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Dysplasia in the uterine cervix Print

Dysplasia is a group of lesions in the uterine cervix characterized by abnormal cellular architecture and morphology at the level of exterior cervical epithelium.

The risk factors for dysplasia are insufficiently known. Aside from infectious factors and hormonal disturbances many authors insist on the possibility of a viral factor causing dysplasia. According to currently existing knowledge the dysplasia seem to be the consequence of genome abnormalities in cervical cells induced by a viral infection.

The importance of an early diagnosis and an adequate treatment of dysplasia is explained by:
- First of all the fact that dysplasia are considered precancerous lesions, being the precursor of a cancer “in situ” and later an invasive cancer of the uterine cervix within 2-15 years in 33% of cases.
- Relatively high incidence (the risk of dysplasia is 3% in women between 20 and 40 years of age)
- a shifted evolutive potential of dysplasia

A classic scheme: mild dysplasia – moderate dysplasia – severe dysplasia – cancer “in situ” – microinvasive cancer – invasive cancer. According to this scheme the cancer “in situ” stage is achieved in approximately 10 years, other 10 years being necessary to pass through the microinvasive cancer stage and then the invasive one. Due to discussible action of the herpes virus and the papillomavirus, this scheme is currently replaced by a new quasi-unpredictable evolution one-year scheme: mild dysplasia – moderate dysplasia – severe dysplasia – cancer “in situ” – microinvasive cancer – invasive cancer.

The diagnosis of dysplasia is not based on any functional or physical signs. The majority of uninfected dysplasia do not have any clinical symptoms. The infected dysplasia sometimes have an appeal symptomatology: leucorrhea, minimal, sometimes provoked hemorrhages, pelvic pain.

Only a systematic cytological examination and colposcopy can evoke a diagnostic which can be finally confirmed through histological examination.

Remark: for more information on cytology and colposcopy access the “Services provided by the “Calmed” clinic””.

Treatment:
 Any diagnosed dysplasia will be treated, because even a mild dysplasia can directly evolve to a cancer “in situ” or a microinvasive cancer. The “Calmed” Clinic:
- Uses a destructive treatment with laser photovaporisation for mild and moderate dysplasia when a clear visualization of the junction between the flat and the cylindrical epithelia is possible. The rate of recovery after a treatment course represents 85-96%, and after a repeated treatment – 95%. Despite the fact that electrocauterization and diathermocoagulation are very popular given their accessibility, these methods do not have the advantages of laser treatment. The use in Calmed Clinic of a CO2 laser with a light bundle in fiber and with a light bundle emission in short pulsations with the highest maximal power (unique in Moldova) makes the photodestructive effect to be completely superior to the photothermic one. As a result, it is ideal for procedures requiring the minimization of thermal affection of the tissues and a maximized rate of their destruction.
- In mild and moderate dysplasia without a clear visualization of the junction between the flat and the cylindrical epithelia colization is performed.
- In complicated severe dysplasia a large excision with a diathermal loop is performed
- In dysplasia associated with cervical hypertrophy a surgical intra- and supravaginal amputation of the cervix is performed
- If dysplasia was diagnosed during pregnancy, the woman will be followed-up using cytology and colposcopy to exclude invasive cancer; the birth will be through natural ways, and the lesion will be treated thereafter.

Remark: for more information access the “Services provided by the “Calmed” clinic””.

After treatment follow-up:

The probability of lesion’s persistence and recurrence represents 5-15%. 85% of these are diagnosed within the first 2 years after primary treatment. The follow-up after treatment includes:
1. cytology of the uterine cervix and primary colposcopy – after 3 months.
2. cytology of the uterine cervix – every 6 months.
3. Annual colposcopy within the first 2 years.
4. the patients with severe lesions, which are resistant to repeated destructive treatment undergo hysterectomy.

 
 
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