3rd degree cervical dysplasia

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is a potentially precancerous condition characterized by abnormal growth (dysplasia) of the squamous epithelium on the surface of the cervix. Severe dysplasia, or grade 3 cervical dysplasia, involves more than two-thirds of the epithelium and may involve the entire thickness. This type of lesion is sometimes called cervical carcinoma in situ.

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Epidemiology

Cervical dysplasia grade 3 can develop at any age, but is most often diagnosed between the ages of 25 and 35.

Causes grade 3 cervical dysplasia

To date, the causes of grade 3 cervical dysplasia have not yet been fully studied. As practice shows, almost all patients who were diagnosed with this condition had human papillomavirus (HPV) in their medical history. Many medical workers blame it for the appearance of atypical cells - provocateurs of various pathologies.

Other diseases can also provoke these pathological changes:

• Hereditary predisposition.
• An inflammatory process occurring in the pelvic organs.
• Sexually transmitted infections. For example, syphilis.
• Other infectious diseases. For example, genital warts and chronic cervicitis.
• Decreased immune strength of the body.
• Long-term smoking and alcohol consumption.
• Hormonal imbalance.
• Early onset of sexual activity. Doctors consider the risk of dysplasia high if this occurred before the age of 18. Increased mechanical impact and hormonal stimulation of the epithelium leads to failures in its development.
• Trauma that could have occurred due to frequent births, abortions, diagnostic curettage of the fundus of the uterus.
• Ignoring the rules of intimate hygiene.
• Don't be picky. Having more than one partner increases your risk of getting a sexually transmitted virus.

The pathology considered in this article is classified as a polyetiological disease. This fact indicates that a failure in the development of mitosis and maturation of cellular structures of the mucosa causes a number of provoking factors. And they must be taken into account when prescribing a treatment protocol.

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Pathogenesis

The cervix is the lower end of the female genitals, which consists of a passage connecting the vagina with the uterine cavity. The walls of the canal are cylindrical epidermal cells lining the canal in one layer and saturated with mucous glands.

The mucosa itself consists of three layers, represented by different cellular structures: the superficial epithelium, the intermediate layer and the basal layer.

The pathogenesis of the pathological process consists of a change in the balance of layers. As the analyses show, the superficial and transitional epithelial cells in pathological changes show the presence of mitotically active cells, which should not be present in healthy tissue.

As a result of proliferation, the layer of epithelial cells increases, leading to the development of hyperplasia.

The pathogenesis of cervical dysplasia is rooted in the disruption of normal cell mitosis. This is what provokes cell division where it should not be.

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Symptoms grade 3 cervical dysplasia

At earlier stages, the disease may be asymptomatic. This is why doctors recommend that women see a gynecologist at least once a year, or even more often.

But when the disease is marked by an advanced course, then its signs are very difficult to miss. Symptoms of cervical dysplasia of the 3rd degree are mainly as follows:

• In the lower abdomen, the woman begins to feel discomfort in the form of pulling and/or aching pain symptoms. These symptoms especially intensify during menstruation.
• Itching and burning appear in the area of a woman's primary sexual characteristics.
• Increased pathological discharge: leucorrhoea can be either bloody or of another shade. At the same time, they can emit a foul odor.
• Increased pain during sexual intercourse.

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First signs

As already mentioned above, at an early stage of the disease, a woman may not feel any discomfort. However, the first signs of the pathology may appear much later, at later stages. In most cases, these are discomforts in the genital area and lower abdomen (pain, burning, itching, etc.). This should be a reason to seek advice and examination from a gynecologist.

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Cervical dysplasia grade 3 and pregnancy

Although not often, there are cases when a woman learns such an unpleasant diagnosis during pregnancy. After all, in order to register with a women's clinic, she needs to undergo a certain package of examinations. Cervical dysplasia of the 3rd degree and pregnancy are certainly not a rule, but not an exception to the rule. Such situations do happen.

In this case, the obstetrician-gynecologist who is monitoring the pregnancy prescribes a repeat test and additional examinations for the expectant mother. In this case, such an examination is a biopsy. Conducting this study during pregnancy is quite dangerous due to the high risk of miscarriage, but in this situation, the health, and even the life, of the mother is at stake. A biopsy is prescribed to a pregnant woman only for significant medical reasons.

In most cases, doctors take a wait-and-see approach, prescribing medication or surgical treatment after obstetrics. And against the background of fetal development, they prefer to keep the expectant mother under constant supervision, periodically conducting a cytological examination, which allows observing the pathology in dynamics.

