My approach to treatment
In recent decades, the association between surgical treatment (conization, LLETZ) of pre-cancer of the cervix (CIN 1 to 3) and the increased risk of preterm birth has been well researched. It could be shown that the risk increases with the number of conizations or LLETZ procedures. At the same time, more and more studies have shown that precancerous diseases of the cervix can be treated very well without surgery. This has prompted the American Society of Colposcopy and Cervical Pathology (ASCCP) to classify non-surgical and surgical treatments as equivalent in their guidelines.
On average, it takes 15 to 20 years for a CIN 3 to develop into a carcinoma. The peak age for cervical carcinoma is around 50 years of age. For this reason it can be said that cervical carcinomas are almost never observed before the age of 25 and that surgical treatment is therefore to be viewed particularly critically in this age group. On the other hand, in women around the age of 50, special caution is required when treating CIN 2/3 in order not to overlook an early carcinoma. If in doubt, surgery should be given priority in this age group.
Peeling treatment with trichloroacetic acid
Trichloroacetic acid (TCE) is a very potent acid and can be used in various concentrations. When TCE is applied to body surfaces, the surface cells perish and slough off. These peeling treatments have been used in medicine but also in cosmetics for a long time. TCE is available in various concentrations from 30% to 90% solution. In cosmetics, TCE peeling treatments are used to remove calluses (“peeling”). In medicine, TCE peels are a treatment option for some diagnoses. TCE peels are a good way to treat genital warts in pregnancy because TCE is not toxic to the embryo. Furthermore, early squamous cell carcinomas and basal cell carcinomas of the skin can be treated with it. TCE peelings are now one of the standard therapies for dysplasia (precancerous diseases) of the anal canal (AIN).
Due to the excellent treatment results of anal cancer precursors with TCE 85% with a success rate of approx. 70%, I have started to offer this therapy in my practice for the treatment of CIN 1-3. In a retrospective analysis of 240 patients in 2016, we were able to show that after a single application of TCE came a complete disappearance of the CIN in 82% of the women. Further analyzes finally showed that if the CIN was not gone after the first treatment, a second treatment improves the success to approx. 92%. These results were so convincing that I routinely offer the treatment with TCE 85% in my practice.
In my practice I have already treated over 1000 women with dysplasia of the cervix of varying degrees of severity (CIN 1 to 3). The treatment is generally very well tolerated and takes place under local anesthesia. A burning sensation or cramps are often observed. After the treatment, patients rated the perceived pain on the 10-point visual analogue scale (VAS). The extent of pain from the treatment averaged around 2.5. A transient drop in blood pressure (circulatory weakness) is very rarely observed.
Treatment with the immunomodulator
In my practice, I have been consulted again and again for many years by women who have been suffering for a very long time due to their HPV infection. While the majority of all patients overcome the HPV infection after therapy for pre-cancerous disease of the genital tract, the HPV infection persists in some patients. As a result, recurrences often develop, not infrequently at the same time in a wide variety of places, such as the vagina, the vaginal entrance, the cervix and the anal canal. Some of these so-called “HPV victims” have already had many operations in the genital area with considerable mutilation.
In 2008 I started to develop a treatment concept for these very stressed patients that allows the immune modulator with the molecular formula C14H16N4 to be used in the vagina in a safe way with few side effects. The immune modulator was previously tested against precancerous diseases (dysplasia) of the anal canal (AIN) and the vaginal entrance (VIN). I have now treated many patients in this way and the success of the treatment is promising.
Following these initial successes, I also treated patients with less severe problems, such as women in whom HPV was still detectable after CIN therapy. After a successful treatment of the CIN, regardless of the method used (LLETZ, TCE, laser, cold, etc.), the HPV is also successfully treated in over 90% of the patients and is no longer detectable. If HPV is still detectable after CIN therapy, there is an increased risk of CIN recurrence. In such cases, an 8-week therapy (twice a week) with the immunomodulator can in many cases treat the HPV successfully.
In order to scientifically back up these results from my practice, I began a scientific study in 2009 together with my staff from the clinical department for general gynecology and gynecological oncology at the University Clinic for Gynecology at the Medical University of Vienna (MUW). Patients with CIN 2 and CIN 3 were treated with local application of the immunomodulator with the aim of preventing surgical intervention. After 16 weeks of treatment, 75% of the patients had improved to such an extent that surgery was no longer necessary. In 46% there was a complete healing and in an additional 30% the finding improved to CIN 1. The therapy improved the patient’s immune system to such an extent that the HPV infection could be overcome and the virus was no longer detectable was.
The results have been published in the top US journal Obstetrics and Gynecology and commented on and highlighted by world-renowned researcher William C. Dodson, MD. The publication itself can be found here (Paper, PDF).