Pain relief for women with cervical intraepithelial neoplasia undergoing colposcopy treatment

Treatment for CIN is usually undertaken in an outpatient colposcopy clinic to remove the pre-cancerous cells from the cervix. It commonly involves lifting the cells off the cervix with electrically heated wire (diathermy) or laser, or destroying the abnormal cells with freezing methods (cryotherapy). This is potentially a painful procedure. The purpose of this review is to determine which, if any, pain relief should be used during cervical colposcopy treatment. We identified 17 trials and these reported different forms of pain relief before, during and after colposcopy. Evidence from two small trials showed that women having a colposcopy treatment had less pain and blood loss if the cervix was injected with a combination of a local anaesthetic drug and a drug that causes blood vessels to constrict (narrow), compared with placebo. Although taking oral pain-relieving drugs (e.g. ibuprofen) before treatment on the cervix in the colposcopy clinic is recommended by most guidelines, evidence from two small trials did not show that this practice reduced pain during the procedure. Most of the evidence in this field is of a low to moderate quality and further research may change these findings. Additionally, we were unable to obtain evidence with regards to dosage of the local anaesthetic drug or method of administering local anaesthetic into the cervix. There is need for high-quality trials with sufficient numbers of participants in order to provide the data necessary to estimate these effects

The Burden of Cervical Cancer in South-East Europe at the Beginning of the 21st Century

The situation of cervical cancer prevention in South-East Europe is hardly documented, in spite of the fact that it encloses the most affected countries of Europe. We estimated the number of cases of cervical cancer, the number of deaths from this malignancy and the corresponding rates for 11 countries located in South-East Europe, in the period 2002–2004. Each year, approximately 9,000 women develop cervical cancer and about 4,600 die from the disease in this subcontinent. The most affected country is Romania with almost 3,500 cases and more than 2,000 deaths per year. High world-age standardised mortality rates (>7.5 [expressed per 100,000 women-years]) are observed in 7 countries: FYROM (7.6), Moldova (7.8), Bulgaria (8.0), Bosnia & Herzegovina (8.0), Albania (9.8), Serbia & Montenegro (10.1) and Romania (13.0). A matter of concern is the increasing mortality rate, in younger women, in the countries with the highest burden of cervical cancer. Thus, appropriate cervical cancer prevention programmes should be set up without delay in this part of Europe

Diagnostic conization for cervical neoplasia during pregnancy using the CO2 laser

Cervical conization during pregnancy has been reported as a procedure with a high morbidity, The authors report their experience in triaging pregnant women with abnormal cytopathology by laser CO2 cervical conization, in a retrospective review. Out of a total of 192 pregnant women, cervical conization was performed in 24 cases for diagnostic reasons. Indications for the procedure were suspected invasive disease, unsatisfactory follow-up in patients with high-grade squamous intraepithelial lesions (SIL), a major discrepancy between cytologic and colposcopic results, or suspected glandular disease. The procedure was performed with the patient under local anesthesia, using CO2 laser. Five cases of microinvasive carcinoma and 19 cases of intraepithelial disease were found. There were negligible complications from the procedure. Intraepithelial relapse was diagnosed in 3 women during a follow-up ranging from 24 to 69 months. Although colposcopy has eliminated the need for routine diagnostic conization during pregnancy, certain patients may need to undergo the procedure. The CO2 laser in experienced hands provides an excellent means of performing it safely and effectively