Precancerous disease of the cervix is commonly detected from an abnormal Pap smear. If untreated, precancerous cervical disease may progress to invasive cancer over the course of several years. The terms used to describe precancerous cervical disease have undergone a number of changes over the past several years. Precancerous cervical disease may be referred to as cervical dysplasia, cervical intraepithelial neoplasia (CIN), or squamous intraepithelial lesions (SIL). When the precancerous cervical disease appears very abnormal under the microscope, it is called carcinoma-in-situ (CIS), or stage 0 cancer of the cervix. A stage 0 cancer is said to exist if the cancer is confined to the cervix and has not invaded beyond the surface cell layer of the cervix.
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of stage 0 cervical cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied to your situation. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Treatment for precancerous cervical disease depends on how abnormal the cells appear to be under the microscope, the patient’s general medical condition and whether the patient wishes to have children in the future. Stage 0 cervical cancer is currently treated by surgical removal of the cancer. Because stage 0 cancer is not invasive, local treatment can be successfully performed with several different surgical procedures. These surgical treatments are all effective in treating precancerous cervical disease. Most procedures do not involve removal of the uterus and can permit future childbearing if desired by the patient.
Surgical procedures that preserve the uterus and may permit future childbearing include cryosurgery (freezing), laser surgery, loop electrosurgical excision procedure (LEEP) or cold-knife conization. Cryosurgery, laser surgery, and LEEP can be performed in the doctor’s office or short procedure facility, often with local anesthesia. A cold-knife conization is a more extensive operation that involves removal of part of the cervix under general anesthesia. Not all patients can be adequately treated with cryosurgery, laser surgery or LEEP. This decision depends on the extent and appearance of the disease upon examination. To learn more, go to Surgical Treatment for Cervical Cancer.
Even with surgical treatment of precancerous cervical disease, some patients may experience recurrence of precancerous disease or invasive cancer. Treatment of stage 0 cervical cancer with cryosurgery, laser surgery or LEEP cures 85-90% of women. Approximately 10-15% may experience a recurrence of precancerous cervical disease and approximately 2% will develop invasive cancer following treatment with these procedures. Women treated with conservative surgery require lifelong visits to their doctor to ensure that recurrence of cervical disease can be detected in the precancerous state or early while the cancer is still curable.
If the precancerous disease is more extensive and the patient desires no further children, a simple hysterectomy can be performed. During a simple hysterectomy, the entire uterus, including the cervix with the precancerous disease and an area of normal tissue around it, is removed through a low abdominal incision or the vagina. A simple hysterectomy is very effective therapy if the cancer has not invaded beyond the surface cell layer of the cervix. In addition, doctors can perform a bilateral salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes. The decision to perform a bilateral salpingo-oophorectomy depends on the woman’s age and whether the ovaries are still functioning.
A simple hysterectomy and/or a bilateral salpingo-oophorectomy are the most extensive surgical options used for precancerous disease and require general anesthesia and a hospital stay. Women undergoing a hysterectomy may experience lower abdominal pain and difficulty with urination after the operation. After a hysterectomy, women no longer menstruate and can no longer have children.
Nearly all patients with carcinoma in-situ or precancerous lesions of the cervix will be alive and without evidence of disease 5 years after surgery. Most patients who die do so of causes other than cervical cancer. Even after treatment with hysterectomy, a small number of patients may experience recurrence of their disease. It is important to realize that a few patients already have small amounts of precancerous cells that were not adequately removed by surgery. These cells cannot be detected with any of the currently available tests and are responsible for the recurrences after a simple hysterectomy.