Complications and consequences

To assess the danger of the disease in question, it is necessary to imagine the consequences that it can lead to if the problem is ignored or if there is insufficient treatment.

And the consequences are quite unpleasant:

• Degeneration of atypical epithelium into tumor-like structures with subsequent mutation into cancerous neoplasms.
• Further penetration. That is, progressive growth with damage to healthy cells.
• Gradual appearance of metastases.
• Stealing effect. As studies show, a cancer cell is more active and has increased metabolic processes, which leads to the fact that mutated structures consume nutrients from the body, limiting healthy cells in this.
• Intoxication of the patient’s body is poisoning with toxins – waste products of malignant tissues.

Cervical dysplasia of the 3rd degree is considered by doctors to be a precancerous condition. And if appropriate measures are not taken, there is a very high probability of its development into uterine cancer.

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Complications

With timely diagnosis and modern treatment methods, even stage 3 of the pathology in question is not a death sentence for a woman.

However, even after the necessary therapy, the risk of complications does not disappear.

• If the treatment did not affect the integrity of the organ, there remains a possibility of the disease returning.
• There remains a risk of atypical cells and further development of cervical cancer or cancer of adjacent organs. This is the most terrible complication of this disease.
• A decrease in immunity entails an attack on the body by an invasive infection, against which there is not always enough strength to resist.

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Diagnostics grade 3 cervical dysplasia

A suspicion of the presence of pathology may creep into the specialist's mind during the woman's next visit to the gynecologist or in the woman herself when discomfort symptoms appear in the area of her genitals. Diagnosis of grade 3 cervical dysplasia is carried out similarly and at earlier stages of the disease.

The main diagnostic method here is a cytological scraping, which is sent for laboratory testing (PAP test). If this analysis shows the presence of abnormalities, then the doctor prescribes a more extensive examination of the woman:

• A biopsy is performed, followed by histological examination.
• A number of other laboratory tests. For example, HPV test – human papillomavirus.
• Colposcopy is an examination of a woman's genitals using a special optical device called a colposcope. It allows detecting precancerous and cancerous changes in the tissues of the reproductive organs. In the case of the third degree of pathology, the specialist can observe that all layers of the canal wall have undergone changes.

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Tests

The first thing that is prescribed to a patient with a suspected disease discussed in this article is tests carried out in laboratory conditions.

• PAP test, or as it is called by medical workers - a Pap smear. This analysis refers to cytological studies. The material for it is obtained in the form of a smear taken during a routine gynecological examination. The sample is sent to the laboratory for examination under a microscope. If atypical cells are detected, the woman is prescribed additional examination.
• A biopsy is performed. During colposcopy, a small sample of cervical tissue is pinched off with a special instrument. This is what is examined in the laboratory under high-resolution microscope. The presence of dysplasia and the severity of its development are assessed.
• Testing for human papillomavirus (HPV). The material taken (smear) is sent for polymerase chain reaction (PCR). If HPV is detected, its type is determined.
• Immunohistochemistry with tumor markers. This analysis is not performed on all patients, but only on those who are suspected of grade 3 cervical dysplasia or cancer. Special substances called tumor markers, in the presence of atypical cells, bind to cancerous neoplasms, giving a positive test result.

And also, without fail, a woman must submit:

• General and biochemical blood tests.
• General and biochemical urine analysis.
• Blood to determine blood type and Rh factor.
• Bacteriological and bacterioscopic examination of vaginal discharge for the presence of infection.
• A study of the level of hormones of the pituitary-gonadotropic system.

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Instrumental diagnostics

The most popular are:

• Colposcopy is an examination of a woman's genitals using a colposcope, a special medical device that is a binocular equipped with a lighting device. This examination allows detecting lesions, differentiating between benign and malignant neoplasms, and analyzing the condition of the mucous membrane and the extent of its damage. A smear is taken for further biopsy.
• A biopsy is performed while monitoring with a colposcope.
• If necessary, ultrasound examination.

Differential diagnosis

After passing the entire range of examinations, differential diagnostics is carried out. It includes an analysis of the results of laboratory and instrumental studies, as well as the patient's medical history. Based on this, diseases that are similar in symptoms but not confirmed by research are excluded.

Analysis of the patient's medical history and examination results makes it possible to diagnose not only the disease itself, but also the stage of destruction it is at. After all, based on this, we can talk about adequate, effective treatment or preventive measures capable of maintaining the patient's body in remission.

