My daughter's gynecologist says hysterectomy is not usually recommended but if it is destined to progress why not do it now rather than wait?

Hi, it is difficult to determine what the margins look like after a LEEP procedure as the margins are "burned" in the process. Treatment options fall into one of two main categories: procedures that ablate the abnormal tissue; these do not produce a specimen for additional histologic evaluation, and procedures that excise the area of abnormality; these allow further histologic study. Clinical trials comparing the different treatment modalities have not found that any treatment is significantly more successful than another. Regardless of the modality used, the entire transformation zone should be eliminated. Hysterectomy should not be performed as an initial treatment of CIN 2,3. The incidence of death is significantly higher with hysterectomy than with the less invasive treatment options. If your daughter wants to have a family then a hysterectomy will not be the best option. There are, however, some indications for which hysterectomy remains a valid treatment option for CIN such as if the Conization specimen margins that are positive for CIN 2,3, especially in the setting of completed childbearing and expected poor compliance with follow-up. In most cases, however, the treatment of choice is close clinical follow-up or, in select cases, reexcision to exclude an invasive cancer instead of hysterectomy. Hysterectomy should generally be reserved for those in whom a repeat excisional procedure is not technically feasible or where the cervix and vagina are scarred in a way that severely compromises the reliability of cervical cytology and close clinical follow-up. Thanks for your question - you are close to some excellent resources in your area such as the Penn State Hershey Cancer center (http://pennstatehershey.org/web/cancer/home) and I hope this helps.
Simeon Jaggernauth, DO.

http://www.DRJAG.com

Hi, it is difficult to determine what the margins look like after a LEEP procedure as the margins are "burned" in the process. Treatment options fall into one of two main categories: procedures that ablate the abnormal tissue; these do not produce a specimen for additional histologic evaluation, and procedures that excise the area of abnormality; these allow further histologic study. Clinical trials comparing the different treatment modalities have not found that any treatment is significantly more successful than another. Regardless of the modality used, the entire transformation zone should be eliminated. Hysterectomy should not be performed as an initial treatment of CIN 2,3. The incidence of death is significantly higher with hysterectomy than with the less invasive treatment options. If your daughter wants to have a family then a hysterectomy will not be the best option. There are, however, some indications for which hysterectomy remains a valid treatment option for CIN such as if the Conization specimen margins that are positive for CIN 2,3, especially in the setting of completed childbearing and expected poor compliance with follow-up. In most cases, however, the treatment of choice is close clinical follow-up or, in select cases, reexcision to exclude an invasive cancer instead of hysterectomy. Hysterectomy should generally be reserved for those in whom a repeat excisional procedure is not technically feasible or where the cervix and vagina are scarred in a way that severely compromises the reliability of cervical cytology and close clinical follow-up. Thanks for your question - you are close to some excellent resources in your area such as the Penn State Hershey Cancer center (http://pennstatehershey.org/web/cancer/home) and I hope this helps.
Simeon Jaggernauth, DO.

http://www.DRJAG.com