Misha Cohen: Treatment of HSIL

Key Takeaways

so now I want to show you some pictures of the anal area and dysplasia and normal tissue these are photos that have come from high-resolution a NOS copy done in the dysplasia clinic at UCSF first slide here is of normal anal tissue and you'll see that there are no lesions at its normal tissue and as we go forward we can see that there's an abnormal transition zone in the anal area in this particular slide we can look at a high-grade anal lesion and then we have an anal lesion in a woman as well so we can see that there men and women are affected equally with high-grade dysplasia high-grade anal lesions so I'm going to be talking about the treatment of HS il which is basically the ability to prevent anal cancer in people who have HPV associated disease there currently is still no standard treatment of anal h SI l in the western clinic anal surgeons more commonly treat warts or cancer and they rarely treat anal dysplasia there's also controversy within the field over whether treatment prevents enough anal cancer to warrant treatment a Chinese medicine treatment is not invasive and evidence-based with few side effects so that would give some additional impetus for treating anal disease prior to the development of anal cancer so Western anal treatment is more problematic for several reasons one it's painful the ablation therapies two surgeons are not trained in high resolution in osku P it's a very specialized area and therefore they cannot always find the areas that are identified by HRA for treatment leading to insufficient treatment this is one of the things that the people at UCSF and particularly dr. Naomi Jay are trying to train as many anal surgeons and people who are working with people with anal HS al to develop their abilities to be able to use high-resolution a Tosca P there are also commonly recurrences post treatment so non-surgical methods such as Chinese medicine therapies would be a tremendous advantage for people with anal disease additional cofactors for cancer development include cigarette smoking history of oral contraceptive use nutritional deficiencies parody might be a possible cofactor and also the age of for sexual activity so additional risk factors for cancer development include Co infection with HIV other concurrent STDs which can cause the ability to develop more anal or cervical or vulvar disease and lack a follow-up for previous HSL a diagnosis is actually a very important one because there must be follow-up in order to prevent - cancer