V. S. Gruzdev recommends using a special tool. It is a fenestrated forceps with triangular holes with sharp edges; with these forceps, as it were, a piece is bitten out from the anterior or from the posterior lip of the vaginal part of the uterus.

We do not have personal experience in the use of such instruments, but we believe that it is unlikely that a biopsy produced by these instruments will often meet all the methodological requirements that were outlined above.

A piece should be cut especially deep in cases where one of the rare and most insidious forms of cancer is suspected in the patient - central, intramural cancer of the cervix. In such a case, until the cancerous tumor reaches the surface of the cervical mucosa, it is not visible, and only the swelling of the neck and its dense consistency may arouse suspicion and require a trial cutting. Thus, a biopsy will only detect cancer if the cut wedge penetrates deep enough into the muscle.

A deep defect in the cervix, formed during a trial cutting, has to be closed with one or two ligatures to avoid bleeding. With a less deep notch and where there is no bleeding, you can limit yourself to tamponing the vagina.
It goes without saying that both the operation and preparation for it must be carried out according to all the rules applicable to any vaginal operation.

If the doctor cannot determine exactly which area of erosion is most suspicious of cancerous degeneration, then the excised piece should have a large surface.

If a cancerous neoplasm has arisen in the upper cervical canal, then microscopic diagnosis can only be made by examining a scraping.

At the end of the biopsy operation, the cut piece of tissue is washed from blood, then placed in a jar with 5-10% formalin solution or 96% alcohol. To avoid possible errors, the jar with the drug should be labeled with the patient's last name, first name and age, the date of the biopsy, and the place from which the piece was cut.

Recognition of cervical cancer originating from the cervical mucosa. Cervical cancer can develop both from the stratified squamous epithelium covering the mucous membrane of the vaginal part of the uterus, and from the cylindrical epithelium of the mucous membrane of the cervical canal.

From this, of course, it does not follow that cancer of the vaginal part of the uterus will always be squamous, and cancer of the cervical canal will always be cylindric. Regardless of the morphological form of cancer, cancer of the vaginal part of the uterus in the initial stage of its development can be detected earlier than incipient cancer of the mucous membrane of the cervical canal. This is quite understandable, since the vaginal part can be subjected not only to palpation, but also to direct examination, and the mucous membrane of the cervical canal remains inaccessible to the eye. Therefore, when palpation and examination with mirrors reveal an area suspicious for cancer on the vaginal part, a test cut (biopsy) is made to establish the diagnosis.

But what to do in the case when the anamnesis and clinical phenomena (bleeding and spotting in the menopause or in old age, contact bleeding, etc.) raise suspicions of cancer, and examination in the mirrors does not reveal anything suspicious on the mucous membrane of the vaginal part of the uterus ? It would be a big mistake to wait for further developments. Suspicion must be, as it must be tirelessly repeated, in the shortest possible time either confirmed or rejected.

If the suspicion is based, in addition to these symptoms, on the presence of a small limited hardening on the anterior or posterior lip of the uterine os, then a deep notch can still detect incipient cancer of the cervical canal, which comes close to the vaginal part, but has not yet germinated on its surface. If cervical cancer at an early stage of its development is located higher but towards the internal pharynx, then in the presence of clinically suspicious symptoms, an examination of the vaginal part of the uterus may not detect anything, and the diagnosis can only be made by microscopic examination of a scraping taken from the cervical canal.

Microscopic diagnosis of cervical cancer can be simple and easy for every pathologist.

In the initial stages of the disease, differential diagnosis between a cancerous (and precancerous) neoplasm and various forms of inflammatory processes of the cervix can present great difficulties even with a microscopic examination of a cut piece of tissue. In this case, it may be necessary to consult with a more experienced specialist.

Microscopic diagnosis of cervical cancer by studying native, unstained preparations - smears taken from the affected area of the cervix. In view of the fact that there may be contraindications for the production of a biopsy (acute and subacute inflammatory processes of the female genital organs, the presence of pyometra, etc.), the aspirations of clinicians and pathologists were aimed at finding new research methods that could replace a biopsy.

A similar method could be of great interest in the dynamic monitoring of patients with cervical cancer during radiotherapy.

Favorable results have been achieved in this direction in recent years. As shown by a number of reports by the authors, according to which the discharge taken from the affected area of the cervix in a native, unstained preparation is examined, gives the highest percentage of matches with the data of a histological examination, while the study of stained vaginal smears using the Papanicolaou method not only has no advantages over with the method of studying native drugs, but also significantly inferior to it, being more complicated and less reliable.