Cervical leukoplakia belongs to the “interesting” gynecological pathologies and is in a special position. The mechanism of development of this pathology is still unclear, so doctors are not able to definitely answer the question of how the disease will proceed - benign or malignant. The frequency of occurrence of this pathology is different (according to statistics from different authors) and ranges from 1.1% to 12.5%. It is with difficulties in establishing the causes and pathogenesis of the disease associated with the complexity of the treatment of leukoplakia.
Definition of leukoplakia
The condition in which the epithelium, covering the vaginal or visible part of the cervix, thickens and argues, and the cervix thickens, is called leukoplakia. The literal translation of the word "leukoplakia" from Greek means "white plaque". Indeed, pathological areas on the neck when viewed with the naked eye look like whitish spots or plaques. Abroad, the concept of leukoplakia has been replaced by intraepithelial neoplasia or dyskeratosis.
Depending on the macroscopic picture, the following forms of leukoplakia are distinguished:
- simple, which is considered the initial stage of the process, while the white plaques are flush with the mucous and do not protrude above its surface, they can easily be overlooked during the examination of the cervix,
- verrucous or warty (second stage of the disease) - whitish growths overlap each other, because of which the cervix looks bumpy, and the leukoplakia lesions themselves significantly rise above the mucosa and it is almost impossible not to notice them,
- erosive - there are cracks and / or erosive areas on whitish plaques.
After a histological examination of a piece of plaque, simple leukoplakia and leukoplakia with atypia (proliferative) are isolated. Simple leukoplakia (atypical ones that are not identified, that is, cells inclined to rebirth) are attributed to the background processes of the cervix. Leukoplakia with atypia (there are atypical cells) is considered a precancer.
Causes of leukoplakia
Experts still have not figured out what "starts" the process of leukoplakia. But it is assumed that the provoking factors are certain conditions of the body or the effect on the cervix. In this regard, all causal factors are divided into exogenous (internal) and endogenous (that is, those that act "outside").
in the hypothalamus-pituitary-ovarian-uterine system, which leads to anovulation and an excess of estrogens (both relative and absolute) and lack of progesterone:
- uterine fibroids and other tumors,
- ovarian dysfunction,
Factors that act from the outside:
- cervical injury:
- cervical tears in labor
- neck damage during abortions,
- other intrauterine procedures (diagnostic curettage, hysteroscopy).
- aggressive effects on the neck
- cauterization (electrocautery of the neck),
- exposure to chemicals (solkovagin).
- genital infections:
- human papillomavirus
- ureaplasmas and mycoplasmas
- herpes infection
- promiscuous and early sex life.
Under the action of certain factors in the mucous neck first an inflammatory process occurs. Then mechanisms are connected that lead to keratisation (keratinization) of the stratified squamous epithelium of the visible part of the cervix. It is known that this epithelium is normally non-threshold. As a result, epithelial cells are gradually rearranged, which ends with the formation of horny scales and plaques. It is characteristic that glycogen is absent in these scales.
Leukoplakia of the cervix, which is perhaps the most unpleasant, proceeds without symptoms. As a rule, the disease is detected by chance during a regular visit to the gynecologist. But there may be complaints from the patient, which are more likely associated with comorbidities than with leukoplakia itself. In case of inflammation of the vagina and / or the cervix, the woman may experience pain during sexual intercourse and contact bleeding. Also, the patient complains about the allocation of an unusual color, and, as a rule, with an unpleasant odor. If the process continues to spread and captures the adjacent vaginal walls, a burning sensation and itching may occur.
When viewed in the mirrors, the doctor observes on the cervix a thin, whitish film that is not removed with a swab, and when you try to peel it off, there is bloody discharge. This is the first stage of the disease - simple leukoplakia. With warty leukoplakia, the film of which rises a couple of millimeters above the mucous membrane, the raids can be easily removed with a swab, after removing which pink glossy areas of the neck are detected. The plaques themselves have clear contours, round or oval in shape.
Leukoplakia during pregnancy
If a woman planning a pregnancy has this disease, the doctor strongly recommends that you first treat leukoplakia, and then get pregnant. Leukoplakia does not adversely affect the course of pregnancy, nor the growth and development of the fetus. But in the period of gestation, when the hormonal background changes dramatically and rapidly, the progression of the process is possible. If the disease occurs during gestation, its treatment is postponed for the period after childbirth. Births are recommended to lead through the birth canal. The exception is the growth of plaques and their spread to the vaginal walls, in which case a cesarean section is performed.
In the case of malignancy of leukoplakia lesions, that is, the appearance of atypical cells, the following symptoms may occur:
- leukoplakia focus sharply and significantly increased in size,
- unexpected formation of seals or erosion in the area of flat leukoplakia,
- there is uneven density of the lesion of flat leukoplakia, especially from one pole of the plaque,
- with erosive leukoplakia, an ulcer is formed in the center of the seal,
- the appearance of ulcers on the surface of erosive leukoplakia:
- papillary or warty growths are formed on the plaque of simple leukoplakia.
The listed symptoms should alert the doctor, although the process of malignant transformation can proceed without visible changes in leukoplakia foci.
The diagnosis is established on a set of data of clinical, laboratory, cytological and colposcopic examination. During the patient's initial treatment, the doctor carefully collects anamnesis (identification of provoking factors), complaints and examines the cervix and vaginal walls in the mirrors. Further, additional examination methods are prescribed:
Cytological examination of smears
Cytological examination allows to determine the qualitative composition of epithelial cells. For this purpose, smears are taken from the visible part of the cervix, from the lower third of the cervical canal and from the transition zone (leukoplakia plaque boundary and a healthy cervical area). The material is taken with a special brush or Eyre trowel.
When examining the material through a microscope, “flocks” of stratified squamous epithelium cells (normally covering the vaginal part of the neck), in which there are phenomena of hyper- and parakeratosis, are detected. In the case of hyperkeratosis, a large number of non-nuclear scales are determined. And with parakeratosis, the density and color of the cytoplasm in small cells is enhanced, with possible violations of their differentiation, proliferation and atypia.
Examination of the cervix with a colposcope has important diagnostic value and allows not only to identify leukoplakia areas that are not visible to the naked eye, but also to determine their size and assume the presence of an atypical transformation (precancer).
If leukoplakia lesions are visible during a banal examination in mirrors, they speak of a clinically expressed form. In the case of determining pathological foci only during colposcopy, this is called a colposcopic form.
Signs of colposcopic form is the identification of the so-called silent iodine-negative zones, which are detected only when conducting a Schiller test. Schiller’s test is to stain the cervix with iodine solution (called Lugol’s solution). A positive test is indicated by a uniform coloration of the neck in brown color, with a negative sample revealed undyed patches. The leukoplakia lesions do not stain with iodine, since the altered epithelium cells do not contain glycogen, which reacts to iodine in brown.
Clinically expressed forms are leukoplakia lesions (thin and thick), visible during normal examination, as well as colposcopically, punctuation (multiple red dots) coarse or tender, as well as mosaic. Mosaic and punctuation are determined only when viewed with a colposcope and indirectly indicate a precancerous transformation.
For histological examination, a biopsy of the cervix is performed, followed by a mandatory scraping of the cervical canal. The material is taken from the most suspicious part of the neck under the control of colposcopy. Histological examination allows to assess the depth of involvement in the pathological process of the epithelial layers of the cervix, and, most importantly, to identify atypical cells. The histological picture of this disease is as follows:
- cell proliferation of multilayer epithelium,
- uneven thickening of multilayer epithelium due to a pronounced increase in the number of intermediate cells,
- horny layer (normally absent),
- granular layer located under the horny,
- hyper and parakeratosis,
- lymphocytic stromal infiltration.
It is carried out according to indications.
Various methods of treatment are used to eliminate cervical leukoplakia. But first of all it is necessary to eliminate the inflammatory process (if it exists) and other provoking factors. When detecting inflammation of the genital organs or the detection of genital infections, drugs with antiviral, antibacterial, anti-trichomonas or antifungal effects are prescribed (depending on the identified pathogen). In the case of the diagnosis of hormonal disorders, corrective hormone therapy is prescribed. How to treat leukoplakia of the cervix uteri is caused by many factors, and the specific method of treatment is selected taking into account its disadvantages and merits.
The method is to apply an electric current to the affected area, after which a burn is created. Electro-waves are fed to the electrode (loop or “button”), which is in contact with the damaged part of the cervix. Since the burn surface is formed after treatment, the method is also called cauterization. Cauterization of leukoplakia of the cervix, although quite an effective method (reaches 70%), is very painful. The advantages of the DTK method include only:
- availability of the DTK apparatus in almost every gynecologist's office.
