Treatment by cryotherapy – Principles
The technique of cryotherapy depends on the destructive power of cold injury to the normal and neoplastic epithelial cells. Nitrous oxide (N2O) or carbon dioxide (CO2) gases are used to induce the freezing effect on the cervix. The temperature of either of the gases, when released to atmospheric pressure from a compressed state, drops to -60 to -80 °C. When the gas is applied to the cervix, the tissue temperature is reduced to -20 °C, causing permanent damage to the epithelial cells.
The ectocervix has sparse sensory nerve endings. As a result, an ectocervical procedure like cryotherapy does not require any anaesthesia.
Cryotherapy should be used to treat only those CIN1/CIN2/CIN3 lesions that fulfil the following criteria:
Ideally, a punch biopsy should be obtained from the lesion before cryotherapy, although it is not necessary to wait for the biopsy report to perform the procedure. In the screen-and-treat approach, cryotherapy can be performed for VIA- or HPV-positive women who fulfil the above-mentioned criteria without colposcopic or histopathological verification. However, this is likely to result in substantial over treatment and should be reserved for settings where colposcopy/histopathology facilities do not exist.