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Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

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Treatment of cervical intraepithelial neoplasia – Principles

  


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Cervical precancers are treated with either of the following techniques:

  • Ablation of the transformation zone: The epithelium and part of the subepithelial stroma of the transformation zone are destroyed using either cold injury (the procedure is called cryotherapy) or heat injury (the procedure is called thermal ablation).
  • Excision of the transformation zone: The epithelium and part of the subepithelial stroma of the transformation zone are removed either using a large loop powered by an electrosurgical unit (the procedure is known as large loop excision of the transformation zone; LLETZ) or using a surgical blade (cold-knife conization; CKC). LLETZ is also known as loop electrosurgical excision procedure (LEEP).


The entire transformation zone undergoes HPV-induced clonal change and is at risk of developing CIN. Therefore, the whole transformation zone should be treated (ablated or excised), irrespective of the size or location of the lesion.


When the HPV test is used as a primary screening test in a screen-and-treat setting, all HPV-positive women are treated without further triage with VIA, cytology, or colposcopy. In a screen, triage, and treat setting, HPV-positive women are treated only when the triage test result is abnormal. In other settings (mostly higher-resource settings), women are treated after the diagnosis is confirmed to be CIN2 or CIN3 on histopathology. HPV-positive women with CIN1 may be followed up after 1 year and treated if there is persistence or progression of the lesion. These women may be treated immediately when follow-up cannot be ensured.

The choice of treatment (ablation or excision) depends on certain features of the cervix that can be visualized during examination after application of acetic acid for 1 minute.

The next section describes the selection criteria for ablative treatment and the steps to determine eligibility for ablative treatment.








































































  
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