Cervical Disease and Non-Surgical Treatment

Currently if you have an early precancerous change of the cervix, or cervical intraepithelial neoplasia, or CIN, the treatment, is to watch if very early, and then if it advances to moderate or severe disease (II or III) is to surgically remove the abnormal area. This is done with a LEEP or a freezing called cryosurgery. A group of researchers from Bochum, Germany and Vienna Austria have looked into using Imiquimod for the treatment of pre-invasive cancer of the cervix. This is a medication used for the treatment of genital warts caused by HPV, and marketed as Aldura, and we have written on some of this progress in prior posts. Most of the topically applied medications for HPV caused genital warts are locally destructive medications that essentially burn off the warts. Imiquimod is different because it works locally on the immune system to enhance the body's ability to reverse the changes of the cells that HPV has induced to effectively resolve the infection. A group, headed up by van Seters, reporting in the New England Journal of Medicine in 2008 has already reported treating vulvar intraepithelial neoplasia (VIN), which is a precancerous change of the vulvar tissue due to HPV, using imiquimod. The treatment involved applying medication in a suppository, almost daily, for 16 weeks. Treatment success was measured by performing HPV tests and cervical biopsies at the end of 20 weeks in the study. The researchers studied over 50 women and about 73% had their severe or moderate dysplasia regress to mild or resolve, and about 39% of those with placebo had regression. About 60% of the women treated had their HPV tests go negative, and only 14% of the placebo group had their test go negative. A worrisome issue was at the end of the study biopsies the patients underwent conization treatment to look more completely at the tissue. There were three cases in the placebo group found to have microinvasive cancer in the conizaitons, stressing that biopsy alone may not always able to accurately determine the extent of the disease. During the study it should be said that women with the HPV 16 virus did not clear their virus with placebo treatment, confirming what we have emphasized to patients that it is more likely women with HPV 16 are going to keep their infection. The suppositories used were made by the research team and are not available for general use, but this research is very promising as a possible surgical alternative.

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