CHAPTER 4: SCREENING FOR CERVICAL CANCER

140 Chapter 5: Diagnosis and Management of PrecancerTable: 5.1 Comparison of cryotherapy, LEEP and cold knife conization5Cryotherapy LEEP Cold Knife ConizationChapter 5: Diagnosis and Management of PrecancerAdvantages • High cure rate (86–95%)for small lesions• Equipment simple andrelatively inexpensive• Can be performed bytrained and competentphysicians and nonphysicians.Trainingtakes a few days• Can be performed as anoutpatient procedure in aprimary care setting• Fast (about 15 minutesfor double-freezemethod)• Anaesthesia not required• Electricity not required• Complications and sideeffectsrare• High cure rate(91–98%)• Reliable histologyspecimen obtained,which allows invasivedisease to be ruled out• Few complications• Can be performed onan outpatient basis ata secondary level• Fast (5–10 min) andtechnically simple toperform• In a see-and-treatapproach, diagnosisand treatment can beoffered at the sametime, maximizingtreatment coverage• Highly effective (curerate 90–94%)• A single surgicalspecimen, without“burnt” edges, isremoved, whichfacilitates theevaluation of themargins for completeexcision of thediseased areaDisadvantages• Less effective for largerlesions (cure rates< 80% at one year)• No tissue sampleavailable for histologicalexamination• Needs continuous supplyof carbon dioxide ornitrous oxide• Causes prolonged andprofuse watery discharge• Requires intensivetraining• Postoperative bleedingin less than 2% oftreated women• More sophisticatedequipment needed• Requires electricity• Requires localanaesthesia• Requireshospitalization and anoperating theatre• Requires spinal orgeneral anaesthesia• Requires highly skilledpersonnel• Complications mayoccur, includingbleeding, infection,stenosis and cervicalincompetence withpossible decreasedfertilityThe “screen-and-treat” approachIf there is no capacity for tissue diagnosis with colposcopy and histology, treatmentbased on screening alone may be appropriate, especially in limited-resource settings.Screening tests for the screen-and-treat approach can include visual tests, HPV or