CKC (Cold Knife Conization) - This procedure is a type of cone biopsy and involves the removal of a cylindrical or cone-shaped specimen from the cervix. The specimen includes the transition zone (area where cells change from squamous cells to glandular cells) and all or part of the endocervical canal. This procedure typically involves more bleeding than when LEEP is used and involves general anesthesia.
Colposcopy - While most people are familiar with this procedure being performed on the cervix, a colposcopy can be performed on the vagina and also external genitalia including the anal region. A solution of acetic acid (the equivalent of table vinegar) is swabbed over the affected area and the doctor uses a colposcope to microscopically observe the area. The acetic acid causes the cells to fill with water thus reducing the flow of light through the cells. As a result affected cells show up as white areas. The whiter the area the worse the dysplasia.
Cone Biopsy - This is an extensive surgical biopsy of the cervix. It is referred to as a "cone" biopsy because it removes a cone shaped area of tissue from the cervix to later be examined under a microscope. The doctoral will typically take a small area of normal cells surrounding the abnormal lesion to provide for margins free from disease/abnormality. The procedure can be performed under general anesthesia, local anesthesia only numbing the genital area or, if performed using LEEP utilizing a numbing agent applied to the cervix. An oral or intravenous pain medication may also be given with a local anesthetic.
Cryosurgery - This procedure utilizes liquid nitrogen to freeze the area of abnormal tissue for removal. It can be used to remove genital warts caused by low risk HPV types and to remove lesions caused by high risk HPV types as well. The procedure is usually performed in a doctor's office however no abnormal tissue can be salvaged for analysis.
ECC (Endocervical Curettage) - This procedure utilizes a curette (spoon shaped device) to remove a tissue sample from the endocervical canal, the area between the cervix and the uterus. The tissue sample can then be sent to the pathology lab for analysis. Similar to a PAP the procedure can be performed during a colposcopy and only takes a few seconds to obtain the sample. Some cramping or pressure may be felt during the procedure.
In situ hybridization (ISH) for HPV DNA - This laboratory procedure assists in determining the types (strains) of HPV which you may have. The nucleic acid contained within the cells is tested for sensitivity to specific "probes". An example of this is the HPV 16/18 probe, or HPV 31/33/35 probe. It can also detect low risk HPV strains. If someone tests positive for types 6 and 11, they should still receive the Guardasil shot as it can aid in the prevention of HPV types 16 and 18 which are covered by the vaccine and account for 70% of all cervical cancers.
Laser Ablation Surgery - Use of a laser (typically CO2 laser) to vaporize abnormal tissue. No specimen remains for testing purposes after this procedure. It has also been shown that vaporized HPV virus has been found in the air within surgical suites when performing ablation for HPV lesions. Surgeons must be cautioned to utilize protective devices to prevent inhalation of these particles from the surrounding air. Laser ablation can be used on the cervix, vagina, anal and perianal area. It is also useful in other conditions but we will limit our discussion to its uses relating to HPV treatment.
LEEP (Loop Electrosurgical Excision Procedure) - This technique uses a thin low-voltage electrified wire loop to cut out abnormal tissue. LEEP can cut away abnormal tissue in the cervix seen during colposcopy. It can also remove tissue high in the cervical canal which cannot be seen during colposcopy. This may be done instead of a cone biopsy. While the LEEP is typically performed on the cervix, the procedure can also be used for other areas.
Pap Test - Thus test is named for Dr. George Papanicolaou who developed the it. It is a screening tool which can detect certain viral conditions (such as HPV) and other cancer causing conditions. The Pap test is usually performed in conjunction with a pelvic examination. It involves removing a small sample of cervical cells using a scraper or small cervical brush. While typically not painful, some discomfort or "pressure" may be felt during the procedure.
Trachelectomy - This is a surgical procedure which removes the cervix and lymph nodes. After surgery a cerclage is performed to close the lower uterus. While this procedure allows for a woman to maintain her fertility, there are high rates of miscarriage and early delivery. Typically a C-section would be performed for delivery after a woman has undergone a trachelectomy. This is usually the treatment option for young women with early stages of cervical cancer (IA2 or IB1). Most doctors have limited experience with this procedure and therefore it is not commonly used.
