Non-inflammatory diseases of the cervix
N.M. Shakhova, MD, L.V. Borovkova, MD, Ph.D. Grechkanev, MD, I.A. Kuznetsova, Ph.D., A.N. Zinoviev, PhD, MS Zinovyeva, MD, O.V. Kachalina, MD, I.A. Yanvareva
The tutorial details the stages of examination and management tactics for patients with various diseases of the cervix uterus using modern methods of diagnosis and treatment. On a large illustrative material, the diagnosis of cervical pathology using optical coherent tomography is considered. Particular attention is paid to the classification of pathological conditions of the cervix, screening methods, differentiated approach to the choice of treatment method.
The book is intended for obstetrician-gynecologists, clinical residents, interns.
Cervical diseases occupy a leading position in the structure of the female genital pathology, in particular cervical cancer (cervical cancer) is in second place in the world for cancer diseases and in the first place among the causes of female mortality from cancer pathology in developing countries. According to WHO (1999), almost 370 thousand new cases of cervical cancer are diagnosed each year. The highest prevalence of the disease (75%) is observed in Central and South America, Southern and Eastern Africa, and in the states of the Caribbean, and only 25% are in the developed economic countries of Europe and North America. Reducing the incidence of cervical cancer is mainly due to older age groups, and among women under 30 years of age it increases.
In Russia, the annual incidence of cervical cancer is 14.9 cases per 100,000 women. Its reduction can be achieved by adequate treatment of benign conditions of the cervix. Currently, a two-stage system for the prevention of cervical cancer is defined:
1) identification and treatment of benign diseases of the cervix,
2) identification and treatment of cervical dysplasia.
In recent years, a link has been established between the occurrence of cervical cancer and infection with human papillomavirus, mainly of the 16th and 18th types. Cervical cancer is most common in women who have sex with several partners at the same time, and those whose husbands have extra-marital sex. There is an obvious relationship between the incidence rate of cervical cancer and socio-economic conditions. There is a correlation between increasing the frequency of cervical cancer and the use of oral contraceptives in women who smoke intensively, and less often this pathology is observed in those who use mechanical contraceptives.
Pathological processes on the cervix should be considered as a polietiologic diseases.
The risk factors for their occurrence include:
hormonal disorders: increased gonadotropic function, changes in estrogen metabolism with a predominance of estradiol,
traumatic injuries of the cervix arising after childbirth or abortion (a predisposing factor in such cases are violations of trophism and innervation of tissues),
chronic inflammatory processes accompanied by degenerative changes, early onset of sexual activity, promiscuous sexual life,
infectious diseases of the genital organs caused by human papillomavirus, chlamydia and herpes simplex virus type 2.
Anatomical and functional features of the cervix
In the cervix, there is a vaginal part that protrudes into the lumen of the vagina, and a supravaginal part, located above the attachment of the walls of the vagina to the uterus. The vaginal part of the cervix (exocervix) is covered with stratified squamous epithelium. The cervical canal (endocervix) has a spindle-shaped form, its length from the outer os to the isthmus reaches 4 cm, its width is up to 4 mm, the external opening is round or in the form of a transverse slit. The mucous membrane of the cervical canal is covered with a single row high cylindrical epithelium with a basal nucleus.
The epithelium covering the exocervix consists of 4 layers of cells:
basal cell layer - immature epithelial cells located on the basement membrane in one row. These cells have irregular contours and different sizes. The basement membrane separates the flat stratified epithelium from the underlying connective tissue,
parabasal cell layerlocated in several rows above the basal cells. The cells of the basal and parabasal layers have mitotic activity,
intermediate cell layerconsisting of 6-7 rows of moderately differentiated cells,
cell layer (2-3 rows), which tend to keratinization and easily undergo desquamation depending on the phase of the menstrual cycle.
The main function of stratified squamous epithelium is protective.
The border between the squamous flat epithelium of the vaginal part of the cervix and the high cylindrical epithelium of the mucous membrane of the cervical canal is called the transition zone. Under the cylindrical epithelium of the transition zone are the backup cells, which are arranged in several layers. Under the influence of various factors, they can differentiate into stratified squamous or cylindrical epithelium.
In most cases, the transitional zone in women of reproductive age coincides with the external pharynx, and in postmenopause it shifts to the lower third of the endocervix, in young women (up to 25 years old) it is located on the exocervix.