DTC has a lot of flaws, so it is rarely used now. Cauterization is carried out in the first phase of the cycle, after the monthly periods have ended. The disadvantages include:
- significant painfulness of the procedure
- exacerbation of inflammatory diseases of the uterus, ovaries and tubes,
- high risk of bleeding, both during cauterization and after (premature scab rejection),
- prolonged healing (up to 2 months)
- cicatricial deformity of the cervix up to atresia (fusion) of the cervical canal, therefore, is used only in women who have given birth.
Cold treatment of leukoplakia - cryotherapy or cryodestruction, is a highly effective method. The efficiency of cryodestruction reaches 94%. The pathological area is affected by liquid nitrogen of very low temperature. As a result, crystals are formed in the cells, which lead to their destruction and subsequent necrosis. The method of contact, the duration of the procedure depends on the nature and area of the pathological focus (2 - 5 minutes). The advantages of "freezing" include:
- good effect
- the possibility of use in birthless,
- lack of scars.
Among the drawbacks of cryodestruction it is worth noting:
- relapse of leukoplakia,
- the probability of shortening the cervix, which reduces the chances of conception.
The most effective treatment for leukoplakia today is considered to be laser therapy. Laser coagulation of the leukoplakia lesion is performed in the first phase of the cycle and does not require anesthesia. The method is contactless and consists in treating the pathological focus with a CO2 laser beam. As a result, the liquid evaporates from the treated (pathological) cells, which contributes to their destruction. Then a thin coagulation film is formed on the wound surface that prevents the penetration of the infection into the wound. If the process spreads to the vagina, the treatment is carried out in 2 stages. At the first stage, the cervix is processed, at the second - the arches and walls of the vagina. The advantages of the method are:
- high efficiency,
- no scar deformity of the cervix (it is possible to give birth),
- fast healing (16-40 days).
Among the shortcomings, it is necessary to note the high cost of the method and the availability of special equipment (available only in specialized clinics).
Radio wave method
For the treatment of this method using the apparatus "Surgitron". The method is modern, effective and contactless. The essence of the treatment is the introduction of an electrode into the cervical canal, at the tip of which electrical waves are converted into radio waves. Pathological cells heat up, liquid evaporates from them and destruction of the leukoplakia focus occurs. The advantages of the method include:
- no scar deformation of the neck,
- fast healing.
The disadvantage is perhaps one. Not all women's clinics have a Surgitron unit.
This method of treatment of leukoplakia consists in the treatment of the pathological part of the neck with Solkovagin. The composition of this drug includes organic and inorganic acids that coagulate (cauterize) the abnormal cells. The method is painless, suitable for those who have not born, reaches an efficiency of 75%. Of the drawbacks, it should be noted that the depth of penetration of the drug is not more than 2.5 mm, which makes its use ineffective with atypical coarse leukoplakia. As well as the impossibility of treating large areas of cervical lesions.
In the postoperative period, doctors strongly recommend to maintain sexual peace for 1.5 months. It is also prohibited to lift weights, take hot baths, go to baths and saunas. In addition, douching and the use of hygienic tampons are prohibited. You must follow the rules of intimate hygiene. In the first 10 days after any method of treating the cervix, the appearance of abundant liquid discharge may occur, which should not frighten a woman. This is a reaction to the treatment and indicates healing of the wound surface.
Traditional methods of treatment
In order to eliminate leukoplakia of the cervix, no traditional treatment methods are allowed. A variety of douching, the introduction of herbal tampons, etc., will not only benefit, but also contribute to the spread of the process and the appearance of atypical cells.
Previously beloved doctors such methods of treatment of any pathology of the cervix, such as the introduction of tampons with sea buckthorn oil or rosehip, aloe ointment, etc. are not currently used. It is proved that the listed drugs affect tissue metabolism, which causes the proliferation of abnormal cells and provoke the development of dysplasia.
Answer: Yes, a complete cure is guaranteed at almost 99%. The prognosis for this disease is favorable, in case of timely treatment and elimination of provoking factors. Otherwise, recurrence of the process is possible, and in 15% reincarnation of leukoplakia in dysplasia and malignant regeneration of the cervix.
Answer: Yes, all patients after treatment are taken on the dispensary registration. Every six months, cytology smears are taken from them, colposcopy and HPV testing are performed. With negative results and favorable colposcopic and cytological picture after 2 years, the patient is removed from the register.
Answer: In principle, this pathology does not prevent conception, problems with pregnancy may be due to other factors provoking leukoplakia. These can be hormonal disorders or hidden genital infections. In any case, when revealing leukoplakia, it is necessary to undergo treatment first, and then plan a pregnancy.
Answer: Yes, Gardasil and Cervarix vaccines are currently being developed. The introduction of these vaccines prevents infection with human papillomavirus, which provokes not only the occurrence of cervical leukoplakia, but also dysplasia and cervical cancer.
Answer: Yes you can.But it is recommended to treat the disease, especially if there are complaints (discomfort during sexual intercourse, blood discharge, etc.).
Causes of cervical leukoplakia
A synonym for leukoplakia is hyperkeratosis. These are absolutely equivalent concepts. There are no exact reasons for the development of the disease. But under the influence of factors, the stratified squamous epithelium begins to coarsen.
The following main provocative moments can be distinguished:
- Not careful personal hygiene. It is recommended to wash 1–2 times a day. Douching and other such manipulations should be carried out only as directed by a physician.
- Indiscriminate sex and, as a result, various infections (Trichomonas, gonorrhea, viral lesions, etc.). Often they take a long time, or are not completely cured, and provoke similar changes on the cervix.
- Disruption of the endocrine organs; the thyroid gland, the female reproductive system, plays the greatest role.
- Immunodeficiency states, against which many pathological processes in the woman’s body occur.
- Serious postpartum injury of the cervix, its scar deformity.
- Various permanent mechanical injuries of the cervix: violent sex, incorrectly installed intrauterine device, multiple abortions, biopsies, etc. These procedures stimulate enhanced cell division of the squamous epithelium of the cervix, as a result of which malfunctions and mutations can occur.
We recommend reading the article on cervical ectopia. From it you will learn about the signs of cervicitis and its effect on the cervix, the causes of ectopia and methods of treatment.
And here more about cervical dysplasia.
Symptoms of cervical leukoplakia
In most cases, the pathology runs unnoticed by the woman. No pain, discharge, etc. Sometimes you can still pay attention to the following symptoms:
- The increase in the number of vaginal whiter, and often they can have an unpleasant smell. The more extensive the lesions, the greater the discharge.
- If hyperkeratosis affects the external genitalia, itching appears in this area, dryness, scratching. Sometimes a woman marks white spots in places of leukoplakia.
- Also, with marked hyperkeratosis of the cervix, bloody contact discharge may appear (after intimate relationships, especially stormy).
All other signs that a woman can mark are not directly related to leukoplakia, most often they simply reflect the state of health of the woman at the moment.
Forms of cervical leukoplakia
Leukoplakia can affect part of the cervix or almost its entire surface. From the point of view of the clinical picture, the following forms can be distinguished:
- Flat leukoplakia, which is characterized by the appearance of areas of gray-white color, while in density they practically do not differ from the rest of the epithelium. When touched with tweezers or another object, “plaque” is not removed and is not injured. Histological examination (after biopsy) determines acanthosis and parakeratosis.
- Verrucous (warty) leukoplakia is characterized by the appearance of "growths", tuberosities. They are formed due to the fact that the constantly horny epithelial cells are not exfoliated, but remain in place. When viewed immediately visible such "warts".
- Ulcer-necrotic form, in which at the site of hyperkeratosis over time, tissue defects appear. Outwardly, it is difficult to distinguish from conventional erosion; a biopsy helps to clarify the diagnosis.
Look at the cervical leukoplakia video:
Treatment of cervical leukoplakia
Approaches to the treatment of leukoplakia depend on many components. The main ones include the following:
- Does a woman plan a future pregnancy?
- as far as the process is common,
- a relapse is a first-time case or some other points.
When a factor provoking the formation of leukoplakia is detected, one should seek to remove it or reduce its effect on the organ. The most commonly used methods are drugs:
- Antibacterial and anti-inflammatory therapy. Optimally, if the drugs are selected taking into account the sensitivity of the flora and after a complete survey for pathogens.
- Antiviral medications when HPV, HSV, etc. are detected.
