- The Issues Required To Pay Attention In The Early Post-Operative Period:
The most important fact in post-operative period is to follow the prohibitions. Sexual intercourse should not be had for 1 month, you should avoid activities, which will cause filling of water into your vagina such as going into pools, sea, thermal hot spring or bathtub.
You shouldn’t run for the first week after conization. Perineum movements are the reasons for it. As a result, LEEP conization is a procedure performed by excessively heating a thin wire. Cervix is an organ, in which bleeding occur too much. By this means, it may renew itself even if it is by connective tissue. Excessive movements in the first week may cause cervix to move too and bleeding in the early period. However, there is no obstacle for you to continue your normal life.
- Follow-Up In The Patient With Routine Negative Limits
The facts determining the control frequency are the statuses of surgical limits, whether glandular epithelium is uptaken and HPV typing. However, the most ideal observation is to receives mear 1 time in 6 months and at the same time to make HPV typing.
The problem is that it is expensive in the conditions of Turkey. Receiving smear once in 3-4 months and making HPV typing at the end of 1 year may also be preferred.
In a study published in 2011, the recurrence risk of the disease in the patients with negative smear+HPV typing in 6th month is found 1.8% and the recurrence risk of the disease with CIN II, III or more advanced lesion found 45-60% if both of them are positive. And it is really high risk. (Kocken M, Helmerhorst TJ, Berkhof J. et al. Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study. Lancet Oncol. 2011;12(5):441.)
Another question continuously asked by the patients is how many years the follow-ups would take.
The studies show that there is to risk of recurrence of the lesions for 20 years in a female, in whom lesions such as high risk in other words HGSIL or CIN 2 CIN 3, adenocarcinoma insitu are detected. Even if the patient passes age 65, the follow-ups should continue by annual smear or HPV typing. This status is not valid for CIN 1.
- Follow-Up In The Patients With Positive Conization Limits
Many factors affect follow-up and treatment ways in this patient group. The follow-ups of the patient are shaped by his/her age, fertility, demands. General attitude is not to touch for the first 3 months after conization and then re-evaluate the patient.
It will be appropriate to perform endocervical curettage after 4 and 6 months (taking biopsy from cervical canal), to receive smear and to evaluate with colposcopy. This period is quite appropriate. Because the tissue under the canal recovers by growing upwards/outwards while cervix recovers. Therefore, if there is problematic tissue below, this tissue will also come outwards, so making diagnosis will get easier.
However, in case the lesion of the patient is CIN 3 or insitu cancer, colposcopic biopsies will be performed at the end of 3 months and conization may be repeated.
On the other hand, if the results obtained by these diagnosis methods we have listed are positive, in this case conization may be performed if the patient has the demand to become pregnant, if she has completed her family and has high risk, hysterectomy (operation of receiving uterus) may be applied.
It should be emphasized that the decision should always be taken with the patient by appropriately explaining the risks to her without exaggerating or vice versa without showing as unimportant.
It is important that unnecessary operations are avoided. However, if there is risk, possible situation should be clearly demonstrated and the necessary things should be performed as her gynecologist.
- Observation Of The Patients, Whose Uteruss Are Removed Due To CIN , CIN or In situ Cancer
The risk of development of VAIN, in other words vaginal in situ neoplasis is very very low in these cases. Therefore it is sufficient to monitor the patients by annual smears.
Recommendations To Cases, In Whom Precancerous Lesion, Cervical Intraepithelial Lesion Are Detected In Cervix, During Treatment Process
- Your husband or boyfriend should use condom and the issue should be evaluated by a doctor :-). SIf you have CIN 3, high risk HPV frequency of your partner is about 58%. After the treatment, the condom should be used for at least 6 months, the ideal is for at least 1 year exept for the couples desiring to have child. If you ask me, I also evaluate the husbands of my patients 🙂
In a study performed, while the rate of removal of HPV from the bodies of the females in terms of the couples using condoms after the treatment is 96%, this rate decreases to 77% in terms of the couples, who do not use condoms, in other words it reduces at 23% rate. Thus, please absolutely use condom (rubber). (Hogewoning CJ, Bleeker MC, van den Brule A.J. et al. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial. Int J. Cancer. 2003;107(5):811.)
- HPV vaccines
HPV vaccines are not therapeutic. However, the studies recently conducted has shown that the vaccines prevent re-infection at least in terms of HPV types they include just like the condoms (by the way, they may not prevent as much as condoms), so they may be performed. In a study published in 2013, the frequency of relapse in the ones, who have been vaccinated after conization, in the patients observed for 3.5 years in average, containing and carrying HPV type 16, 18 and having HGSIL is detected as 2.5% and it is detected as 8.5% in the ones, who have not been vaccined.
However, this issue is speculative and needs more researches. (Kang WD, Choi HS, Kim S.M. Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)? Gynecol Oncol. 2013 Aug;130(2):264-268.)