1. TACTICS FOR GP background and precancerous diseases of the cervix and endometrium. Professor of obstetrics and gynecology GP TMA, prof. Najmutdinova D.K.

2. CURRENT 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.

3. 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.

4. 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.

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

6. Terminology 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

7. 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.

8. Uterine cervix

9. Tools for cytology

10. Sampling technique to smear cytology

13. cytological study

14. Кольпоскопия с прицельной биопсией

15. colposcope

16. Transformation zone with inflammation Transformation zone with inflammation

17. Exocervicitis

18. The picture of inflammation on Schiller

19. Exocervicitis

20. Atrophic vaginitis and Exocervicitis

21. Area of transformation. Iodine negative. phenomenon Exocervicitis

22. Atrophic Exocervicitis

23. Polyps of the mucous membrane of 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.

24. Cervical 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.

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

26. Cervical polyp

27. Erosion and pseudo cervical congenital erosion true erosion pseudo

28. true 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).

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

30. pseudoerosion 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.

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

32. Cervical pathology

33. Schiller probe

34. leukoplakia 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.

35. erythroplakia 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.

36. Ectropion (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.

37. Cervical 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.

38. Mild dysplasia

39. severe dysplasia

40. processing with acetic acid

41. Treatment 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).

42. The spread of cancer of the cervix

43. Infiltrative cervical cancer

44. Cervical Cancer

45. Diseases of the body of the uterus. Endometrial hyperplasia. WHO histologic classification distinguishes three main types of hyperplastic processes in the endometrium: endometrial polyps, endometrial hyperplasia and atypical endometrial hyperplasia.

46. 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].

47. Precancerous 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.

48. etiology 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.

49. Diagnostics 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

50. I phase of the menstrual cycle

51. US

52. endometrial hyperplasia

53. endometrial polyp

54. Hysteroscopy

55. hysteroscopy

56. hysteroscopy

58. adenocarcinoma

59. Endometrium in the I and phase II Mc

60. endometrial hyperplasia

61. Clinics: Giperpolimenoreya dysmenorrhoea metrorrhagia Perimenstrual spotting

62. Treatment age of the patient Causes hyperplasia and nature of the disease clinical manifestations Contraindications to a particular method of treatment Portability of medical drugs Concomitant extragenital and gynecological diseases.

63. Hormone therapy COC Progestins (norkolut, Duphaston, 17- DIC, Depo - Provera) Anti gonadotropins (Danazol, Danoval) Anti estrogens (Mefipriston) GnRH agonist (Zoladex, Buserelin, Diferellin)

64. Surgical treatment: endometrial ablation hysterectomy

65. Multiple uterine fibroids, endometrial hyperplasia

66. hysteroresectoscopy

67. hysteroresectoscopy

68. hysteroresectoscopy

69. hysteroresectoscopy

70. hysteroresectoscopy

71. conclusion 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.

72. 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