- Immunomodulatory agents - interferons, vitamins, etc.
- Treatment of the cervix with Solkovagin is applied against the background of conservative treatment, if the area of hyperkeratosis is small, deep tissues are not involved in the process.
- Laser removal can be used even with extensive lesions, relapses, with the exception of the cancer process. This removes the area of the cervix, there is a thermal burn of tissues. After such treatment, a healing period of 3 to 4 weeks is needed.
- Radiowave conization - excision of tissues using a "radio wave knife". This is one of the most popular and relatively gentle methods. It can be used in combination with dysplasia, even severe.
- Cryodestruction - the impact on the affected area with liquid nitrogen, after which a gentle scar is formed. Used for small and shallow lesions.
- A method such as DEK (diathermocoagulation) can also be used. It is the most traumatic and requires a long healing period.
- With a combination of dysplasia and leukoplakia or precancerous conditions, with the recurrence of hyperkeratosis on an individual basis, preference may be given to more serious operational methods. This is an amputation of the cervix, cone-shaped resection or even removal of the uterus (for example, if there are myomatous nodes, refractory endometrial hyperplasia, etc.).
But it is necessary to understand that such treatment is unlikely to help get rid of the pathology. This is nothing more than an addition to the main regimens.
Prevention of cervical leukoplakia
There is no specific prophylaxis for leukoplakia. The main recommendations are as follows:
- Preference should be given to barrier methods of protection during sexual intercourse (condoms), especially to sexually active girls. This is STI prevention.
- It should be regularly examined by a gynecologist (even in the absence of complaints), and treatment should be carried out promptly and in full.
- It is advisable to avoid performing abortions, numerous scraping and other traumatic procedures of the cervix.
- You should also lead a healthy lifestyle. Excess weight, smoking, unhealthy food indirectly contribute to the development of leukoplakia. After all, impaired metabolism, an excess of toxins in the body - all this leads to mutations and changes in the properties of cells.
Leukoplakia - what is it in gynecology?
For a start it is worth saying that such a violation is attributed to the group of so-called precancerous pathologies. And today, many female antenatal clinics hear the diagnosis of leukoplakia. What is it in gynecology? How does it manifest itself? What kind of tissue affects?
This disease is accompanied by thickening and subsequent keratinization of the mucous membrane of the reproductive organs. Most often, doctors in modern medical practice are registering cervical leukoplakia, in which the cervical canal is also affected. In addition, changes in the integument are often observed in the vaginal part of the uterus. Leukoplakia of the vagina and vulva is less commonly diagnosed.
This problem is not considered too common - according to the results of statistical studies, about 5-6% of women are faced with a similar disease. Nevertheless, it cannot be ignored in any case. The fact is that this disease significantly increases the likelihood of malignant tissue degeneration and the development of cancer in the future.
The main causes of the disease
There are some factors under the influence of which such an unpleasant and dangerous disease as leukoplakia can develop. What is it in gynecology? For a start it is worth saying that the cause of tissue changes can be the impact of both external and internal environment.
Internal causes include malfunctioning of the endocrine system. Violation of the hormonal background can lead to anovulation, hyperestrogenia, a sharp decrease in progesterone levels, as a result of which hyperplastic processes in the tissues are observed.
Quite often, uterine leukoplakia is the result of an infectious-inflammatory process. In particular, risk factors are previously transferred adnexitis, endometritis, violations of the normal menstrual cycle. In addition, tissue changes can develop against the background of infections, including herpes, ureaplasmosis, cytomegalovirus and papillomavirus infection, mycoplasmosis, chlamydia, etc. Non-specific infectious diseases (for example, cervicitis, colpitis) can also be dangerous.
Chemical and traumatic damage to the tissues of the uterus, resulting from termination of pregnancy, diagnostic or therapeutic procedures (curettage, cauterization of erosions) also contribute to the development of the disease. Risk factors include a decrease in the activity of the immune system, promiscuous sex life.
Types of leukoplakia
There are several forms of the disease called leukoplakia. Gynecology identifies three main, although in fact there are several classification schemes. However, depending on the characteristics of the course of the disease, the following types of pathology may appear in women:
- Simple form of leukoplakia. Considered one of the background changes. This process is characterized by thickening and gradual keratinization of the surface layers of the epithelium - while the basal and parabasal layers are not affected by this disorder.
- Proliferative forms of the disease. Accompanied by impaired normal differentiation of tissues, resulting in a change in all layers of cells and the gradual formation of atypical structures. This form of the disease is regarded as a precancerous condition.
Depending on the course of the disease, flat (on the surface of the epithelium whitish films are formed), scaly (horny areas can be seen), erosive (change of cells accompanied by the formation of erosion), warty and some other forms of lecoplakia are distinguished.
What are the symptoms of the disease?
Many women are interested in questions about what signs leukoplakia is accompanied by. Reviews of doctors and patients, as well as data from statistical surveys prove that most often this disease proceeds without any symptoms. Most often, the pathological change and keratinization of the cells is detected by the doctor during a routine gynecological examination.
Only occasionally leukoplakia causes some visible disturbances - most often only if it occurs against the background of inflammation. Women with similar problems complain about the appearance of a small amount of whiter with an uncharacteristic color and smell. Sometimes itchy external genitalia. Some patients complain of painful menstruation and pain during intercourse.
What is the diagnostic process?
Quite a few patients today are interested in questions about what constitutes leukoplakia. The symptoms and treatment of this disease, the complications that are associated with it, also interest women. But no less important information is the process of diagnosis.
As already mentioned, the doctor may suspect the presence of leukoplakia during a routine examination of the cervix using mirrors. In the presence of whitish areas and keratinized tissues, tissue is scraped off (by the way, these areas can be either single or multiple).
During laboratory testing, a specialist may notice the presence of cells with parakeratosis and hyperkeratosis. In some cases, an additional knife biopsy and histological examination of the tissue of the exocervix is carried out - this makes it possible to determine the presence of deep proliferation and cell atypia.
Further, an extended colposcopy is carried out, during which the doctor manages to examine well the plaques formed on the tissues. In addition, it is extremely important to determine the cause of the development of the disease, therefore, hormonal, bacteriological, immunological studies and some other tests are often prescribed to patients. Sometimes consultation of the endocrinologist and the oncologist is in addition required.
Types of disease
According to external signs, the following types of cervical leukoplakia are distinguished:
- Flat (the initial stage of the disease, in which only the granular and basal layers of the epithelium are thickened).
- Warty (proliferation of altered cells, cervical surface roughness).
- Erosive (joining cracks, erosion).
According to morphological criteria, leukoplakia can be simple (pathology affects only the surface layers of the epithelium) and proliferative (most often it degenerates into cancer).
Causes and symptoms of leukoplakia
The following factors can affect the development of the disease:
- hormonal disorders in the body,
- pathologies of the thyroid gland, ovaries, adrenal glands,
- reduced immunity
- postponed STDs and inflammatory diseases of the genital area,
- wounds, erosion, scratches on the cervix, injuries (during childbirth, abortion).
Symptoms of cervical leukoplakia are often absent. Typically, the disease is detected during a gynecological examination or colposcopy.
If the spots spread to the vagina, the clinical picture includes itching, often - strong, as well as the appearance of cracks, abrasions.
Since leukoplakia can be combined with inflammatory and infectious processes, the symptoms are pain during intercourse, unpleasant odor, and viscous vaginal discharge. With a long course or malignancy, a woman may experience intermenstrual bleeding.
The risk of leukoplakia is the risk of developing uterine cancer. According to statistics, more than 30% of cases of the disease tend to malignant cell degeneration. The consequences of cervical leukoplakia with early contact with a doctor are reversible. If you eliminate the aggravating factors (STIs, inflammation, erosion), the prognosis for recovery is favorable.
Causes of cervical leukoplakia
In the etiology of cervical leukoplakia, there are effects of endogenous factors (hormonal and immune regulation disorders), as well as exogenous causes (infectious, chemical, traumatic). A change in the hormonal homeostasis is a violation of the functional relationship in the hypothalamus – pituitary – ovary – uterus chain, leading to anovulation, relative or absolute hyperestrogenism, progesterone deficiency and, as a result, hyperplastic processes in target organs.
Occurrence of cervical leukoplakia is often preceded by infectious-inflammatory processes (endometritis, adnexitis), menstrual disorders (amenorrhea, oligomenorrhea). Background factors include human papillomavirus infection, ureaplasmosis, chlamydia, mycoplasmosis, herpes, cytomegalovirus infection, nonspecific colpitis and cervicitis, recurrent ectopia, decreased general and local reactivity, promiscuous sex life. The development of leukoplakia is promoted by traumatic and chemical injuries of the cervix during surgical abortion, diagnostic curettage, drug burning or diathermocoagulation of cervical erosion, and other aggressive interventions.
