1st degree cervical dysplasia

Pathological processes occurring in the epithelium of the cervix, associated with the appearance of modified cells in the tissue structure, are called intraepithelial dysplasia. A mild form of such damage to the squamous epithelium in gynecology is defined as grade 1 cervical dysplasia.

This diagnosis is very common among women of different age groups.

The pathology belongs to class XIV diseases - diseases of the genitourinary system (Diseases of the genitourinary system) and has the ICD 10 code - N87.0 (Dysplasia of cervix uteri grade I).

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Causes grade 1 cervical dysplasia

The key causes of grade 1 cervical dysplasia are HPV types 16, 18, 31, 33, 35, 52 and 58. At the same time, as experts from the International Agency for Research on Cancer (IARC) note, more than 15 types of papillomavirus are carcinogenic or conditionally oncogenic, that is, capable of causing cancer. In particular, 99% of squamous cell cervical cancer are associated with infection with HPV 16 and HPV 18.

Mild dysplasia (cervical intraepithelial neoplasia grade I), like any other, develops as a result of the penetration of the HPV virion into the body and the introduction of its nucleocapsids into the stratified squamous epithelium lining the mucous membrane of the cervix. The virus does not like the upper layer with old cells, it seeks to penetrate deeper - into the parabasal layer, since intensive proliferation and differentiation of cells occurs in it, and where enough proteins accumulate, which is what is needed for the reproduction of the virus.

Having penetrated the genome of a normal epithelial cell, the virus with its E7 protein blocks the Rb gene, which is “responsible” for the accumulation of proteins for cell division and, at the same time, regulates excessive cell division (by stopping the supply of proteins). And while E7 remains attached to Rb, the cell cycle will occur under conditions favorable for HPV.

Viral causes of grade 1 cervical dysplasia are aggravated by the fact that HPV genes attack the p53 protein of human cells, which controls their biological cycle and protects cell DNA from damage (causing apoptosis of defective cells). By integrating its proteins into the genome of epithelial cells, the virus inactivates the protective functions of p53, and cells with damaged or altered DNA continue to live. This allows the virus not only to feel comfortable in the host's body, but also to successfully reproduce, causing neoplasia - abnormal growth of modified cells. This complex process means the diagnosis of grade 1 cervical dysplasia, in which the pathology is localized in the upper third of the epithelial layer. Due to the abnormality of the cells and their pathological proliferation, doctors call this condition of the cervical mucosa precancerous.

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Risk factors

Among the factors that contribute to the development of dysplasia, which gynecologists point out, we can name indiscriminate and unprotected sexual intercourse, STDs, inflammatory processes in the genitals and, of course, weakened immunity.

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Pathogenesis

Doctors associate the pathogenesis of this lesion with genital papillomavirus infection. Among the nearly two hundred currently known types of human papillomavirus (HPV) that affect mucous membranes, skin, and internal organs, more than four dozen types are sexually transmitted.

Changes in the tissues of the cervix caused by this virus can be considered as a symptom of HPV infection, that is, in essence, a gynecological infectious disease, and then it can be classified according to ICD 10 B97.7 (papallomaviruses as a cause of other diseases).

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Symptoms grade 1 cervical dysplasia

The life cycle of the papillomavirus, which is a persistent infection, has its own characteristics: its incubation period can last for years, and you may not even know about its presence, since it does not manifest itself in any way.

Therefore, most cases of HPV lesions of the cervical mucosa are subclinical, i.e. they do not cause any physical symptoms. So the first signs of cervical intraepithelial dysplasia cannot be felt by patients. Although the pathological process in the epidermis of the cervix is ongoing, and a cytological analysis reveals a number of morphological changes in the form of abnormal cell shape, enlargement of their nuclei and the appearance of large vacuoles in the cytoplasm.

Some symptoms of cervical dysplasia of the 1st degree may be noticed by women when the nature and intensity of vaginal discharge changes. As a rule, such a change (admixture of bloody elements in cervical mucus), accompanied by itching or burning, may be due to additional bacterial infection of the vagina and cervical canal.

Are there complications with grade 1 cervical dysplasia? There are, and they consist of the transition of the pathology to the next stage - moderate cervical dysplasia, in which neoplastic processes affect half or more of the thickness of the squamous epithelium.

