cervical dysplasia: Cryosurgery vs. laser ablation?

Hello, I recently was diagnosed with cervical dysplasia from HPV. I don't know what strain or level of dysplasia I have. So my Dr. scheduled an appt for Cryosurgery on 6/27/08. when I went in for the biopsy I was told that there was a very small faint area that was abnormal. I've reading online the side effects of this procedure and the other options avail. I'm not sure if my dr. does the laser ablation (maybe due to cost) but read that it is the most effective procedure to remove any bad cells and less cervical scarring, also if I have a reocurrance it will be easier to treat 2nd time around. If My Dr. does not offer the laser ablation should I maybe ask for a Dr that does or try to find one? I'm only 23yrs old and to have this so earily is very scary and depressing. I worry that it could reocure and I would regret not having gotten the best treatment avail in the 1st place. Does anyone know if I would be able to recieve the laser ablation through another Dr. than the one treating me without going through the whole process of testing again? I have very good health Ins. but do not know if i would be covered to have to re do all over again within 6 wks.

Hi Greenfairy! I'm not sure about cryosurgery or ablation.

I *do* know that if you go for a second opinion(which I what I think you are asking about at the end of your message) you would have your first doctor send his/her notes, biopsy/pathology reports, and possibly the slides/images from any tests he/she has performed. That way the second doctor doesn't have to retest the same things. The second doctor might want some additional tests, but those results should be shared with any doctor you request they be shared with.

Since you are so young, you need to be sure to let your doctor know if you are desiring preserving your fertility. That will help you and your doctor make the best decisions.

You sound anxious, which is understandable. If you aren't totally sure as to why you are having the procedure you are having, either get back to that doctor and ask more questions (if you are comfortable with him/her) OR get a second opinion. After the second opinion, you can decide who will do your procedure: doctor 1, doctor 2, or go for doctor 3 (if insurance will cover it - or if you feel you need it).

I think many doctors agree on procedures, but some have preferred procedures, or they are more skilled at certain procedures.

For example, I had a cold knife cone biopsy. Most people (from what I've read on this board) have a LEEP. The LEEP has a more rapid healing, and I think takes less of the cervix, but it doesn't preserve the margin on the tissue sample like a cold knife cone biopsy can. Since my doctors strongly suspected cervical cancer for me, we went with the cold knife. Later, I learned the doctor basically did a LEEP after the cone to singe the edges of the tissue to speed healing.

I don't know if I've answered any of your questions. I hope I have offered some suggestions though on second opinions.

Let us know how things go!

Originally Posted by greenfairy84

Hello, I recently was diagnosed with cervical dysplasia from HPV. I don't know what strain or level of dysplasia I have. So my Dr. scheduled an appt for Cryosurgery on 6/27/08. when I went in for the biopsy I was told that there was a very small faint area that was abnormal. I've reading online the side effects of this procedure and the other options avail. I'm not sure if my dr. does the laser ablation (maybe due to cost) but read that it is the most effective procedure to remove any bad cells and less cervical scarring, also if I have a reocurrance it will be easier to treat 2nd time around. If My Dr. does not offer the laser ablation should I maybe ask for a Dr that does or try to find one? I'm only 23yrs old and to have this so earily is very scary and depressing. I worry that it could reocure and I would regret not having gotten the best treatment avail in the 1st place. Does anyone know if I would be able to recieve the laser ablation through another Dr. than the one treating me without going through the whole process of testing again? I have very good health Ins. but do not know if i would be covered to have to re do all over again within 6 wks.

What kind of doctor are you seeing - a routine gyno or an gynocological oncologist? If you had a biopsy that you most certainly should be able to find out what stage your cervical dysplasia is at! I was not offered laser and I've read some negative things about it actually and that it is rarely used.

After i found out i had a 2nd abnormal pap and had highrisk HPV from my routine gyno - who recommended a colposcopy - - I went straight to a gynocological oncologist for my colposcopy and biopsy. Once results were in i got a copy of the path report and spoke to him over the phone. I had CIN II - and whether I had CIN II or III - he recommended a LEEP which is what I had. He also said regardless of my age or potential plans to have a child (I am 42 and have never had kids) he would recommend the LEEP.

I had my LEEP 3 weeks ago today - under sedation, basically I went to sleep but it was not general anesthesia and I did not require a breathing tube. I had NO complications or side effects - the ONLY evidence I had of the surgery was the stuff they use to prevent bleeding - which came out a week later and very moderately - i never even spotted. I got my results a week after the procedure - and he got totally clear margins, all was fine.

I return in one more week for a recheck of him to just look at the cervix to be sure I am healing - and I can then resume all other activities (using tampons, taking baths, swimming and intercourse.)

When I go next week he will tell me when I am to return for my next pap - but I think it will be 3 months.

From what i've read cryo is typically used for very very moderate dysplasia - CIN I only - - or used for warts if you have lowrisk HPV. If you have doubts I'd seek another opinion before going ahead with it.

Best - Mel

Please do not go for the cryosurgery! I had and had normal paps after that and I thought everything was great untill I had to switch doctors and the new doc said that the cryo can hide bad cells under new normal cells, so he did a scrape of the canal and found cancer I had a hyst 4 days later on May 13th.

Hawleycat, am I reading your post correctly. Did your doctor find your abnormal cells after doing an ECC? That's how my doctors found mine. I've never (NEVER) had a bad pap. I had the colposcopy and ECC only because I showed positive for high risk HPV.

What kind of hyst did you have?

I had a total abdominal hyst (cervix and uterus) I had an abnormal pap last year CIN ll dysplasia, he did a cryo on me and my paps were normal after that - i had to change doctors because of my schedule at work and the new doc said he would like to do a ECC to check for cells the pap may not pick up because normal cells will grow over the bad ones, sure enough if he had not done that the pap would be normal like the other ones and he would have released me back to once a year. So I am very grateful to him.

