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Pros and Cons of Laser, cryotherapy, LEEP or cone biopsy

Pros and Cons of Laser, cryotherapy, LEEP or cone biopsy

Question

Dear OncoLink "Ask The Experts,"
I am 30 years old. My post-pregnancy pap smear shows moderate-severe dysplasia. A month later I had a biopsy which confirmed this. I have been told that I will be treated with cryotherapy.

My questions/concerns are:

Did pregnancy hormones accelerate the growth of these abnormal cells?

I hope to get pregnant again in September. How will my treatment influence my chances?

I have read that cryotherapy may not be the best treatment for CIN II-III dysplasia. I know that it is a far cheaper and more common treatment, but is it the best option? I understand that laser and LEEP are often preferable. I am concerned about scar tissue at the junction of my cervix/uterus preventing future pregnancy. I am also concerned that cryotherapy may not precisely remove the abnormal cells and I will be presented with a repeat of my current status.

I have read that laser surgery is far more costly, but that it provides a lower rate of return, does not interfere with future assessment of the junction, and the patient does not have the hassle of weeks of bothersome discharge.  

Answer

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

Laser, cryotherapy, and excision procedures like LEEP or cone biopsy are all effective methods for treating cervical dysplasia. However, they have different advantages and disadvantages. Cryotherapy is easy to perform, and can be done in the office setting. However, as you mentioned, patients tend to have a profuse discharge, which may be bothersome. Laser therapy requires a short day surgery procedure in the operating room, and usually involves anesthesia. The disadvantage to these two procedures is that they work by destroying the abnormal tissue--there is no biopsy specimen, which can be examined. LEEP and cone biopsies produce a tissue specimen, which can be examined, to ensure there is nothing more serious present that we missed at the time of colposcopy. LEEP may be done in the office, while cone biopsies need to be done as a day surgery procedure. In certain circumstances, a cone should be done instead of a LEEP (when the endocervical curettage shows abnormal cells, when cancer is suspected, etc.) All procedures have a small risk of causing difficulty conceiving, and LEEP and cone biopsies may have a very small risk of causing difficulty with premature cervical dilation. However, these risks are small, and many women go on to have normal pregnancies. It has been our practice to use laser or LEEP for low grade lesions, and to use LEEP or cone biopsy for higher grade lesions (like CIN II-III) because of the ability to obtain a tissue specimen.