Lecture of benign damage to the cervix

2021-03-22 12:00 AM

The cervix can change shape depending on whether a woman has had children or not. In unborn women, the cervix is usually round. In the born ones, the opening of the cervix can be spread horizontally.

Outline

Cervical lesions are very common, mainly benign lesions, formerly commonly referred to as cervical ulcers. Today, by using colposcopes, we can distinguish many types of lesions. While these benign lesions are not cancer, they require treatment because:

Progress can be prolonged, causing anxiety affecting the patient's life.

May cause upper genital tract infections and infertility.

Cancer can progress if left untreated.

The normal cervix 

Shape

The cervix can change shape depending on whether or not a woman has a baby. In people who have not yet delivered, the cervix is ​​usually round, in humans, the hole of the cervix can be raised horizontally.

Organize and transform

The outside of the cervix is ​​covered by the layer of the stratified epithelium (the spiny cells). The transition zone in the extra cervical hole is the boundary between the slice epithelium and the cylindrical epithelium.

During pregnancy, the cervix is ​​partially open to the glandular epithelium of the uterine tube.

After menopause, the layer of epithelial cells has a paler appearance, the organizational boundaries are not clear because of its sinking into the cervical canal.

Cervical physiology

The glandular epithelium in the cervix consists of two types of cells:

Mucoid-secreting cells: The nucleus of a cell is pushed down to the bottom, mucus contained inside the cell.

Velvet cells: Thanks to the action of villi, the secreted mucus is pushed into the vagina.

These two types of cells are mainly influenced by Estrogens, they produce mucus with a pH of 7-7.5, the properties of the mucus thus change with the menstrual cycle:

During the first half of the period (before ovulation) the mucus in the inner cervix, the mucus, is most abundant before the day of ovulation.

During the second half of your period (post-ovulation), the cervical fluid gradually thickens due to the influence of progesterone.

Regeneration

The gland may also be a physiological condition in the cervix, at which point the glandular epithelium partially covers the cervix, creating an image that is not smooth, red, and has a little cover of mucus. Routes are common in women of childbearing age who are taking oral contraceptives containing Estrogen. The route is usually due to changes in vaginal pH or due to estrogen hyperstimulation. Therefore, if these changes can be adjusted, the route will gradually disappear.

When there is a regeneration of the slice epithelium in the region of the ingrown gland, the cylindrical epithelium or the ablative (metamorphic) epithelium layer becomes the slice epithelium. Regardless of the circumstances, the regeneration process is not complete, and there will likely exist clusters of roads or Naboth cysts.

Benign lesions of the cervix

Nonspecific lesions

Inflammation of the outer face of the cervix:

The cause of inflammation is usually caused by bacteria present in the vagina, gonorrhea, Chlamydia ... The cervix is ​​red, the gas is cloudy, mucus, sometimes pus, or foul. , the touch bleeds easily.

Inflammation of the hole in the cervix:

Most likely you'll see cloudy mucus in the tube or dirty and cloudy gas if the speculum is pressed against the cervix.

Highway cervical gland inflammation:

The cervical gland is infected with red, easy to bleed. Apply Lugol does not catch the color of iode in the route area. Vaginal visits can be painful for the patient.

Treatment of nonspecific lesions is usually local treatment depending on the cause (antibiotics, antifungal, or anti-protozoans). When there is stomatitis in the cervix, systemic antibiotic therapy is required.

Treatment of cervical gland: if the inflammation is not accompanied, the cervical gland inflammation can resolve on its own. In the case of a wide cervical gland with inflammation and recurrence, anti-inflammatory treatment with specific drugs can be used, then burn the gland (with heat, chemicals, electrocautery, or cold) to destroy the cylindrical epithelium and help regeneration of the slice epithelium. Usually burn the gland after 3-5 days after clean menstruation. Do not burn while pregnancy, during acute vaginitis, or with suspected lesions.

The cervical treatment can leave benign sequelae or recurrent routes. The benign sequelae are:

Naboth cyst is because the sliced ​​epithelium covering the mouth of the gland has not been destroyed, the mucus that continues to secrete more and more will swell into the cyst wall, when the follicle bursts, it leaves the follicle hole.

Orifice: between the slice epithelium, the mouths still keep mucus-secreting.

Inversion: convergence of some remaining glands in the newly restored slice epithelium.

For benign sequelae, if less, only anti-inflammatory is needed for the slice epithelium to repair itself.   

Specific inflammatory lesions

Cervical tuberculosis:  rarely alone is cervical tuberculosis, it can happen in the presence of adnexal TB and endometrial tuberculosis. Lesions in the form of ulcers, warts are easy to bleed, so it is easy to mistake with cervical cancer. A biopsy will reveal specific tuberculosis cysts and inflammatory cells.

Chancre syphilis: Syphilis may be present in the cervix, lesions are hard ulcers, clear margins, easy to bleed, often with lymph nodes.

The test shows syphilis spirochetes (T. pallidum).

Other injuries

Cervical polyps:

Pore ​​polyps in the cervix are also called mucosal polyps, usual polyps with small stalks, soft structures. Bleeding after intercourse.

The perforated polyp usually located in the cervical canal is a deep pink, fibrous polyp that can deform the cervix.

Small-stem polyps can be twisted with clamps. 

Endometriosis of the cervix:

Because endometrial cells are misplaced. Endometriosis of the cervix can be clearly seen after menopause as green or black nodules scattered on the cervix. These are larger and more pronounced during menstruation.

Injury detection

Clinical

The cervix is ​​visible and palpable on examination.

Vaginal examination: feel the cervix, evaluate the size of the cervix, the density of the cervix, and detect pain during cervical lay.

Speculum examination: observed lesions such as inflammation, polyps of the cervix, inflammation of the hole in the cervix. In addition, we can also take samples for Gram staining, transplant, make vaginal smear, and thin cervix to screen for cancer.

Subclinical

Direct biopsy.

Colposcopy: helps to evaluate the benign structure of the surface of the cervix, transition zone, dystrophy, polyps, cervical route. After applying acetic acid, atypical lesions are detected: dysplasia (inversions), pre-cancerous lesions, or cancer, helping to biopsy the correct site.

Apicoectomy: also considered a large biopsy to obtain the outer neck and transition area, thus acquiring lesions in areas where the colposcopy is not visible.

Prevention

Benign lesions in the cervix greatly affect a woman's reproductive health, so disease prevention has an important role:

Women must be explained to women to understand that benign cervical lesions are easy to examine, easy to detect, and simple and effective treatment to make them conscious of regular gynecological exams about once a year for detection. early lesions, plan for treatment, follow up.

Benign lesions are often caused by infection and childbirth, so it is important to explain the importance of menstrual hygiene, personal hygiene, and hygiene.

Build a sense of sterility and disinfection among health workers when performing procedures.

When there is a lesion in the cervix, though benign, it should be treated completely, so that abnormal regeneration cannot occur.