Alternate Dysplasia Treatments

Cold knife cone biopsy, laser conization, and cryotherapy are other methods besides a LEEP cone biopsy that are used to treat cervical dysplasia. Cold knife cone biopsy is used when there is significant suspicion that a cancer is present. The cold knife cone will give more information about the degree of involvement of the cervix than a LEEP in the case where cervical cancer is present. Laser conization was a very popular treatment in the past but has since fallen out of favor due to the high rate of cervical scarring. Cryotherapy involves freezing the cervix but is inferior to a LEEP in almost every way.

Cold knife cone biopsy of the cervix is generally done for cervical cancer not for cervical dysplasia. If there is cervical dysplasia and there is reason to believe that a cancer might also be present, a cold knife cone may be done. Cold knife conization is performed in the operating room usually under general anesthesia, although a spinal anesthesia may also be used. A scalpel is used to cut a cone shaped piece of the cervix off. This specimen is sent to the pathologist to examine. The remaining cervix is then cauterized; stitches are also used to control bleeding. The women is allowed to go home the same day. There may be some cramping afterwards but usually this is pretty mild. Bleeding can be fairly heavy. Pelvic rest (nothing in the vagina) in necessary for at least 2 weeks. Because the specimen is obtained with a scalpel, the tissues are clean up to the edge of the specimen. This allows the pathologist to tell how deep the abnormality goes and whether or not the margins of the specimen are clear of disease. Cold knife cone biopsy can cause weakening of the cervix. This can cause cervical incompetence in future pregnancies.

When lasers were first introduced in medicine many applications of the laser were attempted. Laser conization became very popular during this time in part because laser was the new technology and it seemed like “cutting edge” to use them for dysplasia treatment. Unfortunately, the laser cones caused a great deal of scarring of the cervix which had the potential of causing long term problems. The laser cone was eventually abandoned. In my opinion, there is no indication for a laser cone procedure in modern gynecology. It is my advice that if this procedure is suggested a second opinion should be obtained.

Cryotherapy is still a popular way of treating dysplasia. Cryotherapy involves putting a metal cone shaped instrument against the cervix and passing liquid nitrogen through it. This freezes the cervix causing tissue death. The cervix is allowed to thaw and the frezing is repeated for a total of three freeze-thaw cycles. The cryotherapy can be very painful causing significant cramping. After the cryotherapy, very significant watery discharge is usually present for several weeks. I feel the cryotherapy is an inferior treatment to the LEEP for many reasons. Cryotherapy hurts more than LEEP, causes much more discharge, is more likely to fail, is more likely to cause scarring of the cervix, and does not provide a tissue specimen for pathology. The only advantage crtotherapy has over LEEP is that it is technically easier to perform. Gynecologists are trained to do a LEEP safely. With an experienced provider, a LEEP is extremely safe. Because cryotherapy is much easier to perform, this is the tool that most Nurse practitioners, Physician Assistants, and even Family Physicians use. If someone experienced with LEEP is available in the community, I feel cryotherapy should rarely, if ever, be performed. It is my recommendation that if you need treatment for dysplasia, you should seek out the care of someone capable of doing a LEEP.