Treatment of CIN and Cervical Cancer

Cervical cells showing early (CIN I / CIN II) pre-cancerous changes may return to normal and require no treatment except follow-up screening (although some physicians prefer to treat any abnormality, no matter how minor).  Women with CIN II or III cervical changes usually receive treatment to destroy the affected cells, such as ablation or excision.  For some women a hysterectomy or radiation therapy may be appropriate if they are able to tolerate major surgery.

Treatment for early cancer stages I through IIIB includes options such as simple or radical hysterectomy and radiation, usually with chemotherapy.  Outcome is generally good but depends on how far the disease has spread.

For advanced disease stages, such as IVA, treatment is similar to stages I to III.  The size of the primary tumour is the important factor determining outcome.  In stage IVB, cancer has spread well beyond the pelvis and treatment options include radiation therapy, chemotherapy and possible treatment with new anti-cancer drugs or drug combinations.

While surgical procedures may be curative in a large proportion of cases of cervical cancer, particularly early stage disease, radiotherapy and/or chemotherapy are often used to suppress progression or prolong life. 
 

Treatment of cervical carcinoma in situ (CIN III)

Staging of cervical cancer will determine whether the cancer is only just developing or has spread within or beyond the cervix, and if so, how far.  As the impact of even simple HPV testing is a negative one for women and their families (McCaffery et al 2003), the effect of a diagnosis of cervical cancer on psychological well-being and quality of life can be immense (de Groot et al 2005).  Staging is thus an important element of the disease management process.  Various different management approaches may be involved depending on the progress of the disease (National Cancer Institute 2005a). 

Treatment of CIN III is 100% effective (National Cancer Institute 2005b). Treatments include:

• Loop electrosurgical excision procedure (LEEP): an electrical current is passed through a thin wire or loop, which is used to excise a portion of tissue instead of a knife.
  
• Laser surgery: a narrow beam of intense light is used as a knife to make bloodless cuts or to remove a surface tumour.
  
• Cryotherapy: the affected area of tissue is frozen and destroyed, provided the cervical canal is disease-free.
  
• Conization (cone biopsy): a cone-shaped piece of tissue is removed from the cervix.  This procedure is also used to diagnose cervical cancer.
  
• Total hysterectomy, which is offered in some countries to women who cannot or no longer want to have children.
  
• Internal radiation therapy for women who cannot have surgery.

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