Didactics-Treatment for precancer: consideration for using ablation or excision

Pdf Summary

This document discusses the considerations in using ablation or excision as treatment for precancerous cervical lesions. Thermal ablation (TA) is described as a simple, portable, and outpatient ablative treatment for cervical intraepithelial neoplasia (CIN). It is found to be feasible, safe, and effective, with an overall response rate of 93.8% in treating biopsy-proven CIN2+. There is no evidence that TA impairs reproductive outcomes. Colposcopy and loop excision are described as more resource-intensive and requiring higher levels of expertise. However, not all hospitals have specialists trained in colposcopy, and many do not have colposcopy machines in their clinics. Inpatient excision procedures in an operating theatre under general anesthesia are often required, which can be costly. The document also addresses factors to consider when deciding between ablation and excision, such as the intent, socio-demographic factors of the women referred, and follow-up rates. The document includes data from the colposcopy clinic at the University Malaya Medical Centre (UMMC) in Malaysia, showing that HPV-based primary screening followed by colposcopy is an effective protocol. It also highlights the emotional impact on patients, from fear and distress before colposcopy to a positive outlook on their body and general health after the procedure. Factors to consider in treatment decisions include logistics, geographical factors, health financing structure, human resources, patient literacy level, emotional well-being, affordability, and reproductive wishes.

Asset Subtitle

Prof. Woo Yin Ling
August 2023

Keywords

ablation

excision

cervical lesions

thermal ablation

CIN

colposcopy

reproductive outcomes

HPV-based screening

emotional impact

healthcare logistics