Management of premalignant lesions of the cervix

The screening, detection and treatment of precancer lesions of the cervix have resulted in a dramatic decline in the incidence of cervical cancer in many parts of the world. The effect is most pronounced in countries with organised screening. The proper management of premalignant lesions of the cervix is an important and integral part of any screening programme. The importance of proper colposcopic technique and the adherence to well-established colposcopic guidelines cannot be overemphasized to ensure appropriate treatment. The colposcope is indispensable in treatment planning as it guides the optimal amount of cervical tissue to be ablated or excised and the type of cone biopsy to be taken. Various methods of treatment involving ablative procedures and excisional procedures have been found to be highly efficacious and safe. The choice of treatment modality is very much dependent on individual preferences. However, in those with extensive high-grade lesions, an excisional method has the added advantage of detecting unsuspected microinvasive disease which can be missed if ablative methods are used. Although treatment for squamous intraepithelial neoplasia is well established, the treatment for adenocarcinoma-in-situ is more controversial. Newer methods of treatment are currently being developed to further improve on the good results achievable with present treatment modalities.