TACTICS FOR GP background TACTICS FOR GP background and precancerous diseases of the and precancerous diseases of the

cervix and endometrium.cervix and endometrium.

Professor of obstetrics and gynecology GP TMA, prof. Najmutdinova D.K.

CURRENT PROBLEMSCURRENT PROBLEMS

Despite ongoing screening studies of women of childbearing age, the identification of high-risk groups for genital tumors, the frequency of diseases of the cervix and uterus does not tend to decrease. This pathology is increasing every year, which dictates the need for better knowledge of general practitioners for the timely diagnosis of precancerous conditions in order to prevent the development of malignant diseases of the cervix and uterus.

GOAL:GOAL:

On the basis of knowledge about the features of the cervix of the uterus and endometrium, to teach students - general practitioners to diagnose the presence of background and precancerous lesions of the cervix and endometrium, interpret the results and develop tactics, know the methods of treatment.

TASK:TASK:

- Teach students to interpret and classify the diagnostic criteria for the presence of background and precancerous lesions of the cervix and endometrium.

-Develop skills to provide timely advice and medical care to patients with background and precancerous diseases of the cervix and endometrium.

- To develop skills in clinical examination, identifying at-risk women in the background and precancerous lesions of the cervix and uterus.

- Development of the knowledge for the rehabilitation of post-hospital treatment of background and precancerous lesions of the cervix and uterus.

Фоновые и предраковые Фоновые и предраковые заболевания шейки маткизаболевания шейки матки

Частота возникновения фоновых и предраковых заболеваний шейки матки в среднем колеблется от 10 до 22,6%.

Terminology and classificationTerminology and classification 1. Background processes. A. Hyperplastic processes associated with hormonal

disorders. - pseudo - polyp Papilloma- Leukoplakia- -erythroplakia B. Post-traumatic processes -True erosion -Cervical ectropion 2. precancerous lesions Dysplasia- Leukoplakia with atypia-cells 3. Cervical Cancer

RISK FACTORS OF precancerous diseases and cervical cancer

I. Exogenous factors: injury; Inflammation caused by: viral infection, Chlamydia, Mycoplasma; Chemical and physical factors, used for contraception for

therapeutic purposes. II. Endogenous factors: age hormonal changes; diseases of the endocrine glands;   reduced immune status. III. Social factors: early sexual activity; Early first pregnancy 18 years; frequent change of sexual partner; a large number of births with low social level, and early sexual

activity.

Uterine cervixUterine cervix

Tools for cytologyTools for cytology

Sampling technique to smear Sampling technique to smear cytologycytology

Sampling technique to smear Sampling technique to smear cytologycytology

cytological studycytological study

Кольпоскопия с прицельной Кольпоскопия с прицельной биопсиейбиопсией

colposcopecolposcope

Transformation zone with Transformation zone with inflammationinflammation

ExocervicitisExocervicitis

The picture of inflammation on The picture of inflammation on SchillerSchiller

ExocervicitisExocervicitis

Atrophic vaginitis and Atrophic vaginitis and ExocervicitisExocervicitis

Area of transformation. Iodine negative. Area of transformation. Iodine negative. phenomenon Exocervicitisphenomenon Exocervicitis

Atrophic ExocervicitisAtrophic Exocervicitis

Polyps of the mucous membrane Polyps of the mucous membrane of the cervical canalof the cervical canal

Take one of the first places among the benign pathological processes of the cervix.

Polyps develop in the external os, in the middle or upper part of the endocervix. They have a foot, at an elongation which polyps arising in the middle and upper part of the mucous membrane of the cervical canal, can reach the level of external os or act beyond. Polyps can have a wide base.

Cervical polyp. diagnosticsCervical polyp. diagnostics

detected by a simple examination of the cervix, colposcopy and tservikoskopii. Character of the building trying to find out if the polyp histology.

treatmenttreatment

limited to the removal of polyps (subsequent histological examination required).

Cervical polypCervical polyp

Erosion and pseudo cervicalErosion and pseudo cervical

congenital erosion true erosion pseudo

true erosiontrue erosion True erosion refers to the

short-lived processes: there is no more than 1-2 weeks and into the next stage of the disease - pseudo, and therefore, the actual erosion is observed rarely doctor (the process is usually detected at the stage of pseudo).

Congenital erosionCongenital erosion

Congenital erosion (ectopy) occur in the early periods of ontogeny due to incomplete differentiation of cylindrical and squamous epithelium.

pseudoerosionpseudoerosion Pseudo formed in the further

development of the pathological process, based on the true erosion. The defect is covered by stratified squamous epithelium columnar epithelium, creeps on the erosive surface of the mucous membrane of the cervical canal.

Schiller probeSchiller probe

After treatment with 5% solution of iodine erosion (pseudo) looks light pink starting conversion zone - yellow, atypical processes - white.

Cervical pathologyCervical pathology

Schiller probeSchiller probe

leukoplakialeukoplakia Leukoplakia - the skin

and the mucous membranes of the lower part of the genitals, characterized by thickening and varying degrees of keratinization of the surface epithelium. Isolated flat and warty (leykokeratoz) forms.

erythroplakiaerythroplakia

dark red rounded education or irregular, slightly elevated above the surface of normal mucosa. Erythroplakia more likely to be single and have a small size.

