Cervical Cancer - Treatment for CIN and Carcinoma in Situ

The procedure requires only one office visit. Extensive and deep sections of damaged tissue can be effectively removed and very high cure rates with just one treatment are possible. When used for dysplasia, it appears to be as effective as more invasive procedures.

Some experts feel that the only downside of LEEP is its simplicity. That is, doctors may be tempted to use it for more serious conditions best treated by conization. It also may impair the ability to detect hidden invasive cancer.

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Patients should be monitored closely if the biopsies on the cervical tissue removed by LEEP suggest that the cells may become invasive.

Conization

Conization is an operative procedure that removes suspicious sections of cells covering an abnormally large area, or those extending into the cervical canal. Conization is preferred over LEEP or LLETZ for lesions that are so extensive that they require a larger biopsy for their complete removal. As in LEEP, patients should be monitored closely if patients are infected with HPV virus or the biopsies on the cervical tissue removed show aggressive-grade cells.

The surgery can be performed under general anesthesia in the operating room with either traditional surgical instruments or with lasers. Use of laser surgery has reported success rates of up 96% with infrequent complications.

A technique called frozen section examination (FSE) freezes the margins of the area being removed. Studies suggest that FSE allows immediate and precise evaluation of areas that may harbor invasive cancer cells, and may be important addition to this procedure in women with high-grade CIN.

With conization, the ability to become pregnant can be preserved in many (but not all) cases. In women who do become pregnant, some studies have indicated that this procedure increases the risk for low-birth weight infants, so careful prenatal care is essential. Patients electing this treatment must be certain to undergo diligent follow-up evaluations.

Cryosurgery

Cryosurgery is not usually feasible for large and extensive abnormal areas. The procedure removes abnormal, but noncancerous, tissue by freezing it. Cryosurgery can be performed in a doctor's office in 15 minutes without medication.

The vagina is opened with a speculum and a probe transmits gas (either nitrous oxide or carbon dioxide), which freezes the surface of the cervix.
The gas is applied for three minutes or until ice crystals form on the targeted tissue.
After waiting three minutes, freezing can be repeated for another three minutes.