Cone Biopsy - Treatment May Help Early-Stage Cervical Cancer Patients Preserve Fertility (dateline November 19, 2001)
Most women who are diagnosed with early stage cervical cancer must undergo a hysterectomy, a treatment that results in permanent infertility. However, a new study has found that some cervical cancer patients may be candidates for a different procedure called a cone biopsy, which can preserve fertility. In the study, three out of four women with early invasive cervical cancer who underwent cone biopsies instead of hysterectomies were able to become pregnant and deliver babies after the treatment. Though the researchers caution that cone biopsy should not be a standard treatment for early-stage cervical cancer, it may be an appropriate option for some well-informed women who are aware of the potential benefits and risks of the treatment.
To conduct the study Dr. Bradley J. Monk of the University of California at Irvine and his colleagues treated 133 women who had been diagnosed with an early form of cervical cancer called adenocarcinoma. Each woman received one of three treatments: a radical hysterectomy (surgical removal of the uterus, nearby tissues, upper vagina, and pelvic lymph nodes), simple hysterectmy (surgical removal of the uterus) or a cone biopsy (removal of a cone-shaped region of cervical tissue). The study showed that cone biopsy was successful at treating cervical cancer and preserving fertility. Of the three out of four women who delivered babies after treatment, none had experienced a recurrence of cancer after an average of four years.
Cone biopsy is usually performed to diagnose cervical cancer, but this study shows that it may be an effective treatment for some women. There are two main methods used to perform cone biopsy. The LEEP (also called LLETZ) method, short for loop electrosurgical excision procedure, removes the tissue by using a wire that is heated by an electrical current. Patients are given local anesthesia and the procedure can be performed quickly in a physician's office. Another method of cone biopsy involves using a surgical scalpel or laser to remove the tissue. This procedure typically requires general anesthesia and may be performed in a hospital or outpatient facility. However, an overnight hospital stay is not usually required.
The standard treatment for early stage cervical cancer is a hysterectomy. A simple hysterectomy involves surgically removing the uterus through an incision in the abdomen or vagina under general or epidural (regional) anesthesia. A simple hysterectomy is typically performed in a hospital and involves a few days of recovering in the hospital (approximately three to five days for abdominal hysterectomy). Patients take approximately four to six weeks to heal from a simple hysterectomy. Possible complications of a simple hysterectomy include excessive bleeding, wound infection at the surgical site, or damage to the urinary or intestinal systems. A hysterectomy will result in permanent infertility.
While cone biopsy may be an appropriate treatment option for some cervical cancer patients, Dr. Monk warns that it should not become a standard treatment procedure. Candidates for cone biopsy include cervical cancer patients with small tumors less than three millimeters deep and seven millimeters wide. Also, the cancer must be confined to the cervix. Women should be advised by their physicians of the risks of a recurrence of cervical cancer that can also be associated with cone biopsy.
The most common side effects of cone biopsy include cramping/discomfort and moderate or mild bleeding for a few weeks after the procedure. Patients should avoid sexual intercourse, tampons, and douching until the incision is completely healed, which may take several weeks. Patients should also discuss other possible side effects of cone biopsy prior to the procedure.
The American Cancer Society estimates that in 2001, 12,900 new cases of invasive cervical cancer will be diagnosed in the United States and approximately 4,400 American women will die from the disease. The International Agency for Research on Cancer estimates that nearly 380,000 women are diagnosed with cervical cancer worldwide each year. The number of cases and number of deaths from cervical cancer are higher in less developed countries where routine screening is not widespread.
Cone Biopsy - Additional Resources and References
The study, "Fertility Sparing Treatment for In Situ and Early Invasive Adenocarcinoma of the Cervix," is published in the November 2001 issue of Obstetrics & Gynecology, http://www.greenjournal.org/
Source: Imaginis
Cone Biopsy - Is therapeutic conization sufficient to eliminate a high-risk HPV infection of the uterine cervix?
A clinicopathological analysis.
Anticancer Res 2002 Nov-Dec;22(6B):3733-6
Bodner K, Bodner-Adler B, Wierrani F, Kimberger O, Denk C, Grunberger W.
Department of Gynecology and Obstetrics, Hospital Rudolfstiftung, A-1030 Vienna, Juchgasse 25, Austria.
BACKGROUND: High-risk human papillomavirus infection plays a predominant role in the pathogenesis of preinvasive and invasive cervical cancer. One of the recognized treatments of cervical intraepithelial neoplasia is conization. The aim of this study was to evaluate if cold-knife conization is sufficient to eliminate cervical intraepithelial neoplasia and the associated high-risk HPV infection.
