What does this mean
Normally, the vaginal part of the cervix is covered with stratified squamous epithelium without keratinization. With leukoplakia, the cells of the upper layers accumulate keratin and form a dense white film, which is visible to the naked eye and clearly visible during colposcopy. Morphologists distinguish simple leukoplakia, in which the cells are not changed, and leukoplakia with atypia, which refers to precancerous conditions. Outwardly, these options cannot be distinguished, so just one entry in the map does not say anything about the forecast.
- Simple leukoplakia - without cellular atypia
- Leukoplakia with atypia - a variant of dysplasia
- Visible as a white plaque during examination and colposcopy
- May be combined with ectopia and inflammation
- Only histology gives the exact answer
Causes and risk factors
Epithelial keratinization develops in response to long-term damage. The leading role is given to the human papillomavirus of high oncogenic risk, which changes the cell division program. Chronic inflammatory processes, sexually transmitted infections, cervical injuries during childbirth and abortion, the consequences of cauterization, as well as hormonal disorders are also important. Smoking increases the damaging effects of the virus. All this explains why in case of leukoplakia it is necessary to check for HPV and treat the accompanying inflammation.
- High-risk human papillomavirus
- Chronic cervicitis and vaginal infections
- Cervical injuries during childbirth and interventions
- Consequences of aggressive cauterization methods
- Hormonal disorders
- Smoking
- Early onset of sexual activity and frequent changes of partners
Symptoms
Leukoplakia of the cervix has practically no manifestations of its own and in the vast majority of cases is detected during a routine examination. Sometimes women note an increase in the amount of discharge or contact bloody smears after sexual intercourse, but more often these complaints are not associated with leukoplakia itself, but with concomitant inflammation or ectopia. It is asymptomaticity that makes regular screening the only way to notice changes in the cervix in a timely manner.
- Most often there are no complaints
- Revealed when viewed in mirrors
- Possible heavy discharge
- Occasional contact bleeding
- Symptoms are usually associated with associated inflammation
What examinations are needed
The examination is based on a standard scheme for assessing the cervix. First, cytology—Pap test or liquid cytology—and a test for human papillomavirus are performed. Then an extended colposcopy is performed with samples that help to see the boundaries of the changed area and select a point for tissue collection. A targeted biopsy with histological examination gives the final answer. If there is a lesion inside the cervical canal, curettage of the cervical canal is additionally performed. Be sure to take swabs for infections.
- Pap test or liquid cytology
- High oncogenic risk HPV test
- Advanced video colposcopy
- Targeted biopsy with histology
- Curettage of the cervical canal according to indications
- Smears for infections and flora
Treatment and observation
Tactics completely depend on the histology result. With simple leukoplakia without atypia in a young woman, treatment of concomitant inflammation and observation with repeated cytology and colposcopy at the time prescribed by the doctor is enough. If dysplasia is detected, the altered area is removed: most often, excision or conization of the cervix is performed, which at the same time allows for the complete examination of the removed tissue. Aggressive cauterization without prior biopsy is unacceptable. Prevention includes HPV vaccination and regular screening.
- Observation in the absence of atypia
- Treatment of associated infections and inflammation
- Excision or conization for dysplasia
- Mandatory histological examination of the removed tissue
- Control cytology and colposcopy after treatment
- HPV vaccination and smoking cessation
