Management of pre-invasive disease of the cervix

The management of pre-invasive disease of the cervix is based on local cont rol and prevention of progression to invasive malignancy. Screening continu es to be an effective tool for detecting cervical neoplasia in a pre-invasi ve state due to the long natural history of progression from low-grade dysp lasia to invasion. When abnormal cells are detected with a Papanicolaou (Pa p) smear, a thorough evaluation should consist of colposcopy, directed biop sy, and cone biopsy, where appropriate. In the absence of invasion, local c ontrol may be achieved by excisional or ablative techniques including tradi tional cold-knife cone, laser cone, loop electrosurgical excision, cryother apy, laser or electrocoagulation diathermy. The benefit of excisional thera py is the ability for histologic specimen assessment. Ablative therapies ar e associated with lower complication rates (<2%). Success rates for these m odalities are comparable, exceeding 90%. Eradication of human papilloma vir us (HPV) from the genitourinary tract [associated with over 90% of condylom as, cervical intraepithelial neoplasia (CIN) and invasive malignancies] is not possible with currently available techniques. Semin. Surg. Oncol. 16:22 2-227, 1999. (C) 1999 Wiley-Liss, Inc.