American Medical Association Family Medical Guide - American Medical Association [591]
Treatment
LGSIL (mild) dysplasia often returns to normal on its own and usually can be managed with frequent follow-up care, including Pap smears every 4 to 6 months. More severe dysplasia (HGSIL), which is more likely to develop into cervical cancer, is usually treated surgically. The procedure doctors use most often to treat dysplasia is called by either of two names—LEEP (loop electrosurgical excision procedure) or LLETZ (large-loop excision of the transformation zone). Both names refer to the removal of the outer layer of cervical cells, which are at highest risk of becoming cancerous. The removed tissue is sent to a laboratory for examination to make sure that all the abnormal cells were removed. Your doctor will advise you not to have intercourse or use tampons for 4 weeks after the procedure. The doctor will recommend a Pap smear every 4 months for the first year after a colposcopy, which has a 95 percent success rate in removing abnormal tissue.
If the area of abnormal tissue extends up into the cervical canal, a procedure called a cone biopsy (in which the doctor removes a cone-shaped piece of tissue) may be required. The tissue is sent to a laboratory to look for cancer cells. This procedure is usually performed in an operating room using a local anesthetic during an outpatient visit. Afterward, you may need to rest for a day or so. In very rare cases, a cone biopsy can increase the risk of premature delivery in a future pregnancy, so if you have had a cone biopsy and become pregnant, tell your doctor that you have had the procedure.
LEEP/LLETZ
The procedure doctors use most often to treat cervical dysplasia is called by one of two names, LEEP (loop electrosurgical excision procedure) or LLETZ (large-loop excision of the transformation zone). During the procedure, the doctor inserts a rubber-coated, nonconductive speculum to hold open the vagina and then uses a thin-wire, loop electrode to slice off the abnormal tissue with a low-level electric current. LEEP/LLETZ takes less than 30 minutes and requires only a local anesthetic.
Cancer of the Cervix
Cervical cancer occurs when abnormal cells on the outer layer of the cervix (the lower opening of the uterus) spread deep into the tissues of the cervix, or to nearby lymph glands, and up into the uterus. Most cases of cervical cancer develop in women who have either undiagnosed or untreated cervical dysplasia (see previous page) or its more advanced form, called carcinoma in situ. Cervical dysplasia refers to the presence of abnormal, precancerous cells in the lining of the cervix.
Deaths from cervical cancer have declined sharply, thanks to the prevalence of Pap smears (see page 140). Cancer of the cervix is nearly 100 percent preventable if cervical dysplasia is detected by a Pap smear in its early stages. The majority of women who are diagnosed with cervical cancer have not had a Pap smear within the past 3 years. The more advanced the cancer, the more difficult it is to treat—which makes the Pap smear a potential lifesaver.
Some factors increase the chances that cells in the lining of the cervix will become abnormal or cancerous. The most important risk factor is exposure to certain strains of the human papillomavirus (HPV), which can cause the common sexually transmitted disease genital warts (see page 480). Other risk factors include having sex at a young age, having unprotected sex at any age, having multiple sex partners, or having a sex partner who has had multiple partners or who has had a partner with HPV or cervical cancer. Smoking is also a risk factor for cervical cancer. Women whose mothers were given the drug diethylstilbestrol (DES) during pregnancy to prevent