Against the background of etiological factors, mechanisms are triggered that cause keratinization of the exocervix multilayer epithelium cells (normally not keratinizing). Due to the gradual rearrangement of epithelial cells (disintegration of nuclei and intracellular organoids), horny scales that do not contain glycogen are formed. Foci of cervical leukoplakia can be single or multiple.
Prevention of cervical leukoplakia
In order to prevent the development of cervical leukoplakia and early treatment of erosions, inflammatory and infectious processes in the reproductive organs, the elimination of abortions, injuries of the cervix during labor and gynecological manipulations, prevention of STIs, the use of barrier contraceptives.
Women suffering from menstrual disorders should be monitored by a gynecologist and endocrinologist in order to correct hormonal disorders. In the matter of prevention of cervical leukoplakia and screening and explanatory work, regular gynecological examinations are important. The essential preventive point is the vaccination against HPV.
After destruction of leukoplakia lesions without atypia, a patient is subjected to a colposcopy every six months, a smear test for oncocytology, and HPV tests. After 2 years and in the absence of recurrence, the woman is transferred to the usual mode of observation.
Prognosis for cervical leukoplakia
In the absence of atypia, human papillomavirus infection, elimination of adverse background factors, the prognosis after curing leukoplakia of the cervix is favorable. If the root cause of the disease is preserved, a manifest course and the transition of leukoplakia to cervical cancer are possible.
For simple leukoplakia in women planning childbearing, in order to avoid cicatricial deformity of the cervix, it is preferable to use gentle methods of destruction - cryodestruction, laser vaporization, radiosurgical treatment, and chemical coagulation. Ведение беременности у данной группы пациенток требует повышенного контроля за состоянием шейки матки.
Медикаментозное лечение лейкоплакии
Only a doctor can diagnose a woman with uterine leukoplakia. The treatment in this case is selected individually, since here everything depends on the form and severity of the disease, its causes, as well as the age of the patient and the characteristics of her body.
Drug treatment is advisable if leukoplakia of the cervix is associated with infection or inflammation. In such cases, patients are prescribed anti-inflammatory, antibacterial, or antiviral agents. If there are problems with the immune system, it is necessary to take immunomodulators, vitamin complexes, etc. If the disease has occurred against the background of a failure in the endocrine system, then treatment with hormonal preparations may be needed.
Therapy usually lasts about two months. During this period, the woman should carefully follow all the recommendations of the doctor. By the way, at the time of treatment you need to stop all sexual contacts - this will speed up the process of restoring normal epithelium.
Other treatments for leukoplakia
To date, there are many methods of removing foci of keratinization and tissue thickening. But once again it is worth saying that at first it is extremely important to find out and eliminate the cause of the disease, and only then proceed to remove the lesion sites. To date, there are several popular methods:
- Surgical coagulation involves cauterization of the lesion sites with the help of aggressive medication drugs, for example, Solkovagin. The procedure is almost painless, rarely accompanied by complications. In addition, approximately 75-96% after cauterization, there is a complete recovery.
- Electrocoagulation is a procedure in which parts of leukoplakia are cauterized by electric current. This technique is associated with some serious complications, in particular, bleeding and tissue infection, so it is rarely used in gynecology.
- Another fairly effective method is cryodestruction, which also gives a 96% result. During the procedure, the changed areas are affected by liquid nitrogen, which causes tissue death and rejection.
- Laser removal of leukoplakia is currently considered the most effective and safe. This technique allows you to quickly remove the changed areas and at the same time avoid contact with blood and tissues, then minimizes the likelihood of infection. By the way, in the presence of large lesions, the procedure is carried out several times, until they disappear completely.
- In the most severe cases, an amputation of the cervix is performed with its further plastic reconstruction.
Leukoplakia and pregnancy
In some women, leukoplakia is detected already during pregnancy. Immediately it should be said that the disease is not a direct threat to the child. Of course, there is a risk of premature birth, so the patient must be under constant medical supervision.
Nevertheless, leukoplakia during pregnancy is a risk for a woman. The fact is that fluctuations in hormonal levels and changes in the immune system can cause malignant degeneration. That is why it is so important to diagnose and eliminate the disease even during pregnancy planning.
Unfortunately, there is no medicine that can permanently protect against such a disease. Therefore, the prevention of leukoplakia is reduced to regular preventive examinations at the gynecologist. It is recommended to use means of protection during sexual intercourse, to do tests and smears for various infections and inflammatory diseases in time, and if they are detected, to undergo a course of treatment in time. Naturally, it welcomes the strengthening of the immune system, as well as proper nutrition, a moderately active lifestyle and other health measures.
In the absence of malignant tissue degeneration, treatment is possible - here it is extremely important to identify and eliminate the cause of leukoplakia and only after that remove the changed areas. Such therapy, as a rule, ends in complete recovery. The first two years after the treatment, the patient is obliged to undergo colposcopy every six months - this makes it possible to detect a relapse at an early stage. Unfortunately, if the root cause of the disease has not been eliminated, then the probability is high that the disease will go into cervical cancer.
Leukoplakia (treatment): reviews of doctors and patients
Today, many women are going through the process of treating this disease. How quickly does recovery take place after leukoplakia of the cervix is detected? Reviews indicate that removing horny areas is the fastest and easiest part of therapy. Much more time and effort takes the process of identifying and eliminating the causes of the disease (hormonal therapy, correction of immunity, treatment of inflammatory diseases and infections). According to statistics, most women manage to completely cope with the disease, especially if the process of tissue change was detected in the early stages. After cure, the patient most often can count on fertilization, normal pregnancy and a full-fledged sex life.
What provokes pathology
Cervical leukoplakia is not cancer, there is no accurate data or research to confirm this. But pathology is included in the category of facultative precancers - diseases that are not necessary, but still can degenerate into malignant ones. Statistics indicate that in 30% of cervical cancers, concomitant leukoplakia is detected. Despite the fact that the reliable causes of the occurrence of cervical leukoplakia have not yet been established, a category of women who are most susceptible to such changes on the cervix is distinguished.
- Improper hygiene. Non-observance of elementary hygienic measures or, on the contrary, their excessive fulfillment leads to changes in the functions of the sex glands and epithelium. This is a risk factor for the development of leukoplakia. It is recommended to wash off once or twice a day, without using intimate oils and creams, wet wipes. Douching should not be "normal", they should be carried out only as directed by a physician.
- Genital infections. A special role in the development of leukoplakia is assigned to viral lesions of the cervix and vagina. In particular, different strains of HPV (human papillomavirus), as well as CMV (cytomegalovirus) and chlamydia. This is due to the fact that these pathogens are inserted into the genome of cells, changing their metabolism and reactions, after which they acquire new properties, in particular, keratinization. Other sexually transmitted infections (STIs), if they are converted to chronic forms, also play a significant role in the development of leukoplakia.
- Endocrine diseases. Pathologies such as diabetes, diseases of the thyroid gland, adrenal glands affect not only individual organs, but also the functioning of the organism as a whole. Changes the ratio of sex hormones, the ability of cells to update. The risk of mutations increases, and, as a result, epithelium cells begin to peel off, unusual for them. In many situations, treatment will be ineffective without a proper diet.
- Chronic immunodeficiency. Diseases that lead to a decrease in immunity (hereditary, acquired — HIV, blood pathology) stimulate an inadequate response of the body’s cells to external influences and internal changes. Failures lead to various diseases, including leukoplakia.
- Injury of the cervix. A large number of births with ruptures of the cervix, frequent curettage (including abortion), cauterization, trauma by foreign objects leads to the fact that cells are forced to update more often than usual. This increases the likelihood of mutations, disruptions in division.
Symptoms of leukoplakia of the cervix in most cases are scarce, women rarely give them adequate attention. Therefore, the disease often goes unnoticed for a long time. The main ones include the following:
- uncharacteristic for women increase in whiter,
- whites with an unpleasant smell
- slight discharge of blood after sex
- persistent itching in the perineum and genitals,
- when external genital organs are involved in the process, white spots appear on them.
The pain does not accompany leukoplakia. Its appearance is associated with the appearance of complications or other diseases.
Depending on the clinical course, it is customary to distinguish the following options for leukoplakia.