A specialist must be able to evaluate the clinical picture of the disease. The main criterion in this is the staging of the pathology. Mainly, if a woman already feels the manifestation of pathological symptoms, then the patient is diagnosed with the third stage of cervical dysplasia, or even cancer. After all, the pathology considered in this article is considered a precancerous condition of the organ.

Treatment grade 3 cervical dysplasia

After the diagnosis is made and the severity of the disease is determined, the attending physician begins to prescribe the necessary treatment protocol. Treatment of stage 3 cervical dysplasia is mandatory. Otherwise, the woman faces a bleak prospect: cell mutation into cancerous neoplasms, which will inevitably lead to metastases and death.

Treatment of this disease is carried out using several methods in combination.

1. Therapeutic treatment:
   • Use of vaginal suppositories with antiviral properties.
   • Douching with special disinfectant antiviral solutions and herbal infusions.
   • Tamponade.
   • Use of cauterizing ointments.
   • Oral administration of antiviral drugs: allokin alpha, amizon, epigen intim, lavomax, panavir, groprinosin, kagocel, isoprinosine, modimunal, amixin, protiflazid and others.
   • Immunostimulants: Immunorix, polyoxidonium, pyrogenal, actinolysate, immunal, glutoxim, viferon, deoxynate, genferon, stemokin, gepon, copaxone-teva and other interferon preparations.
2. Surgical treatment.
   • Electrocoagulation is the cauterization of a pathologically altered area using electric current.
   • Laser conization is the removal of the problem using special medical equipment that emits laser beams.
   • Removal of a dysplastic area by radio waves with the participation of a special device, the Surgitron. The essence of the method is similar to the previous ones, but a radio wave of a certain frequency is used as a tool for influencing the problem area.
   • Cryodestruction is the use of low temperatures, namely liquid nitrogen, to remove pathologically altered areas.
   • Ultrasonic destruction. The treatment method is similar to the previous ones, only instead of laser and radio waves, ultrasound is used.
   • Classic surgical treatment using a scalpel.
   • Removal of the cervix.
3. Alternative medicine methods:
   • Homeopathy.
   • Herbal treatment.

You can read more about the treatment of grade 3 cervical dysplasia here.

It is worth warning right away that self-management of the problem in question is unacceptable. Treatment of cervical dysplasia of the 3rd degree should be prescribed only by an experienced specialist and carried out under his supervision and control. Otherwise, time will only be lost in solving this problem, which is unacceptable with such a clinical picture.

Cervical conization for grade 3 dysplasia

Until recently, this treatment method was practically the only way to get rid of the pathology. Conization of the cervix in case of grade 3 dysplasia is the excision of altered tissues of the mucous membrane of the female reproductive system using classical surgical treatment methods with a scalpel, a special surgical loop through which an electric current is passed, or a laser.

Conization of the cervix is the most traumatic method of treatment, since healthy cells are excised along with the affected tissues. A rough colloid scar is formed at the site of the operation. The intervention is performed under general anesthesia, within the walls of a hospital.

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Medicines

One of the methods of treating the disease in question is drug therapy. The drugs prescribed for grade 3 cervical dysplasia are antiviral drugs and immunostimulants. If a classic operation was performed, antibiotics are necessarily prescribed in the treatment protocol.

The following may be prescribed as antiviral therapy: amixin, allokin alpha, kagocel, amizon, epigen intim, panavir, lavomax, isoprinosine, groprinosin, modimunal, protiflazid and others.

The immunostimulating drug isoprinosine is taken orally after a meal, with a sufficient amount of liquid. The starting dosage is two tablets three times a day. The duration of the treatment course is ten days. Then a break of two weeks and then two or three treatment courses are carried out.

Contraindications for taking isoprinosine include a history of urolithiasis, problems with heart rhythm, gout, chronic renal dysfunction, as well as hypersensitivity to the components of the drug.

The following are used as immunostimulants: Immunorix, Polyoxidonium, Pyrogenal, Actinolysate, Immunal, Glutoxim, Viferon, Deoxynate, Genferon, Stemokin, Gepon, Copaxone-Teva and other interferon preparations.

Polyoxidonium is designed to activate the body's immune system and is used both as injections and in the form of vaginal suppositories.

Polyoxidonium injections are administered intramuscularly or intravenously. The injection solution is prepared immediately before administration. The solution cannot be stored.

For muscle injection, 6 mg of the drug is diluted with 1.5–2 ml of distilled water for injection or saline solution.

For intravenous drip administration of 6 mg of the drug, dilute 2 ml of 5% dextrose solution, rheopolyglucin, hemodez-N or saline solution.

