What is dysplasia and how does it develop?
Dysplasia means that the epithelial cells of the cervix have changed their structure and maturation. They are not yet malignant, but they are no longer normal. In almost all cases, the cause is the prolonged presence of oncogenic types of human papillomavirus in cells.
The path from HPV infection to cancer takes years, usually more than ten years, and passes through the stages of dysplasia. This slow development is a major opportunity for medicine: with regular screening, changes are detected long before cancer appears.
- CIN 1 (mild dysplasia) - changes affect the lower third of the epithelium; in most cases goes away on its own when the immune system copes with the virus
- CIN 2 (moderate dysplasia) - changes in two thirds of the epithelium; in some women it regresses, but requires active tactics
- CIN 3 (severe dysplasia and cancer in situ) - the entire thickness of the epithelium is changed; treatment is mandatory
- Invasive cancer - cells grow beyond the epithelium; this is a different category of disease
Risk factors
- Infection with oncogenic types of HPV is a necessary condition
- Long-term persistence of the virus, and not the fact of infection itself
- Smoking significantly reduces the body's ability to get rid of the virus
- Early onset of sexual activity and a large number of partners
- Immunodeficiency, including HIV infection
- Taking immunosuppressive drugs
- Other sexually transmitted infections
- Lack of regular screening is the main factor in advanced cases
- Multiple births
It is important to understand: HPV infection occurs in most people who are sexually active, and in the vast majority of cases, the body gets rid of the virus on its own within a year or two. It is the long-term persistence that creates the problem, and not the fact of contact with the virus itself.
Symptoms
They are usually absent - and this is the main feature of the disease. Dysplasia does not hurt, does not produce discharge and is not felt in any way.
- Absence of symptoms at all stages of dysplasia
- Bloody discharge after sexual intercourse is possible, but more often with pronounced changes
- Bloody discharge between periods
- Discomfort during sexual intercourse
- Symptoms associated with associated inflammation
Asymptomatic behavior is why screening is so important. Waiting for complaints to appear with cervical disease means waiting for the stage when treatment becomes much more difficult.
Diagnostics
- PAP test or liquid cytology is a screening method that identifies altered cells
- Analysis for HPV of high oncogenic risk with identification of types
- Express test CIN-DIAG
- Video colposcopy - examination of the cervix under magnification with treatment with acetic acid and Lugol's solution
- Targeted biopsy of suspicious areas - this is what gives the final diagnosis and degree of CIN
- Curettage of the cervical canal with histology - with changes extending into the canal
- Repeated studies over time with slight changes
Treatment: observation or surgery
- CIN 1 - in most cases, observation with repeated cytology and colposcopy at certain intervals; a significant part of such changes disappear on their own
- CIN 1, persisting for a long time - treatment is discussed
- CIN 2 - tactics depend on age, reproductive plans and examination data: in young women observation is possible, in other cases - treatment
- CIN 3 – treatment is mandatory
- Conization of the cervix - excision of a cone-shaped area with altered tissue; simultaneously a therapeutic and diagnostic procedure, since the removed tissue is examined
- Loop electroexcision
- Laser vaporization and destructive methods - for minor surface changes
- Treatment of concomitant infections
- Quitting smoking actually increases the likelihood of regression of changes
Observation after treatment
- Control cytology and HPV analysis within the time limits established by the doctor
- Colposcopy with altered results
- Observation continues for several years - the risk of relapse remains
- Particular attention if HPV remains positive after treatment
- Pregnancy planning is discussed with a doctor: after conization, shortening of the cervix is possible, which requires monitoring during pregnancy
- Vaccination against HPV is also discussed after treatment - it protects against types with which the woman has not yet been infected
- Quitting smoking
Prevention: What Really Works
- Вакцинация против ВПЧ — наиболее эффективная мера; максимальный эффект до начала половой жизни
- Регулярный скрининг: ПАП-тест и анализ на ВПЧ по графику, рекомендованному врачом
- Отказ от курения
- Использование презерватива — снижает, хотя и не устраняет полностью, риск заражения
- Своевременное обследование при изменённых результатах, а не откладывание «на потом»
- Treatment состояний, снижающих иммунитет
Cervical cancer is one of the few cancers that is almost completely preventable. This requires only two things: vaccination and regular screening.
Where to be examined and treated in Tashkent
High-quality cytology, HPV testing, video colposcopy with the possibility of targeted biopsy, and a histological laboratory are required.
In Tashkent, such examination and treatment of cervical dysplasia is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If the PAP test shows changes, do not panic, but do not delay either: the vast majority of such results do not mean cancer, and timely follow-up examination resolves the issue definitively. Clinic contacts are below on the page.