- Simple or flat. One of the common forms. In this case, leukoplakia foci look like ordinary white spots on the cervix and vagina. They are often noticeable even without colposcopy. Upon careful examination, it is noticeable that, in addition to color, the fabrics are no different from adjacent ones - in elasticity, relief, “plaque” is not easily removed when touching the instrument (unlike, for example, candida), but only with effort, but with the appearance of bloody secretions in this place.
- Warty or verrukoznaya. The growths that appear are similar to normal warts. They appear due to the fact that the horny cells of the epithelium actively reproduce, but are not exfoliated, but grow "like a horn." At the same time, they are easily removed with an instrument, leaving behind a mark on the neck in the form of a pinkish spot. It is necessary to distinguish from ordinary papillomatous growths.
- Ulcerative-necrotic. It is characterized by the fact that keratinizing cells eventually reject with the formation of ulcers. It is necessary to differentiate with the usual erosion, it is often possible to understand the diagnosis only with the help of a biopsy and subsequent tissue research.
How to identify and confirm the disease
Leukoplakia, like many other diseases of the cervix uteri, is not asymptomatic. Therefore, they are found by chance - during routine inspections, when registering for pregnancy. Sometimes leukoplakia becomes a “find” even for a doctor when performing an extended examination of a woman. The following methods help to identify the disease.
- General inspection in the mirrors. The gynecologist even with the naked eye can see white spots on the mucous membrane.
- Cytology. Collecting smears from the cervix (fluid or conventional cytology) using an Eyre's spatula or cytobrush can, with subsequent cytological (cell) research, help to identify tissue that is abnormal for this area.
- Scraping from the cervical canal. May be carried out in outpatient or inpatient conditions. Often accompanied by separate diagnostic curettage of the uterus (RFV). The material is sent for histological examination, where experts find signs of leukoplakia.
- Biopsy. The material can be taken with a normal scalpel (knife biopsy), a loop or special nippers. It is performed without anesthesia or under local anesthesia - it depends on the method and the extensiveness of the lesions. The histologist makes a suitable cut and examines the tissue under magnification. This is one of the reliable methods for the detection of leukoplakia.
- Colposcopy. Informative enough to identify leukoplakia. For a more accurate diagnosis, not only simple colposcopy is carried out (without affecting the cervix with dyes), but also extended. In the latter case, the surface is treated with iodine solution (the keratinizing epithelium absorbs it poorly). On examination, leukoplakia sites are clearly luminous compared with adjacent tissues. After the detection of atypical zones, it is from here that a targeted biopsy should be performed. So the chance to miss the pathology is the smallest.
Almost all studies can be performed on an outpatient basis, sometimes it takes several techniques.
The following drugs are used.
- Antibiotics. Appointed with concomitant genital infections, the presence of inflammation, for example, in places of scratching. If there are no such signs, antibacterial drugs are not used.
- Antiviral. If there is a concomitant lesion of HPV or HSV (herpes simplex virus).
- Immunomodulatory. Often included in the scheme to increase the body's resistance. These are biological additives, preparations from the group of interferons in the form of candles.
- "Solkovagin". This is a solution consisting of a mixture of acids. It is used for treating the cervix in the areas of damage, after which a local minor burn of tissues is formed in these zones with their subsequent recovery. It usually takes two to three treatments at intervals of seven to ten days. But treatment with Solkovagin cannot be performed if dysplasia or inflammation is suspected or present.
The removal of cervical leukoplakia by surgery is the optimal treatment method in many situations. The choice of method is carried out by the attending physician and depends on the age, the number of births in the past, the degree of damage and the results of the examination.
- Electric shock. Differently called DEK. The cheapest way, but has several disadvantages. For example, after such treatment a rough scar is formed, and it takes more than a month to heal, and all this time a woman will be disturbed by abundant unpleasant discharge.
- Cold exposure. Cryodestruction is ideal for small foci with no signs of atypia as a result of the examination. The manipulation is painless, after it an almost imperceptible scar forms, healing is not accompanied by abundant secretions.
- Laser exposure. Suitable for leukoplakia, similar in its positive sides with cryodestruction of liquid nitrogen.
- Conization of the cervix. It can be performed with radio waves or with a surgical scalpel. Preference is given to this method in the presence of atypia in cells, with a combination of leukoplakia and dysplasia. The method has a great advantage in that the material to be removed is sent for histological examination. After that, we can conclude how radically the treatment was carried out.
- Amputation of the cervix. This operation involves shortening the neck, it is the most extensive of all. When combining gynecological problems may be a question about the removal of the entire uterus (extirpation).
What signs should alert
Leukoplakia is dangerous because it can pass into cervical cancer. When viewed from the following signs are alarming:
- sudden increase in the affected area,
- the appearance of various seals in the area of leukoplakia,
- ulceration of areas
- the formation of various growths on the ground flat leukoplakia.
Cervical leukoplakia: symptoms and treatment
Category: Women's Diseases 10394
- Pain during sexual intercourse
- Burning in the genital area
- Genital itching
- Discomfort in the external genital area
- White discharge from the vagina with an unpleasant smell
- Spotting after intercourse
Cervical leukoplakia is a pathological condition in which there is a thickening and keratinization of the integumentary epithelium that lines the cervix. This ailment is included in the group of background precancerous pathologies.
If timely not to carry out adequate treatment, then leukoplakia can be reborn into cancer. Pathological formations can be seen during a pelvic examination.
On the vaginal part of the cervix marked plaques in white or gray.
Factors that can cause progression of cervical leukoplakia are divided into exogenous and endogenous.
Clinicians consider endogenous disorders in the hypothalamus-pituitary-ovary-uterus chain. As a result, anovulation with further progression of hyperestrogenia develops. Also, with this condition, progesterone deficiency may occur. Such changes do not pass for the woman’s body without a trace. Because of them, hyperplastic processes begin to occur in certain organs.
In most clinical situations, it is infectious factors that cause cervical leukoplakia. Often it is preceded by failures in a woman's menstrual cycle, as well as pathologies of an infectious-inflammatory nature.
Background factors for the development of pathology:
- nonspecific colpitis,
- herpes and so on.
Traumatic and chemical injuries can occur when:
- cauterization of cervical erosion,
- curetting for the purpose of diagnosis,
- simple leukoplakia. Also called simple. For this form of pathology characteristic is the appearance of whitish foci that do not rise above the epithelium. Usually no unpleasant symptoms in this case occurs. Therefore, the presence of pathology is detected during the gynecological examination during a completely different matter. But if leukoplakia has just begun to develop, then the doctor may not notice its manifestations on the mucous membrane.
- erosive form. On the cervix white spots are formed. There are cracks around them, as well as areas with erosion,
- warty form. The affected areas of the epithelium are clearly visible on the surface of the epithelium. They have a dense structure. Often these foci are layered on each other. This form of illness can turn into oncology. Therefore, when detecting a wart form, a biopsy is performed to detect atypical cells.
Symptoms of leukoplakia of the cervix are directly dependent on its type.With focal or simple leukoplakia, signs of pathology may not be observed. Discomfort and burning is observed with a warty form.
The symptoms are most pronounced in erosive leukoplakia. From the affected area ooids drip. It is more abundant after sexual intercourse. If plaques spread to the vulvar area, then the patient begins to feel burning and itching.
This leads to scratching, cracking and abrasions. But the appearance of such symptoms can also be observed in other diseases of the internal and external genital organs. Therefore, when they occur, you should immediately consult a doctor for diagnosis and accurate diagnosis.
Cervical leukoplakia: causes, symptoms, diagnosis, treatment and prevention
Focal cervical leukoplakia is not an independent disease, but, in fact, a symptom.
By leukoplakia (the term is translated as “white plaque”) is meant a focal change in the mucous membrane area.
Normally, the cervical mucosa has a pink color, and with the development of leukoplakia, its small areas become lighter (whitish).
Quite often, such a pathological change in the appearance of tissues is a sign of the development of one of the gynecological diseases.
The immediate cause of leukoplakia of the cervix (LSM) is a violation of the process of keratinization of the surface epithelial mucous layer, at which its thickening occurs.
To establish the true cause of the characteristic change requires a series of tests.
Forms of leukoplakia Why does cervical leukoplakia develop? Clinical manifestations of leukoplakia Additional tests Treatment of cervical leukoplakia and leukoplakia prevention measures
Why does cervical leukoplakia develop?
The exact mechanism of the “launching” of the pathological process is not yet clear.
Diseases of infectious and inflammatory origin, as well as damage to the mucous membrane of the cervix (in the healing stage) are among the main causes of focal leukoplakia of the uterus.
