Management of pre-invasive disease of the cervix

Abstract

The management of pre-invasive disease of the cervix is based on local control and prevention of progression to invasive malignancy. Screening continues to be an effective tool for detecting cervical neoplasia in a pre-invasive state due to the long natural history of progression from low-grade dysplasia to invasion. When abnormal cells are detected with a Papanicolaou (Pap) smear, a thorough evaluation should consist of colposcopy, directed biopsy, and cone biopsy, where appropriate. In the absence of invasion, local control may be achieved by excisional or ablative techniques including traditional cold-knife cone, laser cone, loop electrosurgical excision, cryotherapy, laser or electrocoagulation diathermy. The benefit of excisional therapy is the ability for histologic specimen assessment. Ablative therapies are associated with lower complication rates (<2%). Success rates for these modalities are comparable, exceeding 90%. Eradication of human papilloma virus (HPV) from the genitourinary tract [associated with over 90% of condylomas, cervical intraepithelial neoplasia (CIN) and invasive malignancies] is not possible with currently available techniques.