Treatment of Abnormal Pap Smears
Several treatments are available for women with cervical abnormalities, often referred to as dysplasia, CIN (cervical intraepithelial neoplasia) or CIS (carcinoma in situ). Treatments including cryosurgery (freezing), laser (high-energy light), and excision (LEEP).
Excisional therapies include loop electrosurgical excision procedures (LEEP), also called large loop excision of the transformation zone (LLETZ), laser conization, and cervical conization procedures. Most clinicians prefer excisional therapy.
- Loop electrosurgical excision procedure (LEEP) — Excision can be done with a device that uses electrical current; this is called a LEEP procedure (loop electrosurgical excision procedure) or LLETZ (large loop excision of the transformation zone). A thin, wire loop is inserted through the vagina, where it uses an electric current to remove a cone-shaped portion of the cervix. This can also be performed with a laser knife, which uses high intensity energy from a light beam. Excision can be done in the office or operating room after the cervix is injected with local anesthesia to prevent pain. The woman may feel a dull ache or cramp during the procedure. A brown paste is applied after the treatment to prevent bleeding; this often causes a dark vaginal discharge (similar to coffee grounds). Most women are able to return to work or school after the procedure.
- Cervical cone biopsy (conization) — Excision can also be done with a scalpel instead of a loop; this is called a cervical conization or cone biopsy. Conization is usually done in an operating room after the patient has received general anesthesia (medicine given to induce sleep) or regional anesthesia (eg, epidural or spinal).
Following LEEP or conization, most women have mild to moderate vaginal bleeding and discharge for one to two weeks. The bleeding should not be heavy (eg, should not soak a pad in less than one hour).
As with any surgical procedure, complications can occur during excision. These include:
- Bleeding during the procedure — Bleeding is rarely serious, and can usually be managed with suturing or by applying cauterizing material (a liquid or treatment that helps the blood to clot) to the cervix.
- Bleeding after the procedure — Although light bleeding or spotting is normal, some women have heavy bleeding several days or weeks after the procedure. This can usually be treated in the office, but occasionally a procedure in an operating room is necessary.
- Infection — Infections occur rarely after cone biopsy, either on the cervix itself or elsewhere in the reproductive tract. Most infections can be treated with oral antibiotic therapy.
- Perforation of the uterus — This is an uncommon complication, and is more likely to occur in women who are postmenopausal or whose uterus is tipped forward. If the uterus is perforated, it usually heals without any need for treatment. Infrequently, laparoscopy or laparotomy is required to see and repair injuries to internal organs.
Ablative treatment destroy, rather then cut away, abnormal cervical tissue.
- Cryosurgery — Cryosurgery involves applying liquid nitrogen or carbon dioxide to the cervix. This causes the cervical tissue to freeze, which destroys the abnormal cells. Cryosurgery can be done in the office, similar to a pelvic examination, without any anesthesia. It may cause mild cramping or discomfort. Cryosurgery is not recommended in certain situations, such as when the extent and type of cervical abnormality are not clear based upon colposcopy and/or biopsy. Excisional therapy is preferred in these cases. Most women have watery vaginal discharge for one week after cryosurgery.
- Laser ablation — Laser ablation uses high intensity energy from a light beam to destroy abnormal areas of the cervix. The laser is directed to the abnormal area of the cervix through the vagina. This is usually performed in an operating room after the woman has received general anesthesia (medicine given to induce sleep) or regional anesthesia (eg, epidural or spinal). Laser treatment requires special training and equipment. A disadvantage of laser ablation is that it destroys the abnormal tissue, similar to cryosurgery. Laser ablation is not recommended in certain situations, such as when the extent and type of cervical abnormality are not clear based upon colposcopy and/or biopsy. Most women have vaginal discharge for one to two weeks after laser treatment.