That is similar to my story. My gyn did the ECC only because there weren't any abnormal cells anywhere else. I thank God she did it! Prior to that, my general physcian did the HPV test because she was ready to put me on an every-3-year schedule for paps. I thank God she did the HPV test before changing me from annual paps!

I tell you what, I swear by the ECC!

Wow..I never thought of that. I had cryosurgery done last yr and a normal pap 4 months after that ...it came back normal..now I am scared that I could have bad cells covered up by new good ones...I have to wait to have any tests done as I am now 9 months prego. So what test should I ask for to check to make sure it got everything when she did the cryo on me?? I also have like 3 friends who had cryo done for the same thing...this is scary.

Hi I am new to the boards and If I can help anyone with my story I hope it will educate all the ladies going thru the same thing.

I had the hpv virus for most of my adult life, I had leeps done twice I had the freezing, and then I had the cone twice.

I just yesterday had the laser to which I am so upset if I had known all these years that I could have opted to find a doctor who used the laser I would have done it in a heart beat.

The laser is the most efficient and least amount of pain and recovery but not only that it also is the least intrusive it damages/remove less tissue so therefore you have more cervix to live with as the journey never ends with this horrible virus.

I thought I would be in worse pain, as I had just went thru the cone just two months ago....

The Laser is the least pain I had ever suffered in any of these procedures, the cone was so painful and also were all the other procedures except for the laser it is the least uncomfortable and least abrasive to us.

My gyn never saw or knew I had the virus growing on my walls of my vagina therefore by the time I had the cone done two months ago the virus had spread to the top third of my vagina into cn3 as per the biopsy. The problem was using the metal speculum in my vagina the gyn doctor never saw the infection section under the metal spculum. It was only when my new doctor saw with the plastic speculum that there was an infected section on the upper part of my vagina against the walls.

so within two months I was at cn3 again, and yesteday as I said I had the laser. If anyone has to go thru any of this type of procedure please go and find a doctor who uses laser I wish I had known about this years ago I would now have more of my cervix and not have the virus growing on my walls.

I only hope this helps some other women out there, best wishes ang

Angvig, thank you so much for sharing your experience with laser. I agree with your assessment of the treatment options and also had laser for cervical dysplasia. Ang, do you mean that after your cervical issues resolved, you had severe vaginal dysplasia? That would be vain3, the vaginal equivalent of cin3. Was your last operation laser to treat the vain3? Did you ever have any symptoms of vaginal dysplasia? All the best to you.

That is the problem I was at cn3 two months ago and my normal gyn doctor opted to do cone. Once I was in the operating room, she then took other samples and saw the odd spot on my walls and took samples from that also to which the outcome was: cervical was cn1 which means she was not able to get all the area removed and then sample from the wall of my vagina was cn3 or vain3.

so the is when I was referred to another doctor who is an oncolgist gyn, he then took a look and was going to take a sample but could see with his eyes that I was covered on my upper third with displasia.

So the surgery yesterday was to laser the cervix and the vaginal walls.

So what bothers me is that my original gyn whet in and still did all this removal of my cervix even thought she knew that the walls were affected instead of just having me see the specialist she opted to remove a big chunk of my cervix and weeks of recoveray and an entire week of pain, to only be in this spot a month and half later.

Is it better to always ask for laser instead of cone/leep? is laser the least amount of pain with recovery?

Is ECC the best way to ensure that there are no abnormal cells, I had paps for years and then all of a sudden I came back with a cn3 pap, probably with the ecc it would have been caught much faster correct?

Thanks so much.

Okay, so I think laser ablation is a great option, but I'm really glad it was not offered to me. From everything I've read, it seem to have better recovery and it doesn't cause an increase in preterm birth like LEEP.

However, it has a HUGE drawback is that the tissue is destroyed and so it cannot be biopsied. I definitely would have opted for laser if it had been offered, but then I would not have discovered that I had adenocarcinoma in situ! Thank goodness I had a LEEP!

The ECC catches glanular abnormalities which occur further up in the cervical canal. It probably would not have caught your CIN earlier. CIN develops along the "transformation zone" which is exactly the place that the pap smear scrapes.

I think a lot of us here are ECC proponents because a lot of us have glandular abnormalities. Even during the colposcopy glandualr stuff is not easily seen by the visual examination. I think that's why a lot of us think, when they're already in there doing the colposcopy, just do an ECC as well to make sure.

That makes me so angry...she should have sent you straight to the specialist so he could take care of everything in one surgery. Did the specialist biopsy the vaginal wall spot before lasering to confirm it was vain3 or less? Lily is right that the one main drawback of laser is the lack of specimen. I was really concerned about this as well. I had ectocervical dysplasia as well as +ECC so I should have had LEEP or conization for specimen analysis, but I took my chances with laser. Seven months after my laser I have slight spotting and bloody discharge in between periods whenever I urinate and never seem to fully finish a period so I hope I did not make the wrong decision, especially since paps are so imperfect I sometimes wonder if they're worthwhile, and the sensitivity of the hpv test is not high. Ugh.

Yes I am so angry about the other gyn she probably knew by just looking that I was not a candiate for a leep but she proceeded to do so anyway and then as soon as the sample testing came back which was 5 days she told me I needed to go to a specialist. She told me that my margins were at cn1 not cn3 anylonger. I think it was all about $$ she proceeded to do the surgery since I was already in the operating room and then stated I had vain3 in the vagina.

So what should I do about the laser how do I no if I will be ok? The doctor who did the laser claims he got clear margins before I left the hospital. So does that mean they can no longer get samples that are accurate?

thanks,