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Treatment Options for CIN

Treatment Options for CIN. Cervical Cancer screening is designed to detect CIN If CIN is present treatment should theoretically avoid subsequent cancer by 100% (i.e. effective cure rate or zero percent failure rate). Screening Programme Guidelines.

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Treatment Options for CIN

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  1. Treatment Options for CIN • Cervical Cancer screening is designed to detect CIN • If CIN is present treatment should theoretically avoid subsequent cancer by 100% (i.e. effective cure rate or zero percent failure rate).

  2. Screening Programme Guidelines • Identify and invite eligible women (e.g. > 25 years to 60 years) • Cover the population with effective and acceptable test (e.g. VIA) • To give women information about benefits and limitations of the cervical screening test (VIA) • To identify CIN • To follow-up all women who are test positive and offer them appropriate treatment

  3. To inform women how they can  risk of CIN (delay early onset intercourse, avoid STI/HIV, avoid multiple partners, avoid cigarrette smoking ,grandmultiparity, prolonged use of stroidal contraception) • Provide acceptable and effective treatment for CIN (cryotherapy or LEEP) • Identify population at risk for target screening • Evaluate the screening Programme and improve its quality performance

  4. 1. Knife Cone Biopsy (Cold KCB) • Is done under general anaesthesia and still most commonly performed method of Rx in Zimbabwe. Complications of haemorrhage, cervical stenosis, infertility, recurrent miscarriages, pre-term labour. Histological specimen is available.

  5. 2. LASER 3. Deep Electro Diathermy 4. Cold Coagulation • Cryotherapy - destroys abnormal cells by freezing TZ (-60°C - 90°C): An outpatient procedure. Is an ablative technique, low cost, does not require electricity, ease of use, low complication rates, good cure rates (80% - 96%).

  6. 6. LEEP - (Loop Electrosurgical Excision Procedure) uses thin wire electrode with low voltage high frequently alternative current: An outpatient procedure that provides a histological specimen but may remove an excessive amount of cervical stroma.

  7. 7. Hysterectomy - After invasive cancer has been ruled out - TAH can be performed for women with CIN who desire sterilization or have other gynaecological problems e.g. fibroids.

  8. Future treatment for cervical cancer may involve HPV vaccinations, gene therapy and anti-angiogeneic agents (by blocking proliferative response of endothelial cells growth factors  no new blood vessels)

  9. Reduction in cumulative cervical cancer rate with different frequencies of screening

  10. HIV and Cervical Cancer • In 1993 CDC recorded 16,784 cases of women with AIDS and cervical cancer was the most common (1.3%) type of cancer recorded. • ICC was then listed as AIDS defining illness

  11. No change in ICC incidence has been recorded in Zimbabwe as a result of HIV epidemic (Chokunonga E et. Al. AIDS (1999); 13: 2583 – 83)

  12. Treatment of CIN lesions in HIV positive women • High treatment failure rates recorded among HIV positive women ranging from 38% to 62% compared with 15 to 18% among HIV negative women (Chirenje et.al. J.Lower Gen.Tract.Dis (2003), 7: 16 – 21, Maiman M. (1999), Halkomb K. et al (1999).

  13. HIV induced immunosuppression leads to impaired cell-mediated immunity and HPV infections rarely regress spontaneously. • CDC therefore put HGSIL as B defining condition in HIV positive women. • No data available yet on effort of HAART on incidence of ICC.

  14. HIV positive women should be offered cervical cytology screening, referral for colposcopy, and follow-up with 6 monthly cervical cytology surveillance. • Treatment of CIN lesions in HIV positive women has high recurrence rates irrespective of treatment modality.

  15. Global data estimates 466,000 new cases a year, 80 per cent of which are in developing countries. • The highest age standardized incidence rates are in Southern Africa, Central America, South America, parts of Asia (> 40 cases/100,000) Harare has one of the highest ASR at 54/100,000 (1997). • Peak incidence is early fifties in most countries, Zimbabwe peak age is 47 years.

  16. Natural History of Cervical Cancer • Proposal that ICC arises through progression of pre-invasive lesion as opposed to a de novo event was proposed in 1908 by Schanenstein • Carcinoma in “situ” was used to describe cancerous changes confined to the epithelium.

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