Please note: local lesions are often the result of medical procedures, which in particular include hysteroscopy, artificial interruption of pregnancy (abortion) and curettage of the uterus.
Often, the changes appear on the background of the dysfunction of the organs of the female reproductive system (ovaries) and a significant weakening of the immune system. In clinical practice, quite often there are cases of leukoplakia due to various endocrine disorders, in particular - violations of the functional activity of the adrenal glands and the thyroid gland.
Important: The possible onset of sexual activity and the frequent change of partners are also mentioned among the possible causes of the appearance of leukoplakia.
Leukoplakia can occur on the background of the following chronic gynecological diseases:
- endometritis (inflammation of the inner layer of the mucous wall of the uterus),
- salpingo-oophoritis (inflammation of the appendages - fallopian tubes and ovaries).
Infections that can cause leukoplakia:
Please note: in some cases, pale spots that have an external similarity with LSM are a variant of the norm, that is, they are an individual feature of a particular patient.
Sometimes pathology is one of the symptoms of dysplasia or malignant neoplasms of the cervix.
The development of leukoplakia on the background of vaginal dysbacteriosis, and also due to the use of local remedies for the treatment of cervical lesions (intravaginal administration of tampons with oils and ointments) is not excluded. According to statistics, every third patient diagnosed with LSM previously underwent therapy for cervical pseudo-erosion.
The risk group includes women of reproductive age with menstrual disorders, as well as patients with cervical pseudo-erosions and gynecological diseases of inflammatory genesis in history.
Important questions of patients
Having met leukoplakia, women usually have a lot of questions because the pathology is “not heard”. Here are some of them:
- Is cervical leukoplakia a cancer or not? Hyperkeratosis is an optional precancer, i.e. pathology often leads to malignant growth. Every third woman with cervical cancer is histologically confirmed by concomitant leukoplakia. The probability of such a rebirth is individual, many factors play a role. But in any case, careful and regular check-ups with a doctor will help to identify the illness (even if it is cervical cancer) at an early stage, when the probability of a radical cure is nearing 100%.
- How dangerous is the pathology during pregnancy? You can not give any specific numbers, all very individual for each woman. It is important how and when leukoplakia is detected, is there a concomitant pathology of the cervix, etc. But if hyperkeratosis is found during pregnancy, treatment is carried out after delivery. And during the period of carrying out a careful control over the process.
- Can leukoplakia return? Hyperkeratosis is a dysfunction of the cells of the cervix uterus. If the pathological area is removed completely, the provoking factors are minimized, then the probability of recurrence of the pathology is minimal, but it still remains. If the most effective treatment is not chosen, or the woman does not follow the recommendations, the risk of re-acquiring leukoplakia is very high.
Prognosis after treatment
With timely detection and proper treatment of leukoplakia does not pose a particular threat. But women who have it identified need to more carefully monitor their health, undergo regular check-ups and pass all recommended tests. It should be remembered that hyperkeratosis is a precancerous condition, but not a cancer.
We recommend reading the article on menstruation during and after cervical erosion. From it, you will learn about the violation of the menstrual cycle during cervical erosion, the treatment of the disease and the restoration of menstruation.
And here more about the effects of cauterization of cervical erosion.
Leukoplakia is a disease in which epithelial cells acquire an unusual quality - keratinization. Such abnormal functioning increases the likelihood of developing cervical cancer. Leukoplakia proceeds in no symptom, therefore it is detected more frequently during routine examinations or by chance. Prompt treatment helps to reveal hyperkeratosis at the stage when the malignancy of the tissues did not occur.
What is uterine leukoplakia?
When leukoplakia occurs, pathological thickening of the uterine epithelium in the vaginal part. The term leukoplakia came to us from Greek and in translation means "white spot". This name was chosen by chance, because cervical leukoplakia looks like a tumor-like formation of a white or light beige shade. The tumor becomes white due to the disturbance of the processes controlling the keratinization of the uterine surface epithelium.
In gynecology, uterine leukoplakia is, to varying degrees, keratinized areas of squamous epithelium, as well as infiltration formation near the vessels. The consequences of such formation can cause the appearance of a malignant tumor in the uterus. The consequences of the disease are similar to those of cervical epithelium dysplasia. Therefore, the diagnosis of cervical dysplasia and leukoplakia is very important.
Cervical leukoplakia: causes of disease
Let's look in more detail at the causes that can lead to the occurrence of cervical leukoplakia.
Cervical leukoplakia may be a symptom indicating a malfunction of the ovaries. But, as a rule, this pathology is caused by ordinary herpes or human papillomavirus (HPV). Also, the disease may develop due to mechanical damage or erosion of the cervical epithelium.
The causes of the disease may be as follows:
- disorders of the immune system (reduced body resistance to various diseases),
- injuries (careless examination, childbirth, medical abortion),
- endocrine disruption,
- infectious diseases of the reproductive system (both existing and previous),
- violations of the proper functioning of the ovaries (dysfunction),
- and so forth
In fact, there can be quite a few causes, and both one of them and a combination of several factors can be a catalyst for the disease. Do not allow the development of the disease, especially since its consequences are dangerous for the female body.
Consequences of cervical leukoplakia
Sprawling tissues in leukoplakia have a benign nature. but there is a big risk converting them to cancer. Cervical leukoplakia can have serious adverse effects on a woman’s health, including infertility.
To date, there is no drug, taking which you could be sure that you are not afraid of leukoplakia. The only sure way to protect yourself from the dangers of this pathology is regularly go for a routine examination to the gynecologist.
A woman who has a disease, may not know that this is a very serious disease. If you do not start timely treatment of cervical leukoplakia, it is possible that uncontrolled and rapid proliferation of cells of the stratified squamous epithelium may further develop, which can lead to a transition to cancer.
Neutralize the possible consequences will allow timely treatment to an experienced gynecologist in the "ON Clinic."
Cervical leukoplakia - treatment in the "ON Clinic"
Treatment of the cervix is performed after a complete examination of the female body, which includes physical examination and biopsy of the CMM tissues. Based on the results obtained, individual treatment is prescribed. Attention should also be paid to the fact that during treatment it is necessary to limit sexual activity.
How to treat leukoplakia of the cervix
Most often this problem signals the presence of a more serious disease in the body, therefore treatment is prescribed after a comprehensive examination. At a later, advanced stage, when drug treatment does not have the expected result, focal leukoplakia of the cervix is treated with cauterization of the affected area.
Self-treatment and the use of methods of traditional medicine in this case is strictly contraindicated, because can cause the opposite effect and provoke uncontrolled cell division.
Treatment of cervical leukoplakia should be carried out under the supervision of a qualified doctorIt will not only prescribe necessary medications and procedures, but also control the course of the disease. In our medical center "ON Clinic" you will find professional and friendly service, examination and treatment from the best doctors at affordable prices.
Treatment of the disease in the medical center "ON Clinic"
During the treatment of pathologies of the female genital organs, it is extremely important not only to achieve complete recovery of the patient, but also to make it sparing methods, without negative consequences for the body. Therefore, among the many methods of treatment of cervical leukoplakia, in the medical center "ON Clinic" was chosen one of the safest and most advanced - method of radio wave surgery and the device "Surgitron".
If you have been given such a diagnosis, treatment with radio waves will not leave scars and burns on the surface of the epithelium. This is a significant advantage, because scars that remain with standard treatment can lead to tears and heavy bleeding during childbirth.
If you are worried about radiation, then your fears are in vain, the Surgitron device operates on the frequency absolutely harmless to human health. During treatment of cervical leukoplakia in the “ON Clinic”, healthy tissues of the body will not be damaged. The action of the device "Surgitron" is directed exclusively to the tumor-affected epithelium.
To make an appointment with a gynecologist at ON Clinic, call the telephone number listed for your region or fill out a simple appointment form on our website.
Complications and prognosis
Leukoplakia in advanced cases (with no treatment) may first be reborn into cervical dysplasia (a precancerous condition), and then into cancer.
The prognosis is favorable with timely and high-quality treatment, especially with simple leukoplakia. But in some cases, a relapse of the disease is possible.
Features of the disease
It is customary to distinguish two types of leukoplakia, the basis of the separation of which is the morphological picture of pathological foci formed from the cornified epithelium. So, distinguish:
- A simple type, implying keratinization of the surface layer of the epithelium, as a result of which it thickens. In this form, the deep-lying layers are not affected — the basal and parabasal.
- Proliferative - differs by the depth of the lesion, as there is a transformation of the epithelium of all layers of the mucosa with the appearance of atypical structures.