The duration of treatment is determined by the attending physician individually depending on the disease and the stage of the lesion. Suppositories of the drug are placed in the vagina. The therapeutic dosage is 12 mg of the active ingredient. For preventive purposes, this drug is used in a dosage of 6 mg.

Suppositories are used once a day, before going to bed. The duration of treatment is determined by the attending physician individually depending on the disease and stage of the lesion. Contraindications to taking polyoxidonium are pregnancy and lactation, as well as individual intolerance or hypersensitivity to the drug.

Suitable antibiotics include: penicillin, moxiclav, quinolone, metronidazole, cefoperazone, lincomycin, tetracycline, vancomycin, ceftazidime, erythromycin, cefroxitine, latamoxene, cefotaxime and others.

Metronidazole is taken by postoperative patients both in the form of injections and in tablets orally.

The dose of the drug is prescribed individually within the range of 250 to 500 mg twice a day. The duration of treatment is about ten days. But this fact, as well as the dosage, is prescribed and adjusted, if necessary, by the attending physician.

Folk remedies

It should be clearly remembered that folk treatment of dysplasia is permissible only for mild forms of pathology. Third-degree cervical dysplasia is not treated with such methods.

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Herbal treatment

As already mentioned above, the disease considered in this article, which is at a precancerous stage, is not treated by any folk remedies. Including herbal treatment.

Medicinal herbs can only be used as an adjunctive supportive therapy and only with the permission of the attending physician.

Here are some recipes for such a medicine that will help to increase a woman’s immunity or will help to get rid of inflammation faster, or to sanitize the body.

• You can use vaginal tampons soaked in aloe juice. It is worth noting that the leaves from which the juice was obtained must be at least three years old. Wash the leaves, chop them, squeeze out the juice. Make a tourniquet from the bandage. Soak it in the juice of the plant and insert it into the vagina. Insert it so that part of the tourniquet remains outside. This will allow it to be easily removed. The tourniquet should lie so that the medicine comes into contact with the cervix. The duration of therapy is about a month. Tamponade is carried out a couple of times a day and is maintained for four to five hours.
• A similar tamponade can be performed, but using sea buckthorn oil instead of aloe. The duration of therapy is from two to three months.

• You can prepare a mixture by taking two teaspoons of meadowsweet flowers, one teaspoon of sweet clover, two teaspoons of yarrow, three teaspoons of rose hips, four teaspoons of calendula flowers, and three teaspoons of nettle. Grind and mix all the ingredients. Take one teaspoon of the mixture and place it in 200-250 ml of boiling water. Leave it for half an hour. Strain. Douche with the resulting liquid twice a day for one month. Tamponing with this solution is also suitable. In both cases, the liquid should be warm.
• You can also use a healing tea prepared from the mixture: burdock root - one teaspoon, vitex - two teaspoons, astragalus - one teaspoon, red clover - one teaspoon. Grind and mix all the ingredients, pouring in a liter of just boiled water. Put on the fire and bring to a boil, keeping it on the stove for five minutes. Let it brew for a third of an hour. Strain. The resulting liquid is taken orally (internally) two to three times during the day before meals.

Homeopathy

Today, homeopathy is gaining more and more popularity among people who are committed to treating various diseases using alternative medicine methods.

But this does not yet apply to the disease that we are considering in this article. Modern alternative medicine, which includes homeopathy, cannot offer adequate effective treatment for grade 3 cervical dysplasia.

Surgical treatment

As sad as it may sound, but modern oncology today has practically only one method of treating third-degree cervical dysplasia - surgical treatment. There is simply no other way to stop the problem. Only if, for some reason, surgical intervention is unacceptable, the patient is prescribed drug treatment, which includes chemotherapy drugs in the protocol, which can slow down the development of the pathological process. But this does not give a complete guarantee that further degeneration into cancerous neoplasms will not occur.

