Cryotherapy and electrocoagulation are local destructive methods used to treat cervical dysplasia and CIN. Cryotherapy, the best tolerated technique, destroys cells by freezing and involves applying Lugol's iodine. Electrocoagulation uses high heat to treat lesions up to 10mm. Laser ablation can treat CIN extending to the vaginal vaults but is expensive. Excisional biopsy via punch, LLETZ, LEEP or NETZ techniques is used for histopathology and can be therapeutic, reducing recurrence rates below 1%. Conization is used for endocervical dysplasia or when the transformation zone is not fully visualized. Trachelectomy surgically removes the cervix while preserving
5. Local destructive methods
a)Cryosurgery (BEST TOLERATED TECHNIQUE)
Intro by : Townsend
Destruction of cells by crystallization of intracellular fluid
Freeze-thaw-freeze technique – 4-5mm
OPD
Application of Lugol’s iodine
Repeat cryo every 3 months
Disadvantages: indrawing, discharge
b) Electrocoagulation
over 700°C – 8-10mm
6. c) Laser ablation (Expensive)
Boils, Steams & Explodes – upto 5mm
Useful when the CIN extends up to the vaginal vaults
Advantages : no indrawal
Recurrence : 2-8%
EXCISIONAL BIOPSY (histopathology & therapeutic)
Immediate postmenopausal phase
Under colposcopic guidance & local anesthesia
Reduces incomplete excision
0.1-0.2% cases
8. Conization
Endocervical dysplasia
TZ not completely visualized
Discrepancy
Microinvasion
Hysterectomy
old & parous
Fibroid, DUB or prolapse
microinvasion
recurrence after conservative therpy
Insitu adenocarcinoma of cervix
Entire outer margin and endocervial lining of
internal os
10. Prophylaxis : HPV related, given to adolescents
VACCINS – immunity 10 years & reimmunization required
Gardasil: Quadrivalent vaccine, given at 0, 2 and 6 months IM
Cervarix: Bivalent vaccine, 0.5ml at 0, 1 and 6 months
Other prophylaxis – Barrier contraceptive
