Assessment of failures of cryosurgical treatment in cervical intraepithelial neoplasia

Management of precursor lesions of cervical carcinoma: history, host defense, and a survey of modalities

Before the initiation of screening and treatment for cervical cancer precursors, approximately 3% to 4% of women were destined to eventually develop cervical cancer. During the last 50 years the rate of cervical cancer incidence and mortality has decreased by more than 75% primarily because of the widespread availability of cervical cytologic screening and of treatment for documented cervical precancer. Successful screening of the entire population and appropriate treatment of lesions could theoretically reduce this risk to one tenth of the risk of an unscreened population [7,28]. The relatively recent understanding of the etiology of cervical cancer precursor lesions and of the immune response to them has given new direction to management options that incorporate healthy habits and dietary measures as part of traditional ablative or excisional treatment options. As we look to the future we can expect that new markers that more specifically identify individuals at-risk for cervical precancer and cancer will be developed and take precedence in cervical screening. At the same time, treating the cause of these lesions, rather than the result, should provide less traumatic and more successful therapies. To this end, harnessing the immune system through immune response modifiers and HPV vaccines seems to be on the horizon, as do new chemopreventative approaches. Of all human cancers, only cervical cancer, once the second most common cancer among women, stands on the threshold of being virtually eliminated.

Diagnosis and management of cervical intraepithelial neoplasia

Ovarian cancer is the leading cause of death from malignancies arising in the female genital tract. More women die from ovarian cancer than cervical and endometrial cancer combined. All clinicians should understand the concepts of ovarian cancer biology and management. Approximately 90% of all ovarian cancers are epithelial in origin, and such cancers are the focus points of this article.

A clinical-pathology review of cervical intraepithelial neoplasia following cryotherapy failure

Cervical intraepithelial neoplasia (CIN) after cryotherapy can pose both diagnostic and therapeutic problems. To clarify these issues, 27 consecutive patients who underwent cone biopsy for CIN after cryotherapy over a 10-year period at Women's Hospital LAC + USC Medical Center were reviewed. Although the initial features of the cervical intraepithelial neoplasia allowed for outpatient cryotherapy, the features of these failures did not (unsatisfactory colposcopy or CIN in the endocervical curettings). Eleven percent of these patients had stromal invasion on cone biopsy that was not suspected clinically. Patients presenting with cervical intraepithelial neoplasia following cryotherapy may, in fact, have progressive disease (i.e., stromal invasion) that is inapparent clinically. Hence, surgical excision should be considered in these circumstances.

Ten years after cryosurgical treatment of cervical intraepithelial neoplasia

From 1974 to 1977 we treated 96 patients for grade 2 or 3 cervical intraepithelial neoplasia with cryotherapy. They were monitored for 10 to 14 years with an attendance rate of 98%. Treatment resulted in cure in 92%. Nine patients had persisting lesions, and three patients had a recurrent lesion. The last recurrence was diagnosed 6.7 years after cryotherapy.

The treatment of grade 3 cervical intraepithelial neoplasia with cryotherapy: an 11-year experience

The results of treatment of 453 patients with grade 3 cervical intraepithelial neoplasia by cryotherapy are presented. After excluding 31 patients who were lost to follow-up, the failure rate of primary treatment in the remaining 422 patients was 7.1% (30 patients). Outpatient re-treatment of those with persistent disease achieved an overall cure rate of 98%. Statistical analysis to determine prognostic significance with regard to persistent disease was carried out on the following variables: grade, size, and type of freeze. Type of freeze was the only variable to show statistical significance. Cryotherapy remains an effective outpatient modality for the treatment of grade 3 cervical neoplasia. A rigid protocol of patient selection and meticulous cryotherapy technique play a large role in obtaining the high cure rates reported in this study.