Treatment of Cervical Dysplasia

YOU HAVE HAD A COLPOSCOPY AND THE BIOPSIES SHOW THAT YOU HAVE CERVICAL DYSPLASIA. HOW WILL IT BE TREATED? WHAT ARE THE OPTIONS FOR TREATMENT?

Cervical dysplasia (CIN) can be treated in many ways. The choice of treatment is dependent on the extent and severity of the dysplasia; your age; and whether there are other gynecologic problems present. Other major factors in the treatment options are the experience of the physician treating you and the equipment availability for each treatment option. The following are the most common methods of treating cervical dysplasia: CRYOTHERAPY, LASER ABLATION, LOOP EXCISION, CONE BIOPSY, HYSTERECTOMY. This page will explain the different treatment options available to you.

Treament for Cervical Dysplasia

	CRYOSURGERY Freezing the Abnormal Cells			LEEP Loop Electrosurgical Excision Procedure
	LASER ABLATION Evaporating the Abnormal Cells			CONE BIOPSY Looking Under the Microscope

HYSTERECTOMY
When should it be an Option?

WHAT IS IT? Cryosurgergery is literally freezing the abnormal tissues to dealth. Cryosurgery (also called cryotherapy) uses the extreme cold of liquid nitrogen. Externally, it is used by applying the liquid nitrogen directly to areas of the skin where the abnormal vells are. When cryosurgery is used internally, a holow metal tube with a tip, called a cyroprobe, is used to circulate the nitrogen through. The cryoprobe is used to touch and freeze the tissues to temperatures as low as -295° F.
HOW IS IT DONE? A speculum, similar or the same type used to do your regular pap smears, is inserted into the vagina and positioned so that the cervix is clearly visible and the walls of the vagina are seperated. The machine which circulates the liquid nitrogen through the probe will be turned on and the physician will wait until the end of the probe forms a thin layer of ice crystals on it. The probe is then placed against the cervix and kept in place for a specific period of time to freeze the cervix. You may experience some cramping during the freezing. The probe is then removed and the cervix allowed to thaw for a short period. Once again the probe is placed against the cervix and freezes the tissues.
ADVANTAGES? Comparatively inexpensive. Can be done in the office or out patient clinic. You can leave as soon as the procedure is completed.
DISADVANTAGES? The depth of freezing and destruction of cells cannot be controlled. Healing is accompanied by a watery discharge which may last up to 4 - 8 weeks. Should not be used on large areas of abnormal cells. After healing the squamo-columnar junction (Tranformation Zone) is usually not easily seen and is inside the cervical canal, making follow-up difficult. High rate of recurrence.
POSSIBLE COMPLICATIONS: Fainting, hot flushes, severe abdominal pain which lasts for a short period of time, and a small chance of infection.

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WHAT IS IT? LEEP is a surgical procedure that uses and 'hot' or electrified wire to remove tissue from the cervix. The amount of tissue removed can be a little or a lot. LEEP means Loop ElectroSurgical Excision Procedure.
HOW IS IT DONE? A speculum is placed in the vagina just like your regular PAP smear. The doctor will then inject your cervix with a local anesthectic which will numb the cervix. A special sticky pad will be placed on one of your thighs. This helps to ground you and complete the elctrical current which is used by the wire loop. An acetic acid (vinegar and water) solution is applied to the cervix to show the abnormal areas. When the cervix is numb, a special wire loop that is hot and kept heated will remove the abnormal area of cells. This piece of tissue is then sent to the laboratory where it will be processed for many slides and each slide is examined under a microscope. You may have some mild cramping when the tissue is being removed. A solution is then applied to the cervix to control any bleeding you may have.
ADVANTAGES? Can be done in the office. Requires no general anesthesia. Usually takes about 5 minutes and can be done at the time of Colposcopy. Somewhat less expensive than other methods.
DISADVANTAGES? It may be used when there is really nothing wrong. There is a somewhat higher rate of infection with this procedure. You will have a blackish discharge while healing. May have foul-smelling discharge if infection occurs.
POSSIBLE COMPLICATIONS: Infection, heavy bleeding several days after the procedure, severe abdominal cramps.

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WHAT IS IT? A high energy beam of light evaporates the abnormal tissues very precisely.
HOW IS IT DONE? A blackened speculum is placed in the vagina so the cervic can be seen completely. The cervix is then numbed with a local anesthetic. Acetic acid may be applied, but then the cervix is dried using a large Q-tip. The laser is attached to the coloscope and the physician looks through the lenses. A precise beam of light is the used to evaporate the abnormal tissue. Once then entire abnormal area is ablated, the surgery is finished. The laser is self-cauterizing (stops bleeding) most of the time. Occassionally a solution may have to be applied to the cervix to stop small amout of bleeding. You may experience some mild cramping during the procedure.
ADVANTAGES? Extremely precise removal of the abnormal tissue. Does not require general anesthesia. Can be done in the office or out patient setting of the clinic or hospital. Lower failure and recurrence rates than with cryosurgery or LEEP. Much more rapid healing of the cervix without a discharge. Usually heals so that the Transition Zone can be easily seen for follow-up visits. Becoming the treatment of choice for the treatment of most grades of dysplasia.
DISADVANTAGES? Requires expensive, sophisticated treatment and special expertice by the surgeon.
POSSIBLE COMPLICATIONS: Bleeding can occur several days after surgery.

