A range of cervical abnormalities can be detected by screening. In some cases, the changes to the cervix are minimal or of uncertain significance. These cases may be managed with repeated screening, HPV testing, or colposcopy. In other cases, the changes are suggestive of potentially important precancerous or cancerous lesions. These cases are often further evaluated by colposcopy and, depending on the findings, may warrant treatment.
Many cervical abnormalities involve the squamous cells of the cervix and are referred to as cervical intraepithelial neoplasia (CIN). Depending on the extent of the changes, CIN is classified on a scale of 1 to 3. CIN 1 is considered “low-grade;” the condition requires follow-up but may not require treatment. CIN 2 and CIN 3, in contrast, are considered “high-grade” changes that typically require treatment. The goal of treatment is to prevent the development of invasive cervical cancer.
Cervical abnormalities may also involve the glandular cells of the cervix. Adenocarcinoma in situ (AIS) is a cervical cancer precursor that arises in glandular cells and generally requires treatment.
A variety of factors ultimately influence a patient’s decision to receive treatment. The purpose of receiving treatment may be to improve symptoms through local control of the condition, increase a patient’s chance of cure, or prolong a patient’s survival. In the case of precancerous changes to the cervix, the primary goal of treatment is to prevent invasive cervical cancer. The potential benefits of receiving treatment must be carefully balanced with the potential risks of receiving treatment.
The following is a general overview of the treatment of precancerous changes to the cervix. Circumstances unique to your situation and prognostic factors of your condition may ultimately influence how these general treatment principles are applied to your situation. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this condition. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your condition, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Conservative Surgery for Precancerous Cervical Disease
Surgical procedures that preserve the uterus and may permit future childbearing include cryosurgery (freezing), laser surgery, loop electrosurgical excision procedure (LEEP) or cold-knife conization. Cryosurgery, laser surgery, and LEEP can be performed in the doctor’s office or short procedure facility, often with local anesthesia. A cold-knife conization is a more extensive operation that involves removal of part of the cervix under general anesthesia. Not all patients can be adequately treated with cryosurgery, laser surgery or LEEP. This decision depends on the extent and appearance of the disease upon examination.
Women treated with conservative surgery require lifelong visits to their doctor to ensure that recurrence of cervical disease can be detected in the precancerous state or early while the cancer is still curable.
If the precancerous disease is more extensive or involves adenocarcinoma in situ (AIS), and the woman has completed childbearing, a total hysterectomy may be recommended. During a total hysterectomy, the entire uterus (including the cervix) is removed. In addition, doctors can perform a bilateral salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes. The decision to perform a bilateral salpingo-oophorectomy depends on the woman’s age and whether the ovaries are still functioning.
A total hysterectomy and/or a bilateral salpingo-oophorectomy are the most extensive surgical options used for precancerous disease and require general anesthesia and a hospital stay. Women undergoing a hysterectomy may experience lower abdominal pain and difficulty with urination after the operation. After a hysterectomy, women no longer menstruate and can no longer have children.
Wright Jr TC, Massad S, Dunton CJ et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. American Journal of Obstetrics and Gynecology