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Cancer: Cervical & Ovarian Message Board
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Old 09-23-2009, 02:41 PM   #1
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Laser Ablation vs. the LEEP

Hi everyone, to introduce myself, I've just turned 25, finished school, found a great boyfriend, and have been diagnosed with cervical dysplasia (HGSIL). In 2/2009, my gynecologist found an abnormal pap (LGSIL) and in 5/2009, HGSIL was found through a couple of biopsies. In order to remove the abnormal cells, my doctor recommended the LEEP, and I, eager to fight this pre-cancer, agreed and started the process for scheduling the surgery. I was informed that it would take 6 weeks before the surgery could be done due to an anesthesia consult, processing, insurance checks, etc. In the interim, I read up on a procedure called laser ablation and found that it is the procedure with the least future pregnancy complications and quickest healing time. I was upset that my doctor didnt even mention this procedure as an option as I had asked for all the surgery options. I ended up canceling my LEEP procedure and attempted to find a doctor who performed the laser ablation, however that has been hard. Ive been trying to find a doc at John Hopkins who does it however I havent had any luck. Many do not perform that surgery and specialize in the LEEPS, cryosurgeries, or cone knifes. After reading back over this site however, I see where many people have had the LEEP done without many problems, so I am wondering if I should try to have the LEEP done instead since its so hard to find a laser ablation specialist.

I had a few questions...since it has been about 7 months since I found out about the abnormal cells, is there a good chance that it may have gotten worse?

Also, I read in someone's else's post that they'd heard bad things about the laser ablation, but she didnt comment too much on it. I cant find anything bad about it besides a lack of tissue sample to examine after the surgery. What are the cons associated with laser ablation? Do you think that the cons are worth increased fertility? Im very young and having children and a family has always been one of my biggest dreams for my future.

Im pretty nervous about this and am afraid that I will make the wrong decision or have waited too long to get this done. Please help I've been pretty positive about it for the past few months but now I am starting to get anxious and a little afraid...

 
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Old 09-23-2009, 03:52 PM   #2
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Re: Laser Ablation vs. the LEEP

I had laser ablation when per ACOG & ASCCP guidelines I should have had LEEP or cone (since +ecc), and in retrospect I feel like laser conization might have been more appropriate because that can be sent to pathology. I am having several other GYN surgeries next month, so if nothing untoward is found in my cervix, I'll be satisfied with my procedure.

The ONLY downside to laser is lack of specimen. But it can be a pretty darned big downside, so you must make sure there is no occult cancer. Relying on colpo/bx is hit and miss, in my opinion, since so many doctors are total fools and don't know how to colpo. But if you've ruled out cancer, then laser is a great option, because if you had + margins from a LEEP or cone, you'd have the same follow up as someone who had laser and no idea whether all disease was eradicated.

Good for you for researching all of your options. Most GYNs don't even know laser exists since it's been replaced by the cheaper LEEP. It requires expertise and (costly) special equipment.

Last edited by BE 123; 09-23-2009 at 03:55 PM.

 
Old 09-23-2009, 07:17 PM   #3
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Re: Laser Ablation vs. the LEEP

Pinkerbella,

I am totally with you in that I would have completely opted for laser ablation over LEEP, but my doctor didn't offer it. And thank God she didn't because the pathology from the LEEP diagnosed me with adenocarcinoma in situ when previously my diagnosis was only CIN 2.

At the time I really just want to get the procedure over with, so I went ahead with the LEEP. But I was totally worried about the preterm birth issue (not to mention the fact that I generally like my cervix!) I talked to my gyno before she did it, and I basically told her to be super conservative. The plan was to remove only a dime-sized piece of tissue. She removed only the worst area where I had CIN 2, and left the CIN 1 alone. My boyfriend looked at the tissue sample and said it about the size of a dime, folded in half. Very small, but that sample showed AIS.

I've seen a couple of studies that show that LEEP actually doesn't increase the risk of preterm birth if they remove less than 1 cm. I think there was one that even showed that it was 1.5 cm. My LEEP only removed 2mm. Seriously, I can't even imagine that 2mm could have possibly interfered with anything.

I guess what I'm saying is that while I totally understand the appeal of the laser, looking back, I totally support getting a very conservative LEEP instead. Even if they don't remove the whole lesion, the LEEP is something like 80% curative.

Obviously this is just my opinion. I am totally annoyed by the fact that the laser just doesn't seem to be done anymore! We should have choices in our treatment! Still, I've kinda come to the conclusion that the LEEP really is better than the laser.

Good luck!

 
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