Reference Manual - IARC Screening Group

Treatment and Followuplocal anesthesia or electricity. The procedure has few side effects (Table7-4). Disadvantages of cryotherapy are that no tissue is obtained forhistological confirmation of the lesion and a regular supply of liquidcoolant is needed.Table 7-4. Expected Side Effects of CryotherapySIDE EFFECTMANAGEMENTCramping • Counsel patient before the procedure that sheshould expect some degree of cramping duringand after the procedure and that cramping usuallystops shortly after the procedure.• Reduce cramping by pressing lightly on cervixwith the cryoprobe.• If cramping is severe, provide oral analgesic(acetaminophen or ibuprofen).Vaginal discharge(profuse, watery)Light bleeding orspotting• Counsel patient to expect a discharge lasting up to6 weeks.• Counsel patient to return if discharge changes tofoul-smelling or pus-colored: evaluate forinfection and treat with antibiotics.• Counsel patient to return for evaluation if there isheavy bleeding.• Strongly advise abstinence for 4 weeks.• If abstinence unlikely, advise condom use for 4weeks for prevention of pelvic infection.• Counsel patient to expect light bleeding orspotting for 1–2 weeks.• Counsel patient to return for evaluation if there isheavy bleeding.(LEEP) LoopElectrosurgicalExcision ProcedureExcision of cervical lesions by LEEP is done by applying a low-voltage,high-frequency alternating current to a thin wire loop electrode andslowly passing it across the cervix (Figure 7-1). Then the raw area of thecervix is cauterized using a ball-type electrode. This technique has adistinct advantage over other procedures, such as cryotherapy, because itcan provide a specimen for histology. Because LEEP is a relatively newtechnique, there are few large studies documenting long-term successrates beyond 1 year (Table 7-5).7-4 Cervical Cancer Prevention Guidelines for Low-Resource Settings