Simple Hysterectomy

A simple hysterectomy is indicated if the conservative treatment has failed and there is extensive involvement of cervix and vagina. It may also serve as a definitive management of microinvasive carcinoma stage IA2 or of ACIS.

More invasive procedures (radical surgery) may be appropriate but depend on clinical staging and/or type and origin of the tumor in question.

The value of a colposcopically directed biopsy prior to excisional treatment has been debated. The reproducibility and the accuracy of the histological result of this method have been questioned, also the cost-effectiveness and the amount of time between initial positive result and treatment. It has been shown that there is a correlation between the biopsy result and the subsequent histology result, but there is an inherent inaccuracy between the two diagnostic modalities (Barker et al. 2002). Furthermore the correlation between the initial cytology result and the histology result by LEEP can be higher than the correlation between cytology and colposcopically directed biopsy (Berdichev-sky et al. 2004). Therefore it is understandable that a "see and treat" protocol with LEEP being performed at the time of colposcopy has been advocated for high-grade lesions detected by cytology (Ferenczy and Wright 1993; Fung et al. 1997). But overtreatment for less severe lesions should be avoided (Dodson and Sharp 1999).

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