Leukoplakia of the cervix: treatment and diagnosis
One of the most common pathological processes in gynecology is leukoplakia of the cervix, characterized by the appearance in this area of whitish plaques (films). The effects of precipitating factors on the epithelial layer contributes to the loss of cells of normal structure and appearance of atypia. Intense pathological growth of abnormal cells provokes their transformation into cancer. The danger of leukoplakia in the absence of clinical manifestations of the disease, which identifies late diagnosis and impact on further treatment.
Like most diseases of the cervix, leukoplakia is characterized by almost complete absence of clinical manifestations. Women can go for years without suspecting the presence of pathology if we neglect regular visit to the gynecologist.
In some cases, can visually diagnose the disease difficult, especially in the early stage of development. Usually leukoplakia precede other structural changes of the epithelium: erosion, dysplasia, various neoplasms in the cervical canal. Only a comprehensive examination of the body will allow you to assess the real picture of what is happening.
The complex of diagnostic measures includes the following procedures:
- Visual inspection of the cervix during gynecological examination. If the doctor noticed any structural abnormalities of the epithelium, it is an occasion for a more detailed diagnosis using laboratory and instrumental methods of research.
- Smear in the form of collection of secretions from the vagina and cervical canal for microscopic examination. This procedure allows to determine the microbial landscape of the vagina and the type of pathogen infection.
- Screening for STIs. Pay special attention to the detection of human papillomavirus (16, 18) in view of its oncogenic activity. The result of the analysis affects further treatment. Conduct screening for chlamydia, Mycoplasma, Ureaplasma.
- Smear on Cytology for the detection of pathological changes in cervical mucus.
- Inspection of the affected cervix using a colposcope (simple and extended colposcopy). If you suspect keratosis of the cervix, the doctor performs a test of iodine (Schiller test). When painting Lugol neck clearly visible boundaries of pathological neoplasms. With the affected area the doctor extracts tissue fragment (from the border zone between the deformed and healthy tissue) and sends it for further histological examination.
- Biopsy of the suspicious area and examined histologically.
Colposcopic signs of lesions of the cervix:
- thin and thick leukoplakia;
- mosaic (gentle and rough);
- punctate (gentle and rough);
- yadegarynia zone from the point of plaques to extensive sites;
- koilocytes (a symptom of HPV).
Histological signs of leukoplakia:
- hyperkeratosis (keratosis);
- signs of atypia.
Often intraepithelial NEOPLASIA (cervical dysplasia) occurs under the form of dyskeratosis (leukoplakia). Leukoplakia with atypia considered a precancerous condition.
- General blood analysis allows evaluation of the overall condition of the body, the presence of the inflammatory process.
- Immunogram is carried out to determine hormonal levels.
- Hormonal profile. Imbalance of hormones often leads to the development of this disease.
- Application of instrumental methods of diagnostics in the form of ultrasound, MRI of pelvic area shown in the presence of other diseases of the reproductive system.
Any structural disturbance to the tissues of the vagina, cervix and cervical canal should be investigated. Timely diagnosis can prevent the progression of the disease in the initial stage.
Leukoplakia code according to ICD – N88.0
Causes of leukoplakia
Leukoplakia of the cervix every woman develops differently. In some patients a long process, sluggish, others, on the contrary, is developing at a rapid pace, reborn into a malignant tumor. This circumstance depends on the following factors:
- General and local immunity;
- the presence of systemic diseases;
- causes of structural damage;
- forms and stages of the disease.
In most cases, leukoplakia develops in chronic inflammatory process in a small area of the cervical canal. Prolonged pathological process, the cells cease to perform their functions and deform. Thus, there is actinic (keratosis) restricted areas. Whitish circular spots resemble the film. But to remove it in the usual way impossible. These symptoms characteristic flat shape leukoplakia.
If the initial stage is not diagnosed and the process progresses, the structure of the tumors is sealed. Keratinized lifted above the surface of the mucous membrane, reinforced each other. Externally, the inflammatory lesions resemble warts. That is why the second form of the disease called verrucous (squamous).
The most dangerous with pronounced symptoms consider the third form of the disease — erosive. It is characterized by the presence of small cracks and erosion, the bottom of which is covered with white bloom. Expressed in areas of the most hazardous and prone to atypia.
Among the main causes of pathologic process there are distinguished the following circumstances:
- chronic inflammatory processes in the vagina, cervical canal;
- promiscuous (frequent change of sexual partners and STIs);
- early sexual activity (when there is no physiological maturity of the epithelium lining the cervical canal and the cervix);
- hormonal imbalance in puberty and menopause;
- injury of the cervix during surgical manipulation (abortion, curettage, conization);
- gaps in the result of labor;
- venereal disease, viral infection (human papilloma virus);
- lack of proper hygiene;
- hereditary factors (predisposition to cancer, reproductive system).
Leukoplakia of the cervix is characterized by the absence of complaints from the patient. Only in the erosive form of the disease the woman can feel the pain and slight bleeding during and after sex. Sometimes, this disease changes your menstrual cycle, disturbed reproductive function.
