cervical%20cancer%20-%20prevention%20-and-%20screening
CERVICAL CANCER - PREVENTION & SCREENING
Treatment Guideline Chart
Mortality due to cervical cancer can be reduced by prevention, early detection & treatment.
Vaccination may be started as early as 9 years old.
Vaccination may reduce the incidence of HPV-related disease.
Screening for cervical cancer after vaccination is still recommended because only 70% of the virus types associated w/ invasive cervical cancer consist of HPV 16 & 18 types & women may not be entirely protected if they have been infected w/ other HPV types prior to vaccination.

Cervical%20cancer%20-%20prevention%20-and-%20screening Treatment

Surgical Intervention

  • Choice of therapeutic option depends on patient’s age, parity, child-bearing desire, prior cytology and treatment history and history of follow-up, operator experience, and non-visualization of the transformation zone
  • Both modalities have similar efficacy with respect to eliminating cervical intraepithelial neoplasia (CIN) and decreasing the risk of developing invasive cervical cancer
    • Visual inspection with acetic acid (VIA)-positive women are treated with cryotherapy or, if ineligible, loop electrosurgical excision procedure (LEEP)
  • May have an adverse effect on future pregnancies
  •  Treatment failure rate has been varied from 1-25%, usually occurs within 2 years after treatment
  •  Patients treated for CIN2/3 have an increased risk of developing invasive cervical cancer with 56 per 100,000 for at least 20 years post treatment; hence, follow-up is recommended

Ablative Methods

  • Eg Cryotherapy, laser ablation, electrofulguration, cold coagulation
    • Cryotherapy can be performed by trained and competent healthcare providers at all levels (eg doctors, nurses, midwives)
    • Cryotherapy is not recommended in the following conditions:
      • If lesion extends into the canal or covers >75% of the surface area of the ectocervix or extends beyond the cryotip being used
      • If the squamocolumnar junction or the upper limit of any lesion cannot be fully visualized
      • If the endocervical canal sample is diagnosed as CIN2+ or CIN that cannot be graded
      • After prior treatment for CIN2+
      • In the setting of inadequate biopsies of the cervix to confirm histologic diagnosis
      • If cancer is suspected

Excisional Methods

  • Eg Cold knife conization (CKC), LEEP/large loop excision of the transformation zone (LLETZ), laser conization, electrosurgical needle conization
    • CKC is the preferred procedure
    • Should only be performed by a trained health personnel, eg gynecologist
  • Preferred treatment procedure for ≥25-year-old nonpregnant patients with an estimated immediate risk of CIN3+ of ≥60% based on history and current results without previous biopsy confirmation
Editor's Recommendations