Referat

Precancer Lesion and Usage of

Trichloroacetic Acid

Presented by
dr. Ahmad Triadi
04052771420007

Obstetric and Gynecology Departement

Dr. Mohammad Hoesin Hospital Palembang
Medical Faculty of Sriwijaya University
2017
Mentor
Dr. H. Patiyus Agustiansyah, Sp. OG(K), MARS

Moderatore
Dr. H. Agustria Zainal Saleh, Sp.OG (K)

Presentation at
on Thursday, 6th July 2017
OUTLINE
INTRODUCTION
PRECANCER LESION
TRICHLOROACETIC ACID (TCA)
TCA IN TREATMENT OF NIS
SUMMARY
CHAPTER I INTRODUCTION
 Precancer lesion or CIN 250.000- 1 CIN progression to invasive
Cervicalis Intraepithelial milion/year in USA cancer (2thmost common
Neoplasia (CIN) is dysplasia
CIN48/1000 in Nigeria cause of death cancer
premalignant cervical
(37,6 years) among woman)
squamous cells

Application topical 75% &

To circumference
80% Trichloroacetic acid
complication from both,
(TCA) on ectocervix and
surgical and conservative
endocervix uterine present
management, alternative
histology regression and
options for CIN are desired
remission after 4-8 weeks
CHAPTER II PRECANCER LESION
DEFINITION
CIN is premalignant lesion and dysplasia abnormal cervical squamous
cells, that is diagnosed by histology as CIN I, CIN II, and CIN III.
DEFINITION
Pap grading Bethesda Classification

CIN I Low-grade squamous intraepithelial lesion (LSIL)

CIN II High-grade squamous intraepithelial lesion (HSIL)

CIN III
 CIN
Nigeria
CIN US 48 /1000
250.000- 1
milion

Ca Cerviks
Eropa 27.000
meninggal
dari 52.000
EPIDEMIOLOGY

CIN cervical cancer 2th most

common cause of death cancer among
woman after breast cancer
ETIOLOGY
PATHOGENESIS
PATHOGENESIS
SCREENING

Primary
prevention

Papsmear
Secondary
prevention
VIA
Tertiary
prevention
Visual Inspection Acetic (VIA)

Visual inspection
The most common
of cervix uterine
screening in
after application of
Indonesia
3-5% acetic acid
 VIA
Prevent light
Membrane cell from passing
After application Increase Abnormal cell
collapse and through the
of 3-5% acetat osmolarity of contain more
space between epithelium and
acid in cervix extracelluler nuclear protein
cells become appears densely
uterine fluid than normal cell
closely white
(acetowhite)
VIA VIA

Suspected
Negative Positive
cancer

Cryotherapy
LEEP

Screening
every 3-5 Negative
years
Papsmear
Therapy

Excisional : loop electrosurgical excision

procedure, LEEP or cold knife conization
Surgical
Ablative : cervical cryotherapy, laser ablation
Therapy

Routine
Conservative
screening
CHAPTER III
TRICHLOROACETIC ACID (TCA)
PHARMACODINAMIC
There is no Safe to use during
sistemic effect pregnancy

Penetration till
dermis (according Keratolytic agent
consentration)

Adverse effect
burning sensation 1-3
minutes (VAS 3)
PHARMACOKINETIC
Metabolite oxidation
of trichloroetylene Crystalization
acid by cytocrome T = 5-7 oC
P450

Stabilize structure Easy to get

The uses of TCA
Peeling agent for
melasma ,
contangiosum
sclerotherapy and
Moluscum
varices
Therapy of
skin lesion

Telangiectasia vein
Tatto removal
CHAPTER IV
TCA IN TREATMENT OF
CIN
MECHANISMS OF ACTION

Necrotic
Protein
Strong effect till
denaturation
keratolytic reticular
and cell death
dermis
 TCA dosage
Single application topical
85% TCA on ectocervix Single application topical
and endocervix with 70% TCA on cervix uterine
wooden end of cotton tip present regression and
present regression and remission of HSIL and LSIL
remission of HSIL and LSIL after 4 weeks treatment
after 8 weeks treatment
How to use

- Patients were advised not to have sexual

intercourse for 2 weeks
Before use topical TCA applies
- to choose showering over vaseline album or others protection
bathing for 4 weeks around lesion to protect normal
tissue from irritation
- and to use sanitary pads rather
than tampons during menstruation
CHAPTER V SUMMARY
SUMMARY
Precancer lesion or Cervicalis Intraepithelial
Neoplasia (CIN) is dysplasia premalignant
cervical squamous cells CIN are caused HPV type 16, 18, and Hr-
HPV. HPV encoded oncogenic protein
To circumference complication from both, such as E6 and E7.
surgical and conservative management,
alternative options for CIN are desired

Single application topical 70%

& 85% TCA on ectocervix and
Trichloroacetic acid there is no
endocervix with wooden end of
systemic effect and safe to use during
cotton tip present regression
pregnancy
and remission of HSIL and LSIL
after 4-8 weeks treatment
THANK YOU