It is the proliferative form that refers to pathological conditions that are related to precancer. This is due to the depth of the epithelium and the large volume of altered cells.
What is dangerous leukoplakia cervix?
The danger of the pathological process is the high risk of its malignancy. Despite the fact that at first glance the disease may seem harmless, there may be problems with the conception of a child. Often, women of childbearing age are most susceptible to this ailment.
Among all the pathology with localization on the cervix, it is given about 5%, and in 30% of cases the malignancy of cells of the mucous membrane is recorded.
In addition, it should be noted that the disease can spread to the surrounding tissues, involving in the pathological process a set of external genital organs and other areas.
Malignation of cells is also possible against the background of cicatricial changes and cervical hypertrophy. Clinically suspected illness can be on the basis of itching at night, pain and discomfort during intercourse.
The starting point of cancer transformation can be a decrease in immune protection, hormonal imbalances and trauma to the mucous during childbirth or gynecological examination.
Causes and risk factors
Quite a few predisposing factors can provoke the transformation and compaction of the cervical epithelium. This is facilitated by:
- chronic infections
- low immunity
- hormonal imbalance on the background of endocrine pathology, pregnancy,
- long-term inflammatory processes,
- trauma to the cervical mucosa due to mechanical damage during labor or sexual intercourse.
In addition, it should be emphasized that in violation of the menstrual function also increases the risk of leukoplakia. Do not forget about the frequent abortions, spiral contraceptives and diathermocoagulation of erosion, which violate the integrity of the mucous membranes and predispose to this disease.
Symptomatically suspect this ailment is almost impossible, since the clinical signs are non-specific and may indicate a different pathology of the reproductive organs.
A woman may be disturbed by the discharge of white color, thick consistency, itching, discomfort and pain during intercourse.
Required analyzes and examinations
Diagnosis is carried out using cytological examination of a smear taken from the cervix, or by colposcopy and histology of the biopsy material.
Thanks to colposcopy, it is possible to assess the nature and extent of the pathological process. At the same time, Schiller is sampled by staining with Lugol's mucous solution, which helps in finding atypical cells.
When colposcopy can be detected flakes or warty formations on the surface of the mucous.
How to cure leukoplakia of the cervix?
Treatment is possible by several methods: chemical coagulation, cryodestruction. electrocoagulation, radio wave method and laser.
The cheapest method is electrocoagulation, but it affects not only the changed tissues, but also healthy ones. The radio wave method is used in nonpartine girls, as it is considered the safest.
A popular and expensive is the laser, which accurately affects the affected areas at a sufficient depth. It does not leave scars, so it is applied before or after pregnancy.
To reduce the risk of leukoplakia or prevent its recurrence after treatment, it is necessary to adhere to the following recommendations:
- timely treat inflammatory pathology,
- Avoid sexually transmitted infections using external contraception
- control hormonal balance
- monitor the activity of endocrine diseases,
- prevent frequent abortions
- normalize nutritious diet
- avoid stressful situations and overwork.
In addition, you need to pay attention to the women who underwent diathermocoagulation or cryotherapy. must be registered with a gynecologist and regularly undergo examinations. In this way, cervical leukoplakia can be prevented.
Cervical leukoplakia: find and neutralize
Cervical leukoplakia is a disease in which changes occur in the epithelium lining the cervix with its thickening and keratinization. Visual examination of the cervix can be noted visible to the eye elevated areas whitish or gray, which are further detected in the cervical canal. Leukoplakia is given a special place among other gynecological pathologies, as it relates to the precancerous condition of the genital organs and, in the absence of timely treatment, often turns into cervical cancer.
The outcome of leukoplakia and the methods used to treat it depend largely on timely diagnosis and the stage of development characteristic of the disease at the moment. There are several forms of leukoplakia and each of them has its own characteristic features:
- Simple or flat form of leukoplakia, when whitish plaques not rising above the surface of the organ are found.. This stage of the disease does not have symptoms that can draw attention to the disease, its manifestations are so insignificant that the gynecologist may not notice the changes that have occurred to the mucous membrane.
- Scaly or warty form of leukoplakia, with clearly visible elevated areas of altered dense epithelium. With several foci, plaques accumulate and form a lumpy surface. It is very easy to detect the disease in this stage and at the same time it is necessary to perform a biopsy, since it is this stage of leukoplakia that is able to turn into a malignant form. Sometimes epithelial cells begin to change their shape and size, causing cellular atypia. The reasons for such a rebirth and malfunction are not fully understood, but it is considered to be a precancerous condition.
- Erosive form of leukoplakia with the manifestation of white areas surrounded by erosive tissue or cracks.
Causes of disease
The reasons that can cause such pathological abnormalities - a great many and not all of them are clarified to the end. But some of this number that can trigger leukoplakia development are identified:
- infectious diseases of the genital organs with a complicated course, including those obtained through sexual contact,
- hormonal disruptions, expressed in an imbalance between estrogen and progesterone,
- injury to the cervix caused by surgery or during medical procedures on the genitals,
- advanced gynecological diseases that did not receive timely and proper treatment, most often cervical pseudo-erosion.
In women of reproductive age, leukoplakia occurs in 1 percent of 100, and the overall frequency of this pathological disorder among all cervical diseases reaches 12%.
All the many reasons that can be the impetus for the development of leukoplakia are divided into two directions - endogenous and exogenous. Endogenous hormonal disorders are caused by a lack of progesterone, and exogenous ones depend on infections, injuries and chemical exposure.
The above factors cause processes involving the mechanism of keratinization of cells, resulting in keratinization of the cervical epithelium.
Leukoplakia does not have painful symptoms, since there are no pain receptors on the cervix, and this disease does not differ from other characteristic manifestations. Only occasionally, women notice a more abundant discharge from the genitals. Leukoplakia is diagnosed most often when viewed under a microscope during colposcopy using the necessary samples. During the examination, the pathological focus appears as a white spot tightly fixed on the epithelium of the mucous membrane with an uneven surface, which may be rough, folded, and covered with horny scales. When leukoplakia occurs, such a surface is formed from a keratin layer formed from a dense protein layer.
When you remove the keratin layer, you can detect a smooth pink surface, on which the actual dimensions of the pathological area are determined. Under the microscope, areas affected by leukoplakia are represented by growths of connective tissue in the epithelium layer in the form of papillae with the smallest blood vessels located in them.
Changes in leukoplakia
The impact of adverse factors can disrupt the metabolism in the cells of the cervix exiting into the vagina. This causes rapid keratinization of the surface of the squamous epithelium with thickening and the formation of scaly layer. Leukoplakia can occur not only on a flat layer, but also on altered areas with a single layer of cylindrical epithelium and even affect the deep basal layers. This close contact is justified not only by one common cause, but also by the ability to move from one pathological state to another.
An important question that arises in a doctor when diagnosing leukoplakia is what is the most effective treatment method to use in order to prevent the degeneration of a pathological disorder into a malignant state.
The main therapeutic methods for the occurrence of leukoplakia are the rapid elimination of the focus of the disease and minimal injury to healthy tissues by procedures. For this purpose, techniques are used that allow you to select individual treatment with maximum efficiency for each particular case of leukoplakia, for example:
1. Electro-coagulation (cauterization) - a method widely used for the treatment of leukoplakia. Due to its availability and being an inexpensive method of treatment, electrocoagulation is available to all segments of the population and has almost no contraindications. Equipment necessary for the procedure is in every clinic. However, there are disadvantages of electrocoagulation:
- prolonged healing of the injured area
- pain of the procedure,
- damage to healthy tissue around the focus of the disease,
- the occurrence of bleeding after rejection of the crust remaining at the site of cauterization,
- the possibility of resuming the disease after the area not fully covered by the treatment,
- the occurrence of a rough scar at the site of cauterization, which complicates the stretching of the cervix during subsequent delivery, therefore, electrocoagulation is not recommended for young women who have not given birth.
2. Laser coagulation, quite an effective method of exposure to cold. Painless and not traumatic, the only drawbacks, as in the case of electrocoagulation, are the recurrence of leukoplakia, as well as in some shortening of the cervix after the procedure. Laser exposure is one of the best methods of treatment, as it is painless and antiseptic, does not injure the tissues of the organs and does not cause bleeding. The surface film formed after the procedure on the surface of the body, protects against infection and does not develop inflammation. Healing occurs within a month.
Treatment of leukoplakia in women with a curved cervix is often difficult, in such cases it is necessary to resort to surgical operations. For this, a wedge-shaped or cone-shaped partial amputation of the affected area is applied.
