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treatment of CIN
PREVENTIVE DEFINITIVE
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PREVENTIVEBIVALENT vaccine
cervarix)
HPV 16 and 18 QUADRIVALENTvaccine
gardasil)
HPV 16, 18 6, 11
Other measures
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HPV VaccinesGirls age 12-18 years3 dosesIMSite- deltoidInduced
antibodies (IgG, IgG) work locally,prevent attachment of virus to
cervical epithelium
Effective for 7.5 yearsPap smear continued as dont protect
against alltypes of HPV
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Other measuresDelay sexual exposure until cervicalepithelium has
attained physiological
maturityMaintain local hygiene , treat vaginalinfectionUse
condom especially during early sexuallife main penile hygiene as it
may bereservoir for high risk HPVReducing/quiting smoking
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Definitive treatment
Depends on
Age of patientDesire for reproductionRisk factors presentDegree
of dysplasiaFacilities available for follow up(colposocpy/
cytology)
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Observation;Repeat smear;
Colposcopy[every 4-6
months]
Local ablativemethods
Cryotherapy;Coldcoagulation
;Electrodiathermy;Laservaporisation
Excisionalmethods
Large loop excisionof transformationzone ( LLETZ) ;Cone excison(
knife/laser)
hysterectomy
OPTIONS Definitive treatment
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Observation and follow up
Under observation Pap smear follow up at 6 months OR HPV DNA
test at 12 months If both tests are negetive, routine recall is
done ( screening) For CIN I
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Ablation of local lesion
Complete destruction of lesion is consideredto be a satisfactory
treatment
Pretreatment evaluation of extent of lesion isnecessary
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Criteria for Ablation
Entire lesion is visualized within thetransformation zone
No ecidence of microinvastion or invasion No endocervical
glandular involvement No discrepancy in cytology, colposcopy
and
biopsy reports
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Methods of ablation
Principle: crystallizing intracellular water attemperature -
90C
Using nitrous oxide or carbon dioxide
Depth of tissue destruction- 5mm Freeze-thaw-freez technique
used
Cryotherapy
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Destroy cervical tissue at 100- 120C Doesnt need anesthesia
Depth of tissue destruction- 4mm
Methods of ablation
Cold coagulation
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Unipolar electrode used General anesthesia needed Depth of
tissue destruction- 8-10mm
Methods of ablation
Electrodiathermy
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Destroy epithelium by vaporization Method of choice when CIN
extends toonto
vaginal fornices
Depth of tissue destruction- 7mm
Methods of ablation
Carbon dioxide laser
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Contraindication of ablation treatment
Suspected invasion lesion, glandular disease SCJ not clearly
seen Discrepancy in smear/colposcopy/biopsy
findings
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Excision
Cold knife conization OR laser knife conization( preferred)
Done as outpatient with local anaesthesia and
colposcopic guidance Complcations: haemorrhage, infection,
cervical stenosis, cervical incompetence
Conization
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Under local anaesthesia Quick procedure Loop (2-3cm) of thin
stainless-steel wire with
blended current low voltage output used Transition zone is
excised upto depth of 10mm
or more and sent for histology
Large loop excision of transformation zone (LLETZ) /Loop
electrosurgical excision procedure ( LEEP)
Excision
Large loop excision of transformation zone (LLETZ) /Loop
electrosurgical excision procedure ( LEEP)
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CIN lesion associated with other gynaecologicalproblems (
prolapse, fibroid, pelvic inflammatorydisease, endometriosis )
CIN extends into vagina Presistent dyskaryotic smear even with
treatment High grade CGIN in elderly women CIN III Poor compliance
for follow up Cancer phobia
Hysterectomy
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