Treatment Options

Primarily there are three treatment options for abnormal pap smears where the doctor feels certain cells are tissues need to be removed. Each of these procedures are conducted on an outpatient basis and have high success rates of solving the problem. The treatment options are

• Laser ablation
• LEEP
• Cryosurgery

Laser Ablation of the Cervix

The abnormal skin on the cervix can also be removed using a laser. The laser has the advantage of removing the abnormal skin very precisely. Healing is more rapid than with cryosurgery and there is not a bad discharge afterward. The most common problem is bleeding that can occur even several days afterward. These procedures are done as an outpatient at the hospital. Local anesthesia, similar to the LEEP procedure is used for these procedures. Laser treatment of dysplasia is very effective, however about 10% of women may have a recurrence in the future as with the other methods. Certain types of dysplasia can not be treated with this technique.

LEEP:

How is a LEEP procedure performed?
A speculum is placed in the vagina just like for a PAP smear. The doctor will then place a numbing medicine in the cervix (similar to what the dentists use to numb your teeth before filling.) After the cervix is numb, a special wire loop is used to remove the abnormal area. The wire loop is hooked up to a special electrical machine and a sticky pad is placed on your leg in order to complete the electrical circuit. The procedure itself is usually painless, although some mild cramping may occur afterward. The whole procedure typically takes about 5 minutes to perform.

What happens to the tissue that is removed?
The tissue that is removed is sent to the pathologist to make sure that all of the dysplasia was removed.

What kind of follow-up do I need?
Typically you will be seen back in 2-4 weeks to make sure the cervix has healed. You then should have a follow-up PAP smear every 3 months for 2 years to make sure that there is no recurrence of the dysplasia.

What are the risks?
Most women do not have any problems afterward. The most common problem is abnormal bleeding from the cervix, which can occur even several days after the procedure. Infections are very rare. There is also some theoretical risks of damage to or weakening of the cervix, which can result either in fertility problems in the future, or complicate pregnancy. These risks increase with the amount of tissue that needs to be removed in order to cure the dysplasia.

Will I be cured afterward?
Most women will be "cured" afterward, however a small percentage may have a recurrence or persistence of the dysplasia following the procedure. It is, therefore, important to have regular follow-up visits for PAP smears afterward.

Cryosurgery:

What is cryosurgery?
Cryosurgery is a procedure in which abnormal body tissues (sometimes referred to as lesions) are destroyed by exposure to extremely cold temperatures.

When is it used?
Cryosurgery is used to treat skin lesions such as freckles (for cosmetic reasons), hemorrhoids, warts, and some skin cancers.

It is also used to treat skin changes from genital wart virus and precancerous changes on the surface of a woman's cervix. These precancerous abnormalities are usually found from a Pap smear. (The lesions are also called "dysplasia", CIN, or cervical intraepithelial neoplasia.) Sometimes freezing is not an option if the abnormalities are too large.

How do I prepare for cryosurgery?
Most likely you will not have to do anything to prepare for cryosurgery. It is a simple procedure and it is done in a short time in your health care provider's office.

What happens during the procedure?
Your health care provider will use a probe-like tool to treat the affected areas. A very cold gas, usually nitrous oxide, is pumped through the probe. The gas makes the tip of the probe very cold.

Your provider will touch the tip of the probe to the affected area. When the cervix is treated you probably will not feel the cold sensation. Most women tolerate this procedure well, and leave the office with no discomfort.

How long your provider keeps the probe touching the skin or cervix depends on the size and type of the lesion and what type of gas is being used. For some abnormal tissue, such as genital warts, the procedure works best if the tissue is frozen quickly, allowed to thaw for a few minutes, and then frozen again.

What happen. after the procedure?
For skin lesions such as warts, a small blister will form. The blister will later become a scab or a crust. Your health care provider will tell you how to care for the wound.

There are usually no complications from this procedure. However, occasionally women who are having cervical cryosurgery have hot flushes or faint. If you have cryosurgery of the cervix, you will be asked to stay in the health care providers office for at least 10 minutes after the procedure. Although it is rare, sometimes women faint more than 10 minutes after the procedure, so it is a good idea to have someone take you home. Many women have mild abdominal cramping after cervical cryosurgery. Many women also have a watery discharge from the vagina after the procedure.

Some abnormal tissues may need to be treated more than once. Your health care provider will tell you how often you need to be checked for recurrence or retreatment. You will need a follow-up visit to check healing and to see if any abnormal tissue still remains.

If you have cervical cryosurgery for an abnormal Pap smear, your health care provider will tell when you should have your next Pap smear.

Follow your health care provider's instructions for checking back for problems, questions, and your next visit.

What are the benefits of cryosurgery?
Cryosurgery is very effective and is less expensive than other treatments. It can be done in your health care provider's office and anesthesia is not necessary.

What are the risks associated with cryosurgery?
If you are being treated for a cervical lesion, during or after cryosurgery you may experience: fainting, hot flushes, and/or lower abdominal cramping.

If you are being treated for a skin lesion, you may have: discoloration of the treated area, damaged hair and sweat glands in the treated area, and/or minor scarring.

When should I call the doctor?
Call your doctor's office if:

• The treated area is bleeding or not healing.
• The lesions reappear.
• The treated area develops symptoms of infection.
• You have abdominal cramps after cervical cryosurgery that last longer than 24 hours.
• You have a foul-smelling vaginal discharge after cervical cryosurgery for longer than your doctor told you to expect.