Depth of Necrosis in Normal Cervical Epithelium After 85% Trichloroacetic Acid (TCA) Application
Status:
Recruiting
Trial end date:
2021-10-01
Target enrollment:
Participant gender:
Summary
Early detection and treatment of precancerous lesions are the pillars of cervical cancer
prevention. Cervical Intraepithelial Neoplasia (CIN) is a precancerous lesion that
histologically can be found in one of three stages of development; CIN-I (low grade), CIN-II,
or CIN-III (collectively called high grade), depending on the proportion of the depth of the
lesion to the thickness of the cervical epithelium. The higher the degree of CIN, the deeper
the pre-cancerous lesions are found in the epithelial lining of the cervix. Therefore, from
the point of view of precancerous lesions treatment, its effectiveness will be determined by
the ability to eradicate all high-grade lesions. In other words, it has an effect that can
reach depths beyond the depth of the high grade lesion.
According to a study in the US (1982), as many as 99.7% of CIN-III cases had a lesion depth
of less than 4.8 millimeter. Furthermore, a Netherlands study (1990) stated that as many as
99.7% of CIN-III cases had a maximum lesion depth of 3.6 millimeters. While in subjects from
developing countries, study from Peru (2018) showed that 93.5% of CIN-III cases have a lesion
depth of less than 5 millimeters. Based on the results of these studies, a treatment for CIN
can only be said to be effective if it can create a therapeutic effect which can reach depths
of 4-5 millimeters in cervix epithelial.
Trichloroacetic acid (TCA) is an acetic acid analogue, which has long been known as a
chemical peel and also frequently used to treat genital ward and precancerous skin lesions.
The effect of TCA therapy is the destruction of the epithelium forming epithelial necrosis,
followed by re-epithelialization of the supporting tissue and stimulation of collagen
synthesis within approximately in 24 hours. There are no studies regarding the depth of
cervical necrosis that can be achieved by application of this solution to the cervix
epithelial.