Oncology and Fibroids
A female 35 years para 3, liver 3 (P3, L3) with CIN III on colposcopic biopsy what would you do? (AIPG 2009)
1. It’s not advisable to perform hysterectomies outright even if the patient here appears to have completed family. CIN was treated originally with radical hysterectomy but it was found to be too major a procedure for a preinvasive lesion.
2. Hystrectomy was the next choice and later it was found that a conisation is just as good. Colposcopy introduced a way to delineate theexact limits of the lesion and hence helped in the exact treatment of the disease without major surgical intervention.
3. Cryotherapy is limited in its ultility for CIN III and large lesions on the cervix and is hence not used here.
a. Information about conisation
b. Conization can be performed
c. Scalpel (cold-knife conization),
4. Electrosurgical loop (loop electrosurgical excision procedure i.e. LEEP or large loop excision of the transformation zone i.e. LLETZ). Cold-knife conization provides the cleanest specimen margins for but associated with more bleeding than laser or LEEP and requires general anesthesia Laser procedures , here the dots produced by the laser energy can be used to accurately outline the exocervical margins.
5. However, overall, the benefit of using laser for conization may not justify the high cost of the procedure. LEEP procedures have several advantages, including rapidity, preservation of the margins for histologic evaluation, and virtual bloodlessness and do not require GA.