34-year-old woman who consults for repeated coitorragia. She brings a cytology with a high grade intraepithelial lesion (U-SIL). Subsequently, colposcopy and biopsy were performed on a mosaic area and histology showed a focus of invasive squamous cell carcinoma of 2 mm in length. Which therapeutic option is the most appropriate for this patient?
According to the SEGO: "Excise the entire lesion so that it can be evaluated histologically. It involves excision of the entire transformation zone. In general, the excision should be adapted to the size and characteristics of the lesion. Three types of excision are distinguished according to the presence of the endocervical component of the lesion. Excision type 1 (applicable in cases with transformation zone type 1, in which the diathermic loop should not include endocervical canal or exceed 8 mm in depth), excision type 2 (indicated in transformation zones type 2, involves resecting a small part of endocervical canal visible by colposcopy) and excision type 3 (indicated in transformation zones type 3, includes part of endocervical epithelium)". When they speak of excision, it is synonymous with conization; as the lesion is less than 8mm deep, this is the indicated treatment.
Conization.
Total hysterectomy without adnexectomy.
Pelvic radiotherapy with curative intent.
Repeat a more extensive biopsy.
as the lesion is less than 8mm deep, this is the indicated treatment.