But the consequences depend on the oncogenic potential of the papillomavirus: even with a subclinical nature of the infection, 5-10% of women infected with HPV 16 and HPV 18 have a high risk of developing precancerous lesions of the vulva and cervix, which can progress to oncology.

By the way, grade 1 cervical dysplasia and pregnancy can exist simultaneously, since the papillomavirus that was present before gestation does not go away. And, given the peculiarities of the female body's immunity during pregnancy, it can even become active. A mild degree of pathology does not require treatment, nor does it imply delivery by cesarean section.

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Diagnostics grade 1 cervical dysplasia

The earlier the diagnosis of grade 1 cervical dysplasia is made, the better. Standard diagnostic methods for determining this pathology, in addition to a routine gynecological examination, include tests:

• PAP-smear test (Papanicolaou smear) - cytological examination of the mucous membrane;
• HPV analysis (smear from the endoepithelium of the cervix) – determination of the papillomavirus and its serotype using polymerase chain reaction (PCR);
• scraping of cervical tissue and testing it for papillomavirus DNA (Digene test).

Instrumental diagnostics for dysplasia is performed using vaginal endoscopy (colcoscopy) - examination of the cervix through a colposcope, which provides 30-fold magnification and fairly clear visualization of normal and abnormal tissues. For more accurate localization of dysplasia foci, extended colposcopy is performed (with tests using a weak solution of acetic acid and potassium iodide).

Based on the results of the PAP test, if oncology is suspected, a cervical biopsy (under colposcope control) and histological examination of the biopsy are prescribed. This, in fact, is the differential diagnosis of intraepithelial dysplasia.

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Treatment grade 1 cervical dysplasia

It should be noted right away that there is no cure for the cause of cervical dysplasia.

In addition, according to clinical studies of this pathology, a mild degree of cervical neoplasia in 70% of cases goes away within a year without any therapy, and within two years - in 9 cases out of 10.

Therefore, treatment of grade 1 cervical dysplasia consists of monitoring the condition of its epithelium, for which patients must take a smear test once a quarter or every six months. Surgical treatment of this degree of dysplasia is usually not used. Only if colposcopy results are unsatisfactory can an excisional procedure of electrical conization (cone-shaped removal of abnormal tissue) be prescribed.

Gynecologists recommend taking vitamins C, beta-carotene, B2, B6, B9, E, as well as selenium (0.2 mg per day) and zinc (15-25 mg per day).

There are also immunomodulatory and antiviral pharmacological agents:

Vaginal suppositories Viferon and Genferon;

• Novirin (Inosine pranobex, Isoprinosine) - two tablets three times a day for 2-4 weeks;
• Alloferon (Allokin-alpha) for subcutaneous injections against HPV.

Traditional treatment suggests using turmeric (a teaspoon daily), tea with echinacea and rosehip infusion (150-200 ml per day for 3-4 weeks), and douching the vagina with an aqueous solution of propolis.

Herbal treatment is also used, for example, douching with a decoction of a mixture of medicinal plants such as calendula (flowers), licorice (root), yarrow, sweet clover and meadowsweet.

Homeopathy may help some: Beta-Mannan, an aloe extract; Thuja occidentalis; DIM (Diindolymethane), a metabolite of indole-3-carbinol, a compound found in cruciferous vegetables (cabbage, broccoli, etc.). Naturopaths recommend treatment with green tea extract epigallocatechin-3-gallate (EGCG), which inhibits epidermal growth factor receptors and inhibits the proliferation of abnormal cells in neoplasms.

Considering the high level of spontaneous cessation of the pathological process, the prognosis for grade 1 cervical dysplasia is positive if HPV does not belong to oncogenic serotypes.

Prevention

Prevention consists of measures taken to minimize the possibility of infection with the papillomavirus, that is, safe sexual relations using a condom.

Smoking predisposes to the development of cervical abnormalities, as nicotine reduces the level of ascorbic acid, disrupting the pH balance of the epidermis. So quitting smoking is part of the prevention of dysplasia. An extremely important aspect of preventing grade 1 cervical dysplasia is maintaining a healthy immune system.

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