Treatment of grade 3 cervical dysplasia

Today, treatment of grade 3 cervical dysplasia is carried out exclusively surgically using various methods of excision (removal) or destruction (destruction) of pathologically altered tissues.

Since, when a section of the epithelium covering the cervix is destroyed, it is not possible to take a tissue sample for subsequent histological examination, the requirements for the diagnosis of dysplasia, including differential diagnosis (to exclude squamous cell carcinoma of the cervix), are increased.

Treatment methods for grade 3 cervical dysplasia

Surgical or operative treatment can be carried out both on an outpatient basis and in a hospital, depending on the method chosen by the doctor (removal or destruction), which ensures maximum effect with minimal invasiveness of the procedure.

The main surgical methods of treating grade 3 cervical dysplasia used in clinical practice include:

• cone-shaped excision (conization) of affected tissues;
• diathermocoagulation (coagulation with electric current 60-80 W);
• cryodestruction (coagulation with liquid nitrogen or cryotherapy);
• laser treatment (laser vaporization or coagulation).

Also, according to indications (if all layers of the cervical epithelium are affected), an ectomy (resection) of the cervix with a scalpel or ultrasound may be required.

Surgical treatment of grade 3 cervical dysplasia by conization is usually performed during diagnostics, combining biopsy. Here, either a scalpel or "cold knife" technology (with local or general anesthesia) or diathermic excision of the cervical transformation zone using a special loop electrode (electrocautery) can be used. When using this method, cure is observed in more than 90% of cases.

Other surgical methods of removal or destruction should be used only when the degree of dysplasia is precisely determined, a colposcopy with a biopsy has been performed, which did not reveal cervical cancer.

Experts note that in highly differentiated extensive grade 3 cervical dysplasia, cryotherapy is rarely used due to the difficulty of subsequent evaluation of treatment results, the high probability of recurrence and the risk of cervical stenosis, when an excisional procedure or other ablation method is not available.

When prescribing any of the above procedures, the phase of the patient's menstrual cycle must be taken into account: the most favorable phase in terms of restoration of affected areas of cervical tissue is the preovulatory (first) phase.

Laser treatment of cervical dysplasia grade 3

Laser treatment is included in standard protocols for surgical treatment of stage 3 cervical neoplasia.

The laser beam pulse destroys (denatures) protein structures of pathological tissues to a depth of 6-7 mm, and even at low power of the carbon dioxide laser, diseased cells simply evaporate. This method is called laser vaporization.

The laser is precisely focused on the affected area using a colposcope, which prevents the destruction of normal tissue. Treatment can be performed with local infiltrative anesthesia or anesthesia of the paracervical area. Patients may experience some discomfort in the form of spasms of the uterine muscles.

Laser treatment can combine simultaneous laser treatment of dysplastic lesions of the vagina and vulva. In this case, the vessels are cauterized, which eliminates bleeding. There are no scars after such a procedure, and there are no complications with subsequent pregnancy and childbirth, even in women who have not given birth.

However, this method has its drawbacks: the treatment lasts at least half an hour and requires anesthesia, and does not provide the opportunity to obtain a tissue sample for histology. And with laser conization, slight bleeding is possible after a few days.

Radio wave treatment of cervical dysplasia

Radio wave treatment of cervical dysplasia or radio wave coagulation is not included in the standard clinical protocol.

This method of surgical treatment – using an electrosurgical device (Sugitron) that generates high-frequency electrical waves (4 MHz) – allows tissue to be cut and coagulated in a contactless manner.

Its wide application in plastic surgery, which requires surgical precision, penetration control and low temperature conditions, has led to the application of radio wave treatment in other areas of clinical medicine: dermatology, gynecology, proctology, ophthalmology, etc.

This technology allows for simultaneous cutting and coagulation of surrounding tissues with minimal changes to adjacent tissues without burning or pain. The film formed on the wound surface disappears approximately ten days after the procedure, which may be accompanied by small bloody discharge of a serous nature. At the same time, there are no scars on the cervix - as with diathermocoagulation.

The rehabilitation period after surgical treatment

On average, the rehabilitation period after surgical treatment of severe cervical dysplasia lasts from one and a half to two months. During the first month, women experience vaginal discharge (bloody with mucus); pain in the lower abdomen may be felt (as at the beginning of menstruation). Doctors consider this a normal phenomenon. But if the discharge is too abundant and with blood, you should immediately contact your doctor.

The main recommendations for patients, regardless of the specific method of surgical treatment, include abstinence from sexual intercourse (until the end of the rehabilitation period) and a complete ban on any water procedures (swimming in a pool, sauna, taking baths) - except for a shower.

Doctors recommend that women do not lift heavy objects and limit any physical activity during this period as much as possible, as well as use only sanitary pads and carefully monitor their health. For example, malaise and fever are a reason to urgently contact your gynecologist.

The process of tissue restoration in the cervix can take several months, but for control (three months after removal or destruction of the neoplasia) a smear from the vagina is taken and a colposcopy is performed.

The most common complications after treatment of grade 3 cervical dysplasia are the following:

• bleeding after diathermocoagulation or laser treatment (2-7% of cases);
• scars on the cervix (especially after diathermocoagulation and diathermic excision of tissue);
• narrowing (stenosis) of the cervical canal, which makes it impossible to become pregnant;
• menstrual cycle abnormalities;
• relapse of dysplasia;
• exacerbation of existing or development of new vaginal-cervical inflammatory diseases.
• possible complications during labor or its premature onset.
• development of squamous cell carcinoma of the cervix.

Conservative methods of treatment of cervical dysplasia of the 3rd degree

Severe cervical intraepithelial neoplasia (CIN), i.e. stage 3 cervical dysplasia, is a potentially precancerous pathology and in some cases (on average 12-15%) develops into squamous cell carcinoma. Therefore, gynecologists categorically do not recommend treating stage 3 cervical dysplasia with folk methods.

It should be borne in mind that any intravaginal procedures (tampons, douching) performed at home without a doctor's prescription can provoke inflammation or serve as an impetus for uncontrolled progression of the disease.

Since there are no specific medications for the treatment of severe cervical dysplasia, official medicine recommends taking folic acid, vitamin B12, retinol acetate (vitamin A) and, of course, antioxidant vitamins C and E to increase the body's defenses in the fight against the papilloma virus (HPV).

Herbalists recommend taking decoctions of medicinal plants such as astragalus (Astragalus danicus) and purple coneflower (Echinacea purpurea). Indole-3-carbinol (I3C), which is found in all types of cabbage, can help.

The synthesis of immune cells (T-lymphocytes) is activated under the influence of 1,3-β-d-glucans – polysaccharides of the tinder fungus Coriolus versicolor (or Trametes versicolor). An extract is produced from this fungus, widely used by doctors in China and Japan in the immunomodulatory therapy of neoplasms, including malignant ones.

There is also scientific evidence that green tea polyphenols, in particular epigallocatechin-3-gallate, inhibit the proliferation of altered epithelial cells by blocking matrix enzymes and cellular receptors of epidermal growth factor, and induce the death of mutant cells. Many doctors recommend their patients to support the treatment of cervical dysplasia of the 3rd degree by drinking green tea.

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