Diseases

Conization, Cervix (Colposcopy) Information

Acetic acid wash for colposcopy

After the cervix is studied with the colposcope, the cervix is washed with a chemical called acetic acid, which is diluted 3% to 5%. The acetic acid (vinegar) washes away mucus and allows abnormal areas to be seen more easily with the colposcope. Moreover, the acetic acid stains the abnormal areas white. The areas that stain white after the acetic acid wash are called "acetowhite lesions." Sometimes, however, normal areas can also stain white, but these areas have vague or faint borders. In contrast, significant abnormalities, such as genital warts, pre-cancers (dysplasia), and cancers, generally produce acetowhite areas with distinct and clear boundaries.Sometimes staining with a dilute iodine solution (known as Lugol's solution or Schiller's solution) is also performed to further examine for abnormalities. Normal cells will generally take up the iodine stain (and turn brown) in a uniform manner, whereas severe precancers and cancerous areas will not.

Biopsy of the cervix

Finally, colposcopy allows tissue sampling (biopsy) that is targeted to the abnormal areas. In fact, the biopsy of abnormal areas is a critical part of colposcopy because treatment will depend on how severe the abnormality is on the biopsy sample. After colposcopy and biopsies, a chemical is applied to the biopsy area to prevent bleeding (spotting). As part of the biopsy procedure, endocervical curettage (sampling of the tissues within the endocervical canal, or the opening of the cervix to the uterine cavity) is often performed.

Carbon dioxide laser photoablation

This procedure, which is also known as CO2 laser, uses an invisible beam of infrared light. The laser actually vaporizes the abnormal area. Lidocaine, a local anesthetic, is given to numb the area prior to the laser treatment. A chemical is applied afterwards to prevent delayed bleeding. A substantial amount of clear vaginal discharge and spotting of blood can occur for a few weeks after the procedure. To improve healing, sexual intercourse and tampon use should be delayed for several weeks. The complication rate of this procedure is very low, about 1%. The most common complications are narrowing (stenosis) of the cervical opening and delayed bleeding. Disadvantages of this treatment include that this procedure does not allow sampling of the abnormal area and is not satisfactory for treating cervical cancer. It is useful, however, for milder dysplasia. It is generally not considered safe for use during pregnancy.

Cold knife cone biopsy

Cone biopsy was once the major procedure used to treat cervical dysplasia, but the other methods have now replaced it for this purpose. However, when a physician finds more serious lesions within the endocervix or inner area of the cervix, a cone biopsy continues to be recommended. It is also recommended if special sampling is needed to obtain more information regarding certain types of more advanced abnormalities. This technique allows the size and shape of the sampling to be tailored.Complications of this procedure include postoperative bleeding in 5% of women and narrowing of the cervix. Cone biopsy has a slightly higher risk of cervical complications than the other treatments. This procedure is occasionally used to treat carefully chosen cases of cervical cancer.

Colposcopy facts

• Colposcopy is a procedure used by physicians that provides a magnified and illuminated view of the vulva, vaginal walls, and uterine cervix.
• This procedure is often done to evaluate an abnormal appearing cervix or an abnormal Pap smear result.
• Special tests are done during colposcopy, including acetic acid wash, use of color filters, and sampling (biopsy) of tissues.
• Cervical abnormalities include pre-cancer (dysplasia), which can be rated as mild, moderate, or severe, and cancer.
• The type of treatment procedure chosen by the physician depends on the severity of the cervical abnormality, which is determined by analysis of the colposcopy biopsy sample.
• The treatments for cervical abnormalities include the destruction (ablation) procedures - cryocautery and carbon dioxide laser -- and the removal (resection) procedures -- loop electrosurgical excision procedure (LEEP), cold knife conization, and hysterectomy.
• Except for hysterectomy, which is almost always used for invasive cancer and is rarely used for dysplasia, most of the treatments are all safe enough to be performed in the doctor's office.

Cryocautery

Cryocautery is a relatively simple procedure that uses nitrous oxide to freeze the abnormal area. This technique, however, is not optimal for large areas or areas where abnormalities are already advanced or severe. After the procedure, patients can experience a significant watery vaginal discharge for several weeks. To improve healing, sexual intercourse is best avoided for several weeks. Significant complications of this procedure are rare and occur in about 1% of patients. They include narrowing (stenosis) of the cervix and delayed bleeding. Cryocautery does not allow sampling of the abnormal area and is generally felt to be inappropriate for women with advanced cervical disease. Thus, this procedure is not satisfactory for treating cervical cancer, but is useful for milder dysplasia.

Hysterectomy

Hysterectomy is the surgical removal of the uterus. This operation is used to treat most cases of invasive cervical cancer. Sometimes, a hysterectomy is done to treat severe dysplasia. It is also used if dysplasia recurs after any of the other treatment procedures.

Loop electrosurgical excision procedure

Loop electrosurgical excision procedure, also known as LEEP, uses a radio-frequency current to remove abnormal areas. It is by far the most common treatment for precancerous lesions of the cervix. It has an advantage over the destructive techniques (CO2 laser and cryocautery) in that an intact tissue sample for analysis can be obtained. LEEP also is popular because it is inexpensive and simple. A chemical is applied afterwards to prevent bleeding. Vaginal discharge and spotting commonly occur after this procedure. Sexual intercourse and tampon use should be avoided for several weeks to allow better healing.Complications occur in about 1% to 2% of women undergoing LEEP, and include cervical narrowing (stenosis) and bleeding. This procedure is used most commonly for treating dysplasia, including severe dysplasia. LEEP also is used, although infrequently, to treat carefully chosen cases of cervical cancer.

Use of color filters for colposcopy

Another aspect of colposcopy involves the use of color filters. The filters help the physician examine tiny blood vessels (capillaries) in the area of the squamocolumnar junction. Blue or green filtered light can cause abnormal capillaries to become more obvious, usually inside an acetowhite area.Normal capillaries are slender and spaced out evenly. In contrast, abnormal capillaries can appear as red spots (thickened capillaries seen on end) or can produce a pattern resembling hexagonal floor tiles. The worse the cervical disease, the thicker and more widely spaced out are the capillaries. The abnormal capillary pattern ranges from mild, as with pre-cancer (dysplasia), to severe, as with established cancer. Thus, when cancer eventually develops, capillaries take on odd shapes, like punctuation marks.