The alarm signal should be the following phenomena:
- the progression of the disease (involvement in the inflammatory process of new tissue);
- the transfer of disease from one form to another (papillary, warty formations);
- the pain of pulling character in the pelvis;
- pain and any uncomfortable feelings during sexual intercourse;
- purulent or sukrovichnye discharge throughout the menstrual cycle;
- the feeling of dryness and burning in the vagina.
These symptoms may be absent completely or in part. However, this is not a reason for refusal of treatment. In the early stages of the disease clinical manifestations are minimal. And to identify them without special methods of diagnosis is difficult.
Leukoplakia of the cervix provides anti-inflammatory, antiviral and surgical treatment. Surgical intervention is the most effective way to get rid of the leukoplakia. Domestic gynecologists practice several treatments that have proven effective over a long period.
- The laser removal. This procedure is recognized as the most effective treatment of the disease with minimal side effects. The laser beam precisely targets only the affected areas without affecting healthy tissue. The process is completely painless and lasts only a few minutes. The only negative is the high cost of the procedure. Not all companies are ready to provide this service to patients.
- Cryosurgery involves the exposure of the wound surface with nitrogen low temperature. The effectiveness of this type of therapy is 60 to 95%. Advantage think the lack of direct contact with the wound surface, bloodless, asepsis. Duration is on average 5 – 10 minutes. The disadvantages include the impossibility of penetrating into the deeper layers of the epithelium, which contributes to recurrence and a rich sukrovichnye discharge for 1 – 2 weeks.
- Chemical coagulation using the drug Solkovagin. This type of therapy is recognized as the least traumatic. The impact of solution Solkovagin on the affected area performed during colposcopy. The procedure features low cost. However, is not a 100% guarantee of getting rid of pathology. There may be relapses.
- Radio wave conization with apparatus “Surgitron” is recognized as the most effective way of eliminating pathology. It is cone-shaped excision of the affected area. Coagulation and prevents bleeding. The procedure is somewhat painful. Requires the use of local anesthesia. The effectiveness of the procedure is 95%.
- Surgical diathermy in the treatment of the inflammation of high-voltage electric current. The recovery process of the epithelium occurs within 1 to 2 weeks. When conducting manipulation requires some skill, because the doctor works intuitively, without seeing the affected area. Cautery is performed under local anesthesia for 20 to 30 minutes. This type of therapy often used in past years.
- Loop is successful in eradicating the most popular method of treatment of structural disorders of the cervix. Leukoplakia of the cervix is removed, cone-shaped excision of the modified surface using a wire loop. This technique is popular because of the minimal negative impact on the fabric. This allows you to take a fragment of tissue for further histological studies on atypical cells.
How to treat leukoplakia of the cervix, the doctor will decide on an individual basis, after examining the data history. For nulliparous women shown treatment with the least impact on the area of the neck to prevent scarring and shortening. The failure of the cervical canal can lead to a premature birth.
Similar recommendations apply to pregnant women. In most cases, gynecologists do not recommend treatment until the moment of birth and in the postpartum period. But sometimes use laser treatment as a less traumatic method of eliminating the pathological process.
If the expected effect is not reached, the disease progresses, your doctor may prescribe the removal of body.
Leukoplakia of the cervix, in addition to surgical intervention, provides further conservative treatment. In most cases prescribe antiviral therapy ( if infection with human papillomavirus). Antibiotic therapy is indicated for pronounced inflammatory process to the manipulation and after. Microbiology contain important information about the pathogen and its resistance. According to the testimony appointed other drugs.
The recovery period
With any surgical intervention there is a risk of complications. If leukoplakia of the cervix is diagnosed at an early stage of development, the likelihood of complications is minimal. Advanced stage disease requires not only the competent approach to the elimination of the pathological process, but also a long recovery period. The result of treatment depends on the condition of the cervix, the scale of the defeat features of the course of the operation.
The main types of complications include the following:
- isthmic-cervical insufficiency;
- scarring of the cervical canal, shortening;
- infection pathogenic flora;
- reproductive disorders;
- the progression of the disease until the cancer of the cervix.
Compliance with prevention measures in the recovery period will prevent the development of possible complications.
Basic preventive measures:
- full hygiene of genitals;
- the lack of casual sex
- reduction of sexual activity in the first months after surgery;
- treatment of concomitant diseases of the urogenital sphere;
- a soft diet and daily meals;
- immune restoration by the use of immunomodulatory remedies and vitamin complexes;
- lack of stress;
- use linens made of natural fabrics, limiting the use of panty liners based on synthetic;
- regular examination by a gynecologist, compliance with all recommendations of the doctor.
Leukoplakia, as well as any disease of the cervix, poses a real threat not only to reproductive function, but also for life. Therefore, gynecologists strongly recommend that all women with background cervical diseases and cervical canal to take the full survey. Timely diagnosis and competent approach will help to prevent cancer.