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

• 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