Surgical therapy involves the removal of altered tissues. Modern medicine is equipped with several such methods:

• This is the excision of the affected layers by surgical intervention. It is carried out in case of a deeper location of the neoplasm. This is the only way to completely get rid of the neoplasm. But the operation is quite traumatic, causing more damage to the body than other methods. They resort to excision if other methods are not very effective. But modern medicine is ready to offer less traumatic ways to get rid of cervical dysplasia.
• Cryodestruction is a method of layer-by-layer burning of affected tissues using liquid nitrogen, which has a very low temperature. The method is also called "cold cauterization". This procedure is gentle, after which there are practically no colloid scars left on the woman's body.
• Laser coagulation is a method similar to cryodestruction, with the only difference being that instead of liquid nitrogen, the object of tissue impact is a laser beam. As in the previous case, after laser coagulation, tissue scarring is not observed.
• Electrocoagulation is one of the oldest (after strip surgery) methods of cauterization. In this case, the object of action is an electric arc. Cauterization by this method can be carried out on quite deep layers. The procedure is painful and very traumatic.
• Radio wave cauterization. The cauterization procedure is performed using high-frequency radiological waves. There are no scars on the body. It is possible to achieve "evaporation" of problem areas without the risk of affecting healthy fragments of the epithelium. The operation is painless and is performed quite quickly.
• Using a gamma knife or cyber knife. The essence of the method is the ability of radiation supplied by a medical device to seal the blood vessels that feed the angioma. This makes it possible to cut off the supply to the neoplasm, which leads to its death.
• Conization of the cervix. This is the most traumatic method of treatment, since healthy cells are excised along with the affected tissues. A rough colloid scar is formed at the site of the operation. The intervention is performed under anesthesia, within the walls of a hospital. Until recently, this treatment method was practically the only way to get rid of the pathology.
• Amputation of the cervix. Surgical intervention is performed only under general anesthesia. But even today, complete removal of the cervix, and often other organs of the female reproductive system, with a diagnosis of third-degree cervical dysplasia is the only way to save a woman's life and reduce the risk of further mutations, avoid damage to nearby organs and lymph nodes. After this radical excision, a woman will have to reconsider her lifestyle for some time: give up sexual intercourse for at least one and a half to two months, reduce the level of physical activity, give up hot baths, using only a shower (for six to seven weeks).

Women who have undergone one of these operations must be monitored by a gynecologist for the next five years, undergoing a cytological smear test every three months, as well as undergoing a colposcopy.

Over time, if there have been no relapses, a smear is taken once every six months, and a colposcope is taken once every couple of years. This allows the specialist to observe the postoperative dynamics, and if the disease returns, to detect it at an early stage.

Read more about the treatment of cervical dysplasia grade 3 in this article.

Prevention

The essence of recommendations for preventing the development of the disease is to minimize all factors that can become catalysts for the pathology. As practice shows, it will not be possible to significantly influence this process, but it is quite possible to take measures that will at least partially reduce the risk of the occurrence of the disease in question.

This is why prevention of third-degree cervical dysplasia comes down to a number of such recommendations:

• Mandatory compliance with all rules of hygiene of the whole body. Including the genitals.
• Vaccination against highly oncogenic infections, such as human papillomavirus and others (HPV). The optimal time for its implementation is the beginning of sexual activity. The upper age limit is 26-30 years.

• In case of infectious lesions, it is necessary to carry out the treatment prescribed by a specialist in a timely manner and until complete recovery. This also applies, even to a greater extent, to infections affecting the female genital tract.
• Lead a healthy lifestyle. No smoking, drugs and alcohol.
• A woman should have one sexual partner. This will reduce the risk of "catching" a sexually transmitted infection. Avoid casual sex.
• Use barrier methods of contraception after consulting with your gynecologist.
• If you feel unwell or experience even minor discomfort in the genital area, immediately consult your attending physician (obstetrician-gynecologist). Early diagnosis and adequate therapy of any disease is the key to recovery.
• Giving up bad habits.

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Forecast

Cervical dysplasia of the third degree is a precancerous, but still not oncological disease, although the risk of degeneration is quite high. If the disease was recognized in time and all necessary therapeutic and surgical measures were carried out, then the prognosis of the disease discussed in this article can be definitely favorable.

A woman who has undergone such treatment may well live a fairly good life to a ripe old age.

If high-quality treatment has not been carried out, there is a high risk of the affected cells transforming into cancerous neoplasms, which, if the process is ignored, may well lead to death.

The cervix, as well as the uterus itself, are the primary sexual characteristics of a woman, and their damage or loss is not only a physiological, but also a psychological problem for a woman. But in such a situation, you should set the right priorities. After all, the question here is about life or death. In addition to a gynecologist - oncologist, a female psychologist can also help in this matter. He will help the patient correctly assess the situation and decide on radical measures to get rid of the problem. After all, grade 3 cervical dysplasia, if not treated in a timely manner, can lead to an even more terrible and serious disease, such as cancerous cervical lesions with further metastasis. Let every woman never lose the desire to be healthy. It is worth fighting for!

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