Colposcopy, Cryotherapy, Cone Biopsy and Leep

COLPOSCOPY


A colposcopy is a procedure that allows a physician to examine a woman's cervix and vagina using a special microscope called a colposcope. A colposcopy is usually done when a Pap smear result shows abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells and tissue.

A colposcopy also may be used to further assess other problems, such as:

A colposcopy is a quick procedure and is best done when a woman is not having her menstrual period, giving the health care provider a better view of the cervix. A speculum is used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the opening of the vagina. A mild solution is applied to the cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. During colposcopy, the health care provider may see abnormal areas. A biopsy of these areas may be done. During a biopsy, a small piece of abnormal tissue is removed from the cervix. Cells also may be taken from the canal of the cervix. This is called endocervical curettage (ECC).

After a colposcopy, the vagina may feel sore for 1 – 2 days. Vaginal bleeding and/or dark discharge may occur. A sanitary pad can be worn to mitigate the flow of discharge.

Activity should be limited at this time. While the cervix heals, nothing should enter the vagina for typically 1 to 2 weeks. Sex, tampons, and douching should be avoided.

Dysplasia or cervical intraepithelial neoplasia (CIN) are terms that describe the actual precancerous changes that occur in the cervix. These changes are due to Human Papillomavirus (HPV) infections. Dysplasia and CIN are graded as mild, moderate, or severe. Mild dysplasia (CIN 1) usually goes away on its own. Moderate (CIN 2) and severe (CIN 3) dysplasia indicate more serious changes.

CRYOTHERAPY


Cryotherapy is a technique that freezes and sheds abnormal tissue. It can be used to treat mild to moderate dysplasia. Cryotherapy is an effective method for destroying abnormal cervical tissue; studies show that it can destroy all of the abnormal tissue in 77% to 96% of cases.

During cryotherapy, liquid carbon dioxide (CO2), which is very cold, circulates through a probe placed next to the abnormal tissue. This freezes the tissue for 2 to 3 minutes. It may be allowed to thaw and then be refrozen for another 2 to 3 minutes. Cryotherapy is usually done at the doctor's office and may cause some discomfort. Most women feel a sensation of cold and a little cramping, and sometimes a sense of warmth spreads to the upper body and face.

After Cryotherapy, a watery vaginal discharge will occur for about 2 to 3 weeks; during this time, tampons, douching, and sexual intercourse should be avoided.

Most women are able to return to their normal activity level the day after the cryotherapy procedure.

CONE BIOPSY


A cone biopsy removes a cone-shaped wedge of abnormal tissue that is high in the cervical canal to be examined under a microscope. If the dysplasia is more severe and deeper in the cervical canal, a cone biopsy is recommended.  A small amount of normal tissue around the perimeter of the site is also removed so that a margin free of abnormal cells is left in the cervix.

The cone biopsy may remove all of the abnormal tissue. This would mean that no further treatment is needed other than follow-up Pap smears.

The perimeter of the cervical tissue may contain abnormal cells, meaning that abnormal tissue may be left in the cervix. The cone biopsy may be repeated to remove the remaining abnormal cells. If follow-up tests show normal cells, then no further treatment may be needed. If abnormal cells remain, other treatments may be required.

The cone biopsy may show cancer that has grown deep into the cervical tissue (cervical cancer). Further treatment, such as surgery, radiation, or chemotherapy, will be recommended.

A sample of tissue can be removed for a cone biopsy using:

A cone biopsy using LEEP may be done in a doctor's office with an injected medicine that numbs the cervix (cervical block). Oral pain medicine or pain medicine injected into the muscle (intramuscular, or IM) may be used in addition to the local anesthetic.

After a cone biopsy:

Risk Factors:

Women who have had a cone biopsy may have an increased risk of miscarriage or preterm delivery.

After cryotherapy or cone biopsy, it’s very important to have regular follow-up Pap smear. A Pap smear should be repeated every 4 to 6 months or as recommended by a doctor. After several Pap smear results are normal, it will be determined how often future Pap smears should occur.

ENDOMETRIAL ABLATION


Endometrial ablation is minimally invasive, hormone-free, and is used to treat many causes of heavy bleeding.

Endometrial ablation destroys a thin layer of the lining of the uterus and reduces or completely stops the menstrual flow in many women. If ablation does not control heavy bleeding, further treatment or surgery may be required.

The following methods are those most commonly used to perform endometrial ablation:

A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue while suction is applied to remove it.

Fluid is inserted into the uterus through a hysteroscope, a slender, light-transmitting device. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.

A balloon is placed in the uterus with a hysteroscope. Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.

A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.

Electro surgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not used as frequently as the other methods.

Pregnancy is not likely after ablation, but it can happen; if it does, the risk of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should still use birth control until after menopause.

Sterilization may be a good option to prevent pregnancy after ablation. This can be done at the same time with hysteroscopic sterilization (Essure, Adiana).

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