CERVICAL CAUTERIZATION

CERVICAL CAUTERIZATION

Introduction

            This is performed by electric cautery. In electrocautery there is simple burning of diseased tissue while with diathermy cautery there is electrocoagulation (i.e, both incision and coagulation) of diseased tissue. Electrocoagulatio (with high frequency monopolar electrode) is better than electrocautery because the penetration of heat and destruction of diseased gland tissue are uniform and controllable. As electrocautery is quite cheaper than diathermy cautery it is widely used.

Definition

Cervical cauterization is a procedure that is used to destroy abnormal (noncancerous or precancerous) cells on the opening to the womb (cervix). Cauterization is carried out through the use of heat, electricity, cold, corrosive chemicals or laser. The most common methods involve high frequency electric current (electrocoagulation) or freezing (cryocauterization, cryosurgery).

Indication

Cervical cauterization is commonly used ti treat inflammation of the cervix (cervicitis), liquid-filled sacs (cysts) and precancerous lesions of the cervix, such as small areas of  abnormal tissue (cervical dysplasia). Cauterization is used to treat cervical lesions caused by human papilloma virus (HPV) AS 80% of cervical cancers are associated with HPV. It may also be used to stop bleeding that is occurring either spontaneously or following a cervical procedure such as cervical biopsy, cervical polypectomy or cervical conization. Cervical cancer itself is not treated with cauterization but by more aggressive means including surgery and radiation therapy.

Contraindications

Acute cervicitis, vaginitis, pregnancy, acute pelvic inflammatory disease and suspected early invasion carcinoma of cervix under evaluation.

Procedure

Cauterization is performed in outpatient surgery centers and hospital. The woman lies on the exam table in lithotomy position. A speculum is inserted into vagina to hold it open to allow visualization of the cervix. The cervix is cleaned using a vaginal swab that is soaked in a salt solution (saline). Using a lighted, magnifying instrument (colposcope), the vagina and cervix are carefully examined for signs of inflammation or abnormal surface patterns. To allow visualization of abnormal surfaces, a solution of acetic acid is applied to the cervix. The acetic acid turns precancerous and cancerous regions of the cervix white (acetowhitening). A surface anesthetic or cervical nerve block may be administered a few minutes prior to cauterization. Cauterization is performed on any abnormal-appearing regions of the cervix. The method chosen depends on the experience of the physician, availability of necessary equipment and extent and location of lesion.

Electrocoagulation diatherapy uses electric current to destroy tissue. The current is delivered to the tissue through needle or ball electrodes. Electrocoagulation diathermy of deep cervical tissue requires general anesthesia. The most common office procedure for these conditions is Loop Electrical Excision Procedure (LEEP). The excision is done with an electrical wire so that precise control of the excision and electrocoagulation for hemostasis are accomplished. Injection of local anesthesia is necessary for this to be done in the office setting. Sometimes general anesthesia is required.

Chemical cautherization is used to treat cervical cysts, precancerous erosions of the cervix and cervicitis. The area to be cauterized must be dried using a cotton swab to prevent the chemical from trickling onto normal tissue. A cotton swab that has been moistened with the chemical cauterant (e.g biochloracetic acid) is touched to the cervical lesion. Cervical cysts would be punctured before application of the cauterant. After a few minutes the cauterized area is wiped with a dry swab to remove any residual chemical. Laser cauterization (laser vaporization) is an effective treatment of all cervical dysplasias including those that are too large for cryocauterizatiuonand those that slightly extend into the cervical canal (endocervix). Because of the expense of laser cautery equipment, most laser cauterizations are performed in outpatient surgery centers and hospitals and frequently involve general anesthesia. Laser cauterization is carried out by aiming a carbon dioxide laser beam at the cervical dysplasia. Because of the fine degree of control over the depth and width of tissue destruction, the laser can precisely vaporize the dysplasia while leaving adjacent normal tissue intact. A smoke evacuator is utilized to remove smoke from the vagina. Antibiotics and analgesics are prescribed as needed.

After-treatment

            Inform the patient that there will be excessive vaginal discharge for about 3 weeks. Abstinence from sexual intercourse for 3 weeks. Vaginal pessary or antiseptic cream is usually not necessary. Only if the discharge becomes infective they are indicated. Follow-up after 6 weeks: (1) If erosion has not healed completely repeat cauterization is indicated. (2) Pass a uterine sound to check that cervix is not stenosed.

Prognosis

            Electrocoagulation has a high success rate and is associated with a recurrence rate of 3% to 14%. Chemical cauterization has a high success rate for mild dysplasias. Laser cauterization has a high success rate and a recurrence rate of 4% to 23%.

Complications

            Complications associated with cervical cauterization include uterine cramping, lightheadedness, hot flashes and headaches (vasomotor reactions), profuse watery vaginal discharge, bleeding (hemorrhage), upwardly spreading (ascending) infection and narrowing (stenosis) of the cervical canal.