Here We Go Again Round 2

I am 31 yrs old had biopsy, and LEEP done last November due to mild-severe dysplasia. After LEEP I bled for 2 months straight I felt very run down, and tired. I have had to get paps done every 3 months then, 6 months, and finally would end up being yearly pap. I just went for last 3 month pap came back borderline? He then changed results to normal cause (borderline). My HPV tests have been negative since LEEP however, just went for 1st 6 month pap cam back abnormal. All my pap tests he said looked good didn't see anything cervix looks great, what happened? I am now worried all didn't come out after LEEP or maybe it was deeper than he thought. Then don't understand why HPV test has been negative? I am worried about this being a constant problem biopsy's and LEEP not fun I'm sure everyone would agree. 

For starters, one of the main advantages of a LEEP is that the pathologist can assess whether or not the dysplasia was apparently removed or if some of it was close to the edge or margin of what was removed. Also, there is usually a scraping called an ECC above the LEEP.  You should get the reports and see what they say.  Was it close or was it all apparently removed?

No matter what treatment is used, LEEP, cryo, cone or laser, or whether or not the margins were clear, there is a chance of recurrence. If it is soon after the treatment (within a year) it is likely that everything was not removed or destroyed. That is through no fault of your physician(s).  This is microscopic disease that is being treated and is how the disease behaves.  

As far as the Pap, "abnormal" is a very broad statement.  What exactly was found? Is it atypical (ASCUS or ACGUS) or LGSIL or HGSIL.  It makes a big difference.

Regards.

Dr V

http://www.gyncancerdoctor.com 

Thanks Dr. V for responding, right now they say atypical. I have a another pap scheduled for 6 months, and further testing will be done at that time. I'm not sure why wait till 6 months I believe he said protocal? In response to your other question he said everything was removed at time of LEEP, I don't recall hearing the other you mentioned I believe it was called ECC. I was thinking if all was possibly not removed why it took so long to show up in my pap test, cause they all have been coming out normal no problems. I'm sure I may be getting ahead of myself here, but the same thing happened last time. My pap cam back atypical, they did follow up pap, biopsy, told me it was mild-severe dysplasia, and then did LEEP. I have been going to him every 3 months paps been coming out normal he says he hasn't seen anything, and my cervix looks great. Is it possible it was maybe deeper than he thought, if so what could possibly happen next another LEEP, or if deeper is it usually a more invasive approach?

It really all depends upon the LEEP path report.  What degree of dysplasia was present, how much, how close to the margins, what degree of dysplasia was closest to the margins and which margins...endocervical (in the canal) or ectocervical (on the outer surface)? Usually either a scraping (ECC) or a "top hat" LEEP is done to make sure the canal area is clear, unless your doc thought that the problem was clearly all on the outer surface of the cervix by colposcopy magnification. 

If all of the above was clear, and especially if most of it was less than CIN3, then it may very well be that you have atypia from continued healing or other reason for the cervix to be inflamed (cervicitis).  Especially with the HPV being negative, no colposcopic evidence of recurrence, this may very well NOT be a recurrence of CIN.  So, it is reasonable to observe in a situation like this for a short while. 

If you don't have it, you should really get a copy of your path report and operative report to keep just in case.  Sometimes you may change health plan/insurance, or the doctor may change...whatever....  It is best to keep a copy of records of important health care episodes.

Hope this helps. 

Dr V

http://www.gyncancerdoctor.com/ 

I am 33.  I had all you have had done within the last 2.5 years.  Only, after my leep, abnormal and normal paps came back.  Luckily for me my OB decided to ask me if I wanted to go through with a hysterectomy.  My mom had one at 36 for abnormal paps. (She was hush hush about anything else).  I agreed and after the surgery, I found out I also had tumors on my overies that were never detected.  With giving my mother permission to make decisions for me on the table, I awoke to a total hysterectomy and no overies, no tubes etc.  Everything gone!!!!!!!!!!!!  Noone told me the affects of being 31 then and HOT flashes!!!!! Still going through that.  Anyway, about a week and a half after the surgery, my doc called me in for a meeting.  The lab found I did have cancer.  It never showed up in any other tests.  It was "buried up in there".  Luckily, 2 years later I am cancer free so far.  If you need anyone to talk to, get ahold of me.  Sometimes it's easier to talk to a stranger that has been through it than someone who has not that will judge you in other ways.  We all need someone to lean on. 

Sorry to butt in but i had a question about something you said. You note that after your LEEP you had both abnormal and normal Paps. At what point did you decide to go ahead with the hysterectomy? Did you have additional LEEPs that showed cancerous cells or did something else suggest to you that you should go get the hysterectomy done?

 I am in the early