Pathological processes of the cervix, as a rule, occur in the region of the transition zone. Age-related features of the structure of the vagina and cervix predispose to a specific topographic-anatomical localization of pathological processes: for example, girls are more likely to have vulvovaginitis, women of reproductive age have endocervicitis, inflammatory-proliferative processes of the mucous membrane of the exocervix, cancer is localized on the exocervix. For postmenopausal women, the degenerative-dystrophic processes of the exocervix are specific, and cancer is localized in the cervical canal.
Classification of pathological conditions of the cervix
In clinical practice, the International Classification of Diseases X revision of WHO (1996) is widely used to classify benign cervical processes. In class XIV “Diseases of the urinogenital system” ICD-X, clinical and morphological conditions of the cervix uteri were distinguished (Table 1).
Clinical and morphological classification of cervical conditions (according to ICD-X)
Shamilina Marina Nikolaevna
Doctor obstetrician-gynecologist of the highest category, surgeon-gynecologist
+7 (495) 444-66-67
+7 (495) 444-66-46
Moscow, st. Vatutina, 13, Bldg. one
(m. Kuntsevskaya, m. Slavyansky Boulevard)
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open with 8.00 before 18.00
A benign type of uterine cervical disease does not have malignant symptoms, that is, it is not a cancer at all. But if time is not examined and does not prescribe treatment, benign lesions develop into cancer, that is, into malignant ones.
Symptoms and benign diseases
The benign type of cervical disease may not be a concern to the woman at all. But it happens that the patients are tormented by a terrible itching, mucus is secreted from the genitals, which often has an unpleasant odor. There are also occasionally mucus secretions with the presence of blood, which is excreted after or during the intima. If you have these symptoms, do not delay the time, be sure to consult a doctor who will help eliminate the pathology of the cervix, if it is the place to be.
Little about the features of benign diseases
Erosion of the uterine cervix may exist, for example, a week and a half. Then the epithelium of a cylindrical type begins to grow. This, of course, can already be called pathology, since the epithelium in this case is growing is not quite correct. This condition can lead to the formation of brushes. Erosion, growth of the epithelium are the reason to contact a highly qualified specialist and begin treatment.
Forms of cancer diseases
Often, gynecologists have to set as a diagnosis of erosion of the uterine cervix, this disease is considered benign. In this case, the epithelium is damaged, which covers the neck, all this happens if:
- A woman recently had a genital infectious disease,
- Previously, the woman was faced with inflammation of the genital organs,
- after being physically or chemically affected,
- there were violations caused by a failure in hormones.
There is another pathological process of the cervix. We are talking about eroded ectropion, which tends to develop in the process of labor or when scraping occurs. Rough scars begin to form that contribute to the change of the cervix.
Papillomas are formations that appear due to viral papilloma. They have properties to appear on the vaginal walls, on the labia, and even near the anus. To date, scientists have already been able to prove that the papillomavirus has the ability to influence the development of a malignant disease.
A cervical polyp is a kind of thickening that appears in the cervical canal, or rather on the mucous membrane. This ailment is focal. Also, it is not uncommon to find another pathology, or rather leukoplakia. With this type of disease, a thickening of the multilayered epithelium occurs, and keratinization appears in it, which manifests itself as white spots on the cervix of the uterus. These spots can be observed on the vaginal walls. Leukoplakia is a dangerous disease, since atypical changes sometimes begin in the areas affected by it.
How is the uterine cervix examined:
- in order to determine where and how much the cervix is affected, the vagina should be examined as a pap test. A Pap smear test is taken, thanks to this analysis, it is possible to determine whether an inflammatory process is occurring and whether cancer cells develop,
- colposcopy is also performed, the uterine cervix is examined with a microscope,
- It is not uncommon for doctors to resort to infectious screening, several tests are being done during this examination,
- the cervical canal is also scraped, thereby establishing changes that occur to the uterus.