PATIENTS AND METHODS: Thirty-seven high-risk HPV-positive women who underwent cold-knife conization entered this study. The cervical sampling for HPV DNA was performed using the Digene cervical sampler. Smears were taken immediately before and 3 months after conization and the patients were followed-up for 2 years.
RESULTS: High-risk HPV was identified in all 37 patients before conization. In 4 out of 37 patients a coincidence of low/intermediate and high-risk HPV types was present. A CIN II was detected in 5 out of 37, a CIN III in 25 out of 37 and a carcinoma in situ in 7 out of 37 cases. Follow-up at three months revealed that HPV was eradicated by conization in 73%. Patients with persistent HPV infection tended to be older compared to patients with eliminated HPV infection (mean: 34 vs. 36 years; p = 0.25) and showed a higher rate of severe dysplasia (p = 0.07). A high HPV prevalence among patients with positive resection margins and/or recurrence disease was detected (83% and 100%, respectively). A statistically significant higher rate of positive margins and recurrences was observed in patients with persistent compared to patients with eliminated HPV infection (50% vs. 4%. p = 0.001 and 30% vs. 0%, p = 0.003).
CONCLUSION: The data of the present study demonstrated that a high-risk HPV infection is successfully eliminated by conization in most cases. A high HPV prevalence in patients who had positive cone margins and/or disease recurrence was observed. Patients with persisting HPV infection after conization show statistically significant higher rates of positive resection margins and are at increased risk of disease recurrence. HPV testing seems to be, therefore, a valuable tool to monitor the therapeutic results of conization and to discriminate patients who have a higher risk of disease recurrence.
Source:
PubMed
Cone Biopsy - Rate of human papillomavirus clearance after treatment of cervical intraepithelial neoplasia.
Obstet Gynecol 2002 Nov;100(5 Pt 1):965-71
Elfgren K, Jacobs M, Walboomers JM, Meijer CJ, Dillner J.
Department of Obstetrics and Gynecology, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. kristina.elfgren@obgyn.hs.sll.se
OBJECTIVE: To investigate the rate of clearance of human papillomavirus (HPV) infection after surgical treatment for cervical intraepithelial neoplasia (CIN). METHODS: One hundred nine women with CIN I-III, treated with cryosurgery or conization at a university hospital, were observed with cervical HPV deoxyribonucleic acid (DNA) testing by general primer polymerase chain reaction and HPV typing at 0, 3, 6, 9, 12, and 24 months after treatment. Penile HPV DNA was analyzed from current sexual partners.
RESULTS: Eighty-one percent of evaluable women were HPV DNA positive at treatment or enrollment. One year later, seven women (9%) remained positive for the same HPV type. Most women had cleared the HPV infection diagnosed at treatment within 3 months. The cryotherapy group had lower CIN grades, was younger, and had a slower HPV clearance rate (P <.002). Only four couples had HPV DNA of the same type detected.
CONCLUSION: Surgical treatment of CIN usually results in clearance of HPV infection within 3 months. Human papillomavirus DNA testing may be useful as a rapid intermediate end point for monitoring the efficacy of treatments.
Source: PubMed
Cone Biopsy - Links
Imaginis - Cone Biopsy Treatment May Help Early-Stage Cervical ...
Cone Biopsy Treatment May Help Early-Stage Cervical Cancer Patients Preserve
Fertility (dateline November 19, 2001), Format for Printing.
Cone Biopsy - Dysplasia Evaluation and Treatment
A description of where a cone biopsy fits into the evaluation and treatment
of cervical dysplasia. Cone Biopsy. Dysplasia Evaluation and Treatment.
Yahoo! Health Encyclopedia: Cold knife cone biopsy
Cold knife cone biopsy Provided by ADAM Overview | Treatment | Images
Normal values This procedure is only performed if an abnormality
CancerHelp UK
And there is no increased likelihood of caesarian section after cone
biopsy either. Can other treatment affect future pregnancy?
Cone Biopsy - More Studies
Dr. Joe Glickman, Jr., an accomplished medical author, has made available a great deal of research on cone biopsy and LEEP procedures which consists of many university studies. Since Dr. Glickman has spent over 20 years of his career writing medical textbooks he has been able to present some rather complex information in a more simplified form that is easy to understand and read. You can check out his website at www.health-science-report.com
to read more about cone biopsy and other procedures.
