Cervical Cancer treatment

The disease progression of Human papilloma virus (HPV)

Over a number of years, cancer-causing types of HPV can slowly bring on changes that lead to cervical cancer because the cells in the cervix become abnormal. Cervical dysplasia is what we call these abnormal changes to cells in the cervix. Cervical dysplasia lesions can regress, or go on to persist or progress to become a high-grade lesion or cervical cancer [1].

There are no symptoms of cervical dysplasia, although genitals warts are a sign someone has been exposed to certain strains of HPV. Cervical cancer also displays no physical symptoms, especially in the early stages. In the latter stages of the disease, there may be pain in the abdomen or lower back, pain or bleeding while having intercourse, unusual vaginal discharge, or bleeding between menstrual periods [2]. The lack of symptoms emphasize the need for regular cervical cancer screening to help diagnose or monitor HPV, cervical dysplasia or cancer.

Pap smear test results will indicate a squamous intraepithelial lesion, or SIL, which means cell tissue damage or dysplasia. There are different categories of SIL, including [3][4]:

  • atypical squamous cells of undetermined significance (ASCUS) —the cells are abnormal, but no definite diagnosis can be made
  • low-grade SIL, or LSIL—this result means an acute infection, but most of the time it regresses on its own—your clinician may recommend a follow-up, however
  • high-grade SIL, or HSIL—this means a more advanced lesion is present possibility of cancer
  • atypical glandular cells (AGC) —these abnormal cells are the precursors of about 20 per cent of cervical cancers; they are very difficult to detect

Following a Pap test, if follow-up treatment is required a clinician will most likely biopsy the location in the cervix, using a colposcopy or sometimes an endocervical curettage, to confirm the status of the cervical tissue [5].  The biopsy results are described as follows [6]:

Biopsy Results

Cervical intraepithelial neoplasia (CIN-I)— this result means mild or low-grade dysplasia; if it persists for at least two to three visits, it can be assumed that it could lead to cancer. For this reason, CIN-I is usually treated.
CIN- 2 or CIN-3—this means severe or high-grade dysplasia. All or almost all of the cells in the sample may be pre-cancerous and calls for a definite therapy in most cases.
Carcinoma in situ (CIS)—CIS indicates that a small area of cancer has been found; further tests will be done to find out if the cancer is confined to a small area or if it has spread (called invasive carcinoma)—in situ means it has not spread below the skin.

Treatment options for cervical dysplasia

Treatment for cervical dysplasia is dependent on the location, its size and whether the lesion is low grade or high grade. Mild dysplasia may not be treated immediately, but monitored to see if it can resolve without treatment. For CIN II-III, treatment can include [7][8]:

  • cryosurgery —this freezes the lesion, the procedure can be done in the doctor’s office; there can be some discomfort or pain; spotting and watery discharge are common after treatment
  • laser therapy—this destroys the lesion with an intense beam of light; this procedure is often done in a day-surgery clinic; it can be uncomfortable and can cause spotting and discharge afterward.
  • loop electrosurgical excision procedure (LEEP) — the lesion is removed surgically by an electrical current that passes through a very fine wire loop and cauterizes the cervix at the same time so that it does not bleed afterward.
  • cone biopsy—this removes a con-shaped piece of tissue from the opening of the cervix, it can also remove a lesion or a very small cancer; it is typically performed in a hospital with a laser or a scalpel after patients are given anesthetic; bleeding and pain or discomfort are common after this treatment.

References

[1] Maclean, D., A. Ollner, and SR Hosein. “HPV, Cervical Dysplasia and Cancer.” HPV, Cervical Dysplasia and Cancer. CATIE, 2013. Web. 22 Sept. 2015.
[2] ibid.
[3] ibid.
[4] Herndon, Jaime, and Jennifer Wilder, MD. “Cervical Dysplasia.” Diagnosing Cervical Dysplasia. Healthline, 24 July 2012. Web. 22 Sept. 2015.
[5] Maclean, D., A. Ollner, and SR Hosein. “HPV, Cervical Dysplasia and Cancer.” HPV, Cervical Dysplasia and Cancer. CATIE, 2013. Web. 22 Sept. 2015.
[6] ibid.
[7] ibid.
[8] Herndon, Jaime, and Jennifer Wilder, MD. “Cervical Dysplasia.” Diagnosing Cervical Dysplasia. Healthline, 24 July 2012. Web. 22 Sept. 2015.

 

Treatment for early cervical cancer

Treatment for advanced cervical cancer