Cervical dysplasia - series

Answer 1

Normal anatomy

The cervix is the tissue that leads from the uterus into the vagina.

Indications

Cervical cancer is one of the most common cancers in women. It is a cancer of the epithelial tissue of the cervix. Pap smear is the screening procedure used to detect cervical cancer. Limited or early cervical cancer (carcinoma in situ, or cervical intraepithelial neoplasia, or dysplasia) requires treatment with ablation therapy, usually in the form of cervical cryotherapy, or a more extensive procedure, called conization, which removes more tissue.

Procedure, part 1

Ablation therapy is frequently performed using a cryoprobe. A hollow metal probe, through which flows extremely cold liquid nitrogen, is inserted into the vagina and applied to the cervix and held in place for 5-10 minutes. This freezes, and thus destroys, the superficial tissues of the cervix which contains the dysplastic tissue.

Procedure, part 2

Conization is a procedure in which a "cone" of tissue is removed. This procedure is performed for more advanced cervical dysplasia, which remains limited to the cervix (cervical intraepithelial neoplasia, high grade). It allows the surgeon to remove more cervical tissue. Conization is performed using either a knife, laser, or electrocautery. LEEP, or the loop electrosurgical excision procedure is the term used for conization electrocautery. In this procedure, an electric current is run through a loop of wire, which is used to perform the conization. It is the most common method used for conization.

Aftercare

If the tissue removed by conization shows residual tumor, or invasive cancer, then further treatment is necessary. This often consists of surgical removal of the uterus and cervix (hysterectomy).

Reviewed By

Review Date: 02/28/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.