Elimination of pre-cancerous alterations in the cervix
When a precancerous alteration is diagnosed, an evaluation is made as to whether it should be removed with a small operation (usually under local anaesthesia), based on the type and duration of its persistence. The elimination of precancerous alterations occurs in different ways. At IEO, laser is available which makes not only the vaporisation of alterations possible, but also their excision (laser conisation) in order to obtain the histological examination of the visible alteration. Otherwise, the excision can be performed using a diathermic loop and subsequently defined with laser, always under colposcopy guidance.
The methods used for the elimination of alterations are guided by colposcopy that allows the elimination of the visible alteration. On the contrary, interventions without a direct and enlarged view, such as cold knife conisation (through scalpel), are less precise and generally require further treatment.
Treatment of cervical cancer
When an invasive carcinoma is diagnosed, treatment options vary according to the degree of invasiveness and the extension of the tumour. In cases of only initially-invasive carcinomas, with infiltration of less than 7 mm, detection is performed through the histological examination of the pre-cancerous alteration excised. The excision of the alteration through laser conisation can be considered as treatment for a minimally-invasive carcinoma, especially in cases of squamous cell carcinoma, even if in some cases the surgical evaluation of the lymph nodes must be added.
In cases when an adenocarcinoma is found, although minimally-invasive, only laser excision of the tumour can be considered in young patients who still desire pregnancy, otherwise it is better to consider a surgical removal of the uterus.