Introduction

Cervical cancer is one of the common cancers among women in Taiwan. Clinically, it can be divided into precancerous changes and invasive cancer. Studies have shown that most invasive cervical cancers develop slowly over time from precancerous changes of the cervix. Cervical intraepithelial neoplasia refers to abnormal changes in the surface cells of the cervix. It includes different levels of abnormal cell changes, as well as carcinoma in situ, which means the abnormal cells have not spread into deeper tissues.

Etiology

There is evidence indicating that 90% of HPV (Human Papilloma Virus) patients with cervical cancer are associated with early age sexual activities and poor hygiene.

Three degrees of CIN

• CIN I(mild): The surface cells show mild abnormal changes, affecting about the lower one-third of the epithelium.
• CIN II(moderate): The surface cells show moderate abnormal changes, affecting about two-thirds of the epithelium. The cells are still recognizable, but the changes are more severe than CIN I.
• CIN III (severe): The surface cells show severe abnormal changes, affecting almost the entire epithelium, but have not spread into deeper tissues.

Clinical Presentation

• Early stage: Most patients have no obvious symptoms, and cervical cancer is usually detected through a Pap smear.
• Late stage: Patients may notice increased vaginal discharge, abnormal bleeding, or bleeding after sexual intercourse.

Treatment

• CIN I: These lesions may return to normal on their own, so immediate treatment is usually not needed. Follow-up with a Pap smear every 3–6 months is recommended.
• CIN II: Local treatment can be performed, including LEEP (Loop Electrosurgical Excision Procedure) or therapeutic conization of the cervix.
• CIN III: Treatment usually involves cervical conization. If there are invasive cervical cancer or other gynecological problems, a complete hysterectomy may be needed.

Surgical Procedure

• Cervical conization is a common gynecological procedure. It is used when abnormal changes are found in the surface cells of the cervix, such as cervical carcinoma in situ. This procedure can be used for both diagnosis and treatment.

Preoperative Preparation

1. Complete the surgery and anesthesia consent forms.
2. Specimens will be collected for examination, and tests such as X-rays and electrocardiograms (ECG) will be performed.
3. Do not eat or drink anything after 12:00 midnight on the night before surgery.
4. Practice deep breathing and coughing before surgery to help prevent incomplete lung expansion after surgery.
5. On the day of surgery, change into a surgical gown. Please remove underwear, accessories, nail polish, and removable dentures.

Postoperative Care

1. This surgery is performed under intravenous general anesthesia.
2. After surgery, please follow the doctor’s instructions regarding meals. You may drink some water first. If there is no discomfort, start with soft foods such as rice porridge, and then gradually return to a normal diet.
3. This is a day surgery, and you may go home on the same day. The urinary catheter will be removed before discharge. Please make sure that you are able to urinate within 6 hours.

Plans after Discharged 

1. Return to the hospital if any of the following conditions occurs:

• Massive vaginal bleeding
• Fever to 38℃ or higher
• Severe lower abdominal pain

2. After going home, pay attention to vaginal bleeding. It is normal to have slight bleeding for 2–3 weeks. Rest well during the first 1–2 days after surgery and avoid strenuous exercise for 2 weeks to prevent excessive bleeding.
3. Do not lift heavy objects over 5 kg. You can eat normally and get plenty of rest.
4. It is also normal to have increased vaginal discharge for 2–3 weeks. If the discharge has a bad odor, or you have itching, burning, abdominal pain, or fever, return to the clinic.
5. Sexual activity can usually resume about 6 weeks after surgery, once the doctor has checked that the wound has healed.
6. A Pap smear should be done every 3 months during the first year after surgery.