If an infectious disease is detected, it is necessary to urgently prescribe a therapy that will direct its effect on the bacteria, and then will fight the inflammatory process and stimulate the body's immune forces. After the treatment is over, it is necessary to conduct a control type of examinations. If the infectious disease is eliminated, then it is necessary to carry out a procedure that destroys the damaged areas, for this the doctors resort to:
- cryodestruction. To carry out this method, liquid nitrogen is taken, due to which the burning of damaged tissue occurs, and focal diseases start to break down,
- Doctors rarely resort to laser coagulation, evaporate the diseased tissue using a laser beam,
- Not in the last place is the radio wave type of surgery, in the process of which the doctors evaporate the affected tissues using an ultra-high-frequency electromagnetic radio knife.
Thanks to each of the above methods can be treated. No procedure at all causes pain, blood loss in the process of their implementation is not observed, and no other complications appear.
If we talk about the main preventive method by which you can stop the diseases of the cervix uteri, it is completely protected sex. The most common means in this case today is a condom. If you don’t care about the health of your child, then you should remember that, at the age of 12, girls should be vaccinated against HPV.
Thanks to this vaccination, girls being women do not face a terrible disease - cancer. And do not forget about regular visits to the gynecologist.
Grudinina Natalia Anatolyevna
head of department, obstetrician-gynecologist of the highest qualification category
Druzhinina Olga Nikolaevna
obstetrician-gynecologist of the highest qualification category
Efimenko Anatoly Gennadyevich
obstetrician-gynecologist of the highest qualification category
Mikheeva Olga Valerievna
obstetrician-gynecologist of the first qualification category
Porokhina Irina Anatolyevna
obstetrician-gynecologist of the highest qualification category
Other non-inflammatory diseases of the cervix are diagnosed only for women
Men are diagnosed with Other non-inflammatory diseases of the cervix. No deaths have been identified.
mortality in men with disease Other non-inflammatory diseases of the cervix
Women are diagnosed with Other non-inflammatory diseases of the cervix There were no deaths.
mortality in women with disease Other non-inflammatory diseases of the cervix
4 standards have been established for the diagnosis of the disease Other non-inflammatory diseases of the cervix uteri
Diagnosis Other non-inflammatory diseases of the cervix uteri on the 1 place in the frequency of diseases in the rubric of other non-inflammatory diseases of the female genital organs system
Other non-inflammatory diseases of the cervix uteri on the 8 most dangerous disease in the category of other Noninflammatory diseases of the female reproductive organs
The diagnosis is made on the basis of complaints of the patient and the totality of clinical symptoms. Also used laboratory diagnostic methods.
Diseases with similar symptoms
Natural childbirth in women
Low risk, only women get sick, age 13-57
Birth is accompanied by great physical exertion, both for mother and baby
Low risk, sick men and women, age 0-0
The effects of a fall can be very different depending on the nature of the damage.
Moderate risk, sick men and women, age 1-100
The magnitude of the decline is individual, but usually it is below 100/60 mm Hg. for men and 95/60 mm Hg for women
31 disease can be the cause, sick men and women, any age
A person coughing throws out a half a liter of air, which, under pressure, shoots a jet of more than 1 meter in length at a speed of 75 km / h. At the same time, the jet contains about 3000 droplets of saliva and mucus.
61 disease can be the cause, sick men and women, age 1-100
Feeling or chronic feeling of lack of air, manifested by tightness in the chest, increased breathing, may occur after physical activity, but should particularly alert the shortness of breath at rest
58 diseases can be the cause, sick men and women, age 1-100
- the main
- ICD-10 classes
- N00-N99 URINARY SYSTEM DISEASES
- Other non-inflammatory diseases of the cervix
All information on this site is provided for informational purposes only.
and can not be considered as a recommendation for the diagnosis and treatment of diseases.
Medical infographics based on WHO statistics
DISTROPHIC DISEASES VULVA
Dystrophic diseases of the vulva - a collective concept, and includes two nosological forms: sclerotic lichen and squamous hyperplasia.
Sclerotic lichen - chronic benign inflammation of the vulvar skin mucous membranes.
Squamous hyperplasia - a chronic disease of the vulva, characterized by inadequate proliferative epithelial reaction.
Background and precancerous diseases of the cervix uteri
Among gynecological diseases in women of reproductive age, cervical pathology occurs in 10-15% of cases. Cervical cancer is currently the most common cancer of the female genital organs. It is about 12% of the number of all malignant tumors detected in women.
A certain phasing and staging of the pathological processes of the cervix in the development of carcinogenesis is noted. Background and precancerous diseases, in situ cancer and advanced cervical cancer are distinguished.