Secondary Prevention of Cervical Cancer Part 3

Abstract

The management of cervical intraepithelial neoplasia has evolved over the last 20 years. Observation has replaced aggressive therapy in many cases. Evidence based guidelines now guide therapy. This chapter presents an overview of various treatment options, as well as the most recent guidelines of therapy.

Efficacy and Long-term Outcomes of Repeated Large Loop Excision of the Transformation Zone of the Cervix

“…Although a second excisional procedure is often advised in case of disease recurrence, guidelines do not provide clear recommendations for the management of residual or recurrent cervical intraepithelial neoplasia, and little is known about the success rate after a second procedure. 2,9 The success rate of 60.7% that we found is comparable with that found by Bowring et al, 10 the only previous study of the efficacy of repeat large loop excision of the transformation zone procedure. In that study, in which only 19 women underwent such a procedure, 10 of 17 women (59%) had negative cytologic results after a secondary large loop excision of the transformation zone procedure.…”

“…1 High-grade CIN is a precursor of cervical cancer and, therefore, is usually treated with a large loop excision of the transformation zone. 2,3 The aim of this procedure is to eliminate dysplastic cells in the cervical transformation zone.…”

“…After a first large loop excision of the transformation zone procedure, 5-27% of women have recurrent or residual CIN. 2,4 Positive CIN margins, glandular, multiple quadrant disease and high-risk human papillomavirus (HPV) infection are all predictors of recurrent or residual cervical intraepithelial neoplasia after the large loop excision of the transformation zone procedure. [5][6][7][8] Despite the fact that disease recurrence is not uncommon, national and international guidelines offer no clear recommendations as to the preferred mode of treatment and follow-up of residual or recurrent cervical intraepithelial neoplasia.…”

“…In most centers, a second excisional procedure is usually typically performed in case of recurrent high grade CIN. 2,9…”

Hemoperitoneum: a complication of loop electrosurgical excision procedure

“…LEEP is a common procedure that is performed in cases of cervical intraepithelial neoplasia (CIN) using a small wire loop and electric current [6]. Common complications of LEEP are vaginal bleeding, infection, cervical stenosis, and cervical incompetence [17].…”