Ectropion (eversion) endocervixEctropion (eversion) endocervix

Cause ectropion are often birth injuries - tears of the cervix, especially bilateral, resulting from the spontaneous birth.

Ectropion often occurs after improper stitches to the damaged tissue of the cervix.

Cause of cervical laceration and subsequent formation ectropion may be forced extension of the cervical canal with induced abortion, especially in the later stages of pregnancy.

Cervical DysplasiaCervical Dysplasia The basis of the dysplasia are the proliferation and the

restructuring of the basal and parabasal squamous stratified epithelium. Dysplasia develops in the immature metaplasia of the stratified squamous epithelium.

Depending on the intensity of cell proliferation, the presence of atypia and localization process in different (upper, lower) layers of the epithelium differentiate mild, moderate and severe dysplasia.

In severe dysplasia is at risk of intraepithelial carcinoma.

Mild dysplasiaMild dysplasia

severe dysplasiasevere dysplasia

processing with acetic acidprocessing with acetic acid

Treatment of cervical diseaseTreatment of cervical disease

Anti-inflammatory therapy local treatment physiotherapy DEC cryotherapy Surgical treatment (excision or cone biopsy

stateful endocervix, with pronounced atypia perform an amputation of the cervix, vaporization laser beam).

The spread of cancer of the cervixThe spread of cancer of the cervix

Infiltrative cervical cancerInfiltrative cervical cancer

Cervical CancerCervical Cancer

Diseases of the body of the uterus. Diseases of the body of the uterus. Endometrial hyperplasia.Endometrial hyperplasia.

WHO histologic classification distinguishes three main types of hyperplastic processes in the endometrium:

endometrial polyps,endometrial hyperplasia andatypical endometrial hyperplasia.

classification:classification:

glandular endometrial hyperplasia;   glandular-cystic hyperplasia;   atypical endometrial hyperplasia

(synonym - adenomatosis, adenomatous hyperplasia);

  endometrial polyps [Zheleznov BI, 1988, Saveliev, GM, V. Serov, 1994, and others].

Precancerous endometrialPrecancerous endometrial

To include precancerous endometrial atypical hyperplasia (adenomatous), endometrial (diffuse and focal forms).

Particular caution is adenomatosis oncology intensive atypism proliferation and glandular epithelium, and atypical hyperplasia in the basal layer of the endometrium.

etiologyetiology

Disorders of ovulation (anovulation, monophasic cycles), which are characterized by absolute or relative hyperestrogenia.

  Endometrial hyperplasia observed in infertility due to impaired ovulation. Hyperplastic processes in the endometrium occur often with polycystic ovaries, namely the secondary form of the disease that occurs due to dysfunction of the hypothalamic structures and accompanied by obesity.

Less common causes of endometrial hyperplasia are gipertekoz and feminizing ovarian tumor.

DiagnosticsDiagnostics ultrasound Diagnostic curettage of the mucous membrane

of the body of the uterus and subsequent histological examination of the received material.

Cytologic method of studying the contents of the uterus, obtained by aspiration.

hysteroscopy hysterography The level of activity of hyperplastic processes

can be determined by radiometric survey of the uterus

I phase of the menstrual cycleI phase of the menstrual cycle

USUS

endometrial hyperplasiaendometrial hyperplasia

endometrial polypendometrial polyp

HysteroscopyHysteroscopy

hysteroscopyhysteroscopy

hysteroscopyhysteroscopy

adenocarcinomaadenocarcinoma

Endometrium in the I and phase II Endometrium in the I and phase II McMc

endometrial hyperplasiaendometrial hyperplasia

Clinics:Clinics:

GiperpolimenoreyadysmenorrhoeametrorrhagiaPerimenstrual spotting

TreatmentTreatmentage of the patientCauses hyperplasia and nature of the

diseaseclinical manifestationsContraindications to a particular method

of treatmentPortability of medical drugsConcomitant extragenital and

gynecological diseases.

Hormone therapyHormone therapy

COCProgestins (norkolut, Duphaston, 17-

DIC, Depo - Provera)Anti gonadotropins (Danazol,

Danoval)Anti estrogens (Mefipriston)GnRH agonist (Zoladex, Buserelin,

Diferellin)

Surgical treatment:Surgical treatment:

endometrial ablationhysterectomy

Multiple uterine fibroids, endometrial Multiple uterine fibroids, endometrial hyperplasiahyperplasia

hysteroresectoscopyhysteroresectoscopy

hysteroresectoscopyhysteroresectoscopy

hysteroresectoscopyhysteroresectoscopy

hysteroresectoscopyhysteroresectoscopy

hysteroresectoscopyhysteroresectoscopy

conclusionconclusion wide distribution of malignant diseases of the

cervix and uterus necessitate widespread introduction skrinningovyh methods, one of which is a cytological method.

Early diagnosis of background diseases reduces the frequency of precancer and cancer of the cervix and uterus, which in turn is aimed at reducing the frequency of female morbidity and mortality.

Self-study for students:Self-study for students:

Theoretical training:

Identifying women at risk for cancer of the cervix and uterus.

Algorithm for the examination of patients with pathology of the cervix and uterus.

The principles of treatment of diseases of the cervix and uterus.

Practical training:

  Practical skills with the performance analysis of the fence on cytology, inspection of the cervix in the mirror, bimanual examination on models at the Department