3. Radio wave surgery is a non-contact, gentle method using radio waves. The affected cells are evaporated by means of an electrode inserted into the vagina. Healthy genital tissues are practically not damaged, and areas of necrosis are not formed.
All procedures for the treatment of leukoplakia can be performed in the laboratory on the fifth day of the menstrual cycle. Simultaneously with the use of the main methods affecting leukoplakia, it is important to carry out treatment with therapeutic drugs, especially for genital infections that occur.
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Measures for the prevention of leukoplakia
For the timely detection of pathological changes, all women are strongly advised to undergo an examination by a gynecologist at least once every 6 months.
In reproductive age, it is also necessary to take measures to eliminate violations of the menstrual cycle. Any diseases of infectious and inflammatory genesis require timely and adequate therapy.
For more information about the causes of leukoplakia, methods of diagnosis and treatment of the disease, you will receive by viewing this video review:
Julia Viktorova, obstetrician-gynecologist
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Leukoplakia - classification, symptoms, therapy with medicines and folk remedies, prevention
The defeat of the mucous membrane, which is manifested focal keratinization of the epithelium, called leukoplakia.
The disease, which can be detected by the white or grayish color of the lesions, is found in various places where there is mucous membrane. Leukoplakia can degenerate into a malignant neoplasm.
Timely diagnosis will help prevent negative consequences, because the disease is curable.
The number of people suffering from leukoplakia is constantly increasing throughout the world. The disease is marked by multiple lesions of the mucous membrane, the cause of which is keratin.
White or grayish formations caused by the disease can change in size along with the development of the disease and appear on any mucous membrane, including the mouth, anus, genitals.
If pathology is detected, it is recommended to do a biopsy for cytological examination, since thickening of the stratum corneum of the epithelium is considered a precancerous condition.
The treatment of leukoplakia and the methods used for it differ, they depend on the location of the lesion. About a third of all cases are lesions of the larynx.
The disease often acquires a dangerous course and leads to the appearance of complications and relapses; it has three forms (flat, warty, erosive).
It should be borne in mind that each of them stems from the previous one and is more difficult and difficult for the treatment stage.
Not reliably established, which leads to the appearance of leukoplakia. There are factors that provoke the development of pathology:
- viruses (this is the basis for the progression of the disease),
- mechanical trauma (chemical and thermal effects on the mucous membrane),
- bad habits (pathology develops due to smoking),
- intimate toys (leukoplakia of the vulva is often caused by the use of stimulants made of silicone or latex without lubricants),
- iatrogenic causes (30% of women who underwent diathermocoagulation, are faced with cervical leukoplakia),
- occupational hazards, occupational health,
- STIs, hormonal abnormalities,
- reduced immunity (local and general).
- vitamin A metabolism,
- inflammatory processes.
Symptoms and signs of cervical leukoplakia
The diagnosis of cervical leukoplakia is often made to patients who do not have clinical symptoms during routine check-ups. In cases where clinical symptoms are still present, they are not directly related to leukoplakia, but are provoked by the pathology that is the cause of the cellular transformation of the cervical epithelium. For example, in infectious and inflammatory genesis of cervical leukoplakia, the patient has abundant leucorrhea, discomfort in the vagina, itching, burning and minor contact bleeding.
If leukoplakia of the cervix provokes a hormonal imbalance, complaints of menstrual dysfunction will be leading.
Depending on the characteristics of the primary diagnosis, clinical and colposcopic forms of cervical leukoplakia are distinguished.
Colposcopic cervical leukoplakia is not visualized when viewed, but is clearly visible after treating the surface of the cervix with iodine in the form of iodine-negative zones.
To describe the colposcopic picture, specialists use common terms: “simple leukoplakia”, “basis of leukoplakia” and “leukoplakia field”.
Clinically expressed simple focal leukoplakia of the cervix may look when viewed as a thin, whitish film that does not rise above the mucous membrane surrounding it, or resembles a dense, well-defined plaque covered with white scales (scaly leukoplakia) above the surface of the epithelium.
When colposcopic examination pay attention to the basis of the site of leukoplakia. With simple leukoplakia, its area is located at the level of squamous epithelium and does not deform it significantly. When leukoplakia rises above the level of the epithelium and looks like an orange peel, it is called papillary. Regardless of the thickness of the leukoplakia layer, its base looks like an iodine-negative zone, covered with red dots (they are formed by very small vessels).
Mosaic, or fields, of leukoplakia form polygonal iodineless fields separated by thin capillary filaments. After treatment with 3% acetic acid, this pattern becomes whiter clear.
In smears “on cytology”, the presence of leukoplakia confirms accumulations of multilayer epithelium cells with signs of keratinization (hyperkeratosis). That is, in fact, the laboratory assistant detects “scales” in a cell smear.
Since a more dense layer of keratinizing cells is present in the area of cervical leukoplakia, it is impossible to obtain cells of the underlying epithelial layers during tissue sampling for cytological examination. Therefore, the final, and most reliable, method of diagnosis is histological examination. It allows you to explore the cellular composition of the epithelial layers located under the visible area of leukoplakia.
The material for histological examination is a piece of tissue (biopsy) from the "suspicious" part of the cervix. At the same time, diagnostic curettage of the mucous membrane of the cervical cavity is carried out in order to eliminate the pathological process in the endocervix.
The most important diagnostic histological criterion is the presence or absence of cell atypia in the test material. It depends on further therapeutic tactics. Leukoplakia of the cervix without signs of cell atypia is attributed to background diseases of the cervix, and if there is one, to precancerous.
It is necessary to remind patients that the prefix “before” means a high probability of the development of a malignant process, but not its presence. Leukoplakia (diagnostically confirmed) is considered a benign pathology of the cervix. The term "precancer" indicates the need for immediate adequate therapy to prevent negative consequences.
Additional diagnostic measures are required if leukoplakia is accompanied by severe clinical symptoms.
When signs of an infectious-inflammatory process are examined for the presence of pathogens of genital infections, the composition of the vaginal microflora is studied. It is important to examine the patient for the presence of human papillomavirus.
In young patients with severe menstrual dysfunction, ovarian function is examined, for which the concentration of the main hormones (LH, FSH, progesterone, estradiol, etc.) is determined.
Many women are interested in how pregnancy proceeds with cervical leukoplakia. Leukoplakia is rarely diagnosed in pregnant women. As a rule, in most cases, a woman planning a pregnancy is examined in advance and eliminates all existing ailments before it occurs. If we talk about the future course of pregnancy and the health of the unborn child, leukoplakia does not threaten them.
But on cervical tissue pregnancy with leukoplakia of the cervix affects negatively. As already mentioned, leukoplakia is often associated with hormonal fluctuations and injuries of cervical tissue. Pregnancy provokes hormonal dysfunction, and the birth process is often accompanied by significant mechanical damage to the cervical tissue. As a result, after childbirth, leukoplakia may worsen. Thus, it is not leukoplakia of the cervix that threatens pregnancy, but, on the contrary, pregnancy contributes to its progression.
Cauterization of cervical leukoplakia
The term “cautery” very accurately reflects the essence of the diathermocoagulation method. It is based on the ability of an electric current to destroy biological tissue. The point of contact with the special electrode to the site of leukoplakia is dotted so that all points of application merge together and cover the entire area of the pathological epithelium in the form of a crust (scab). In the end, after cauterization on the neck there is a wound ulcer, covered with a scab. When the wound under the scab completely heals (after 12 days), the scab will be torn away.
Диатермокоагуляция требует предварительной анитибактериальной санации влагалища, так как, если во влагалище имеется даже незначительное воспаление, струп отторгнется преждевременно, и поверхность шейки не сможет эпителизироваться правильно.
Несмотря на «возраст», методика остается в списке наиболее эффективных (93 – 98%), однако имеет ряд нежелательных побочных эффектов:
- The procedure can be painful.
- Long-term healing of the postoperative field. Restoration of the mucous membrane begins with the periphery of the surgical field and can be completed completely only after a month and a half.
- A coarse connective tissue scar is formed on the neck, which can be ruptured in future births.
- Cervical endometriosis (implantation). Endometrial cells can penetrate (implant) into the wall of the cervical canal through the existing wound surface.
- Often the scab disappears too early, when the wound to be healed did not have time to heal, and the blood vessels to “close”. In such situations, bleeding occurs.
Cauterization of leukoplakia of the cervix in the correct version does not always lead to complications, just as the use of modern techniques does not always proceed without them.