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WHAT IS IT? A cone biopsy removes a cone or cylinder-shaped piece of tissue from the center of the cervix using a scalpel (called a cold-cone biopsy) or laser beam. It may be done for both treatment and diagnostic reasons. If Carcinoma-in-situ (CIN III) was found on biospy or if abnormal cells extended into the cervical canal beyond the sight of the doctor, she will do a Cone Biopsy. This will give both a definitive diagnosis and also treat CIN III at the same time. Most Cone Biopsies today are done with either the laser or by LEEP. Because CIS may also have some areas which are really invasive cancer, a definitive answer is needed and a Cone Biopsy is mandatory. It can also be used to treat Micro-invasive Cervical Cancer (invasion 3mm or less past the basement membrane).
HOW IS IT DONE? This is usually done in an Out-Patient or Day Surgery Unit. You are put to sleep with general anesthesia. Once you are asleep, your legs are put in stirrups and the lower half of your body and legs are draped with sterile sheets. A sterile, blackened speculum is placed in the vagine if a Laser Cone Biospy is being done. Otherwise, a weighted speculum is used to hold down the back wall of the vagina. An assistant in the OR holds the top and sides back as the doctor needs it done. Two stiches are placed, one on each side of the cervix, to tie off blood vessels that feed the cervix. The decreases the amount of blood loss during the procedure. If LEEP is used, a wire with the proper configuration of the width and depth of the cone planned is selected and is used to 'scoop out' the cone of tissue. For laser or scalpel, a circular incision is made into the cervix at the width needed to include the abnormal areas. The piece of tissue is grasped with a locking forcep to both hold onto it and to manipulate the tissue out of the doctor's way while she continues to cut the wedge from the cervix. The cut is then extended down to the depth that the abnormal cells may be in the cervical canal. A cone-shaped or cylindrical wedge of tissue is removed using the laser or knife. This wedge of tissue is sent to the laboratory where many many slides are made and examined to be sure invasive cancer is not missed if it is present. Examination also makes sure that if there is invasive cancer, the depth below the basement membrane is adeqautely assessed. Once the wege of tissue is removed, any bleeding that occurs is either cauterized or a solution is placed that will stop the bleeding. All intruments are removed from the vagina, the legs are removed from the stirrups, and you are awakened from the genral anesthesia. Most women go home a few hours after the surgery.
ADVANTAGES? It is both a diagnostic and a treament for severe dysplasia (CIN III). High success rate in treating CIN III.
DISADVANTAGES? Cone biopsy is the most invasive treatment for cervical dysplasia, after hysterectomy. Requires a major operating room and general anesthesia. Longer recovery time. May scar the cervix.
POSSIBLE COMPLICATIONS: Because the amount of tissue removed is large, there can be complications for both getting pregnant and staying pregnant. Severe bleeding can occur during the procedure; a few days after the procedure; and about ten days after the procedure (Due to the sutures dissolving and the blood vessels that were tied open and bleed.).

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WHAT IS IT? Permanent removal of the cervix and uterus.
HOW IS IT DONE? A hysterectomy can be done abdominally or vaginally. With micro-invasive disease or even CIS, most physicians will elect and abdominal incision so other tissues can be looked at during the procedure. After the patient you have been put to sleep with general anesthesia, an incision is made throught the abdoman to the inside of the body. The uterus is located and elevated from the pelvis and other surrounding structures. Systematiccally, blood vessels and tissues attached to the uterus are tied and then cut free. The tubes are tied and cut and usually left inplace with the ovaries. An incision is made across the top of the vagina to free the cervix and uterus. The vagina is then sewn closed. The abdomen is closed and you are taken to the recovery room after you awaken from the general anesthesia.
ADVANTAGES? Lowest recurrence rate of all procedures because te cervix has ben removed.
DISADVANTAGES? Major surgery and it may be unneccessary unless there is invasion beyond 3 mm of the basement membrane. Less hysterctomies are being done today for minor reasons. Permanent removal of the uterus and cervix. Long recovery time. Requires hospitalization.
POSSIBLE COMPLICATIONS: It has all the risks of major surgery and general anesthesia. There may be injury to other organ systems such as the ureters which carry urine from the kidneys to the bladder. You may still have a vaginal recurrence of dysplasia.

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