Cervical Cancer - Treatment for CIN and Carcinoma in Situ

Highlights	Symptoms	Treatment for Invasive Cervical Cancer
Introduction	Prevention	Resources
Causes	Diagnosis	References
Risk Factors	Treatment for CIN and Carcinoma in Situ
Prognosis	Treatment for Cervical Cancer

Treatment for CIN and Carcinoma in Situ

Treatment of cervical intraepithelial neoplasia (CIN), including carcinoma in situ, depends on the type and extent of abnormal changes. Some of the treatments for CIN are also used for early-stage cancer.

CIN I often goes away on its own. Careful follow up is required to make certain that the Pap smear and colposcopic exam return to normal.
CIN II or CIN III may turn into invasive cancer if the suspicious area is not removed. This is often done using an outpatient technique called loop electrosurgical excision procedure (LEEP). [See next section.]
If extensive areas of CIN II or III cannot be entirely seen with colposcopy or if they spread into the mucous membrane in the cervical canal, a more aggressive procedure called conization (cone biopsy) may be required.

The cold cone biopsy is a surgical procedure that requires general anesthesia. It is performed when there are severe precancerous changes in the cervix.

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Treatment for Adenocarcinoma in Situ. An adenocarcinoma is cancer inside tissue that looks like or functions as a gland. (A gland is a group of cells that secretes a substance to be used by or removed from the body.) Adenocarcinomas tend to be more aggressive than the more common squamous carcinoma in situ, which grow in the lining of tissue (mucous membrane). Some evidence suggests that adenocarcinomas develop in numerous sites rather than a single location. Hysterectomy is generally recommended. In women who wish to retain fertility, cone biopsies may be performed, although this procedure sometimes causes sterility and it does not always remove all adenocarcinomas.

Follow-Up. Patients treated for CIN require monitoring. Testing for human papillomavirus (HPV) may prove to be useful in determining whether repeat colposcopies may or may not be needed. One study strongly suggested that if both HPV and Pap smear tests are normal on two consecutive visits, then most likely treatment was successful. If either the HPV or Pap smear is abnormal, then it may be reasonable to consider another colposcopy.

Loop Electrosurgical Excision Procedure

Loop electrosurgical excision procedure (LEEP), also called large loop excision of the transformation zone (LLETZ), uses a high frequency electrical current to cut away diseased tissue.

A local anesthetic is applied to the cervix, and a wire loop is inserted into the vagina.
A button-sized slice of tissue is removed from the cervix for examination.
A deeper slice is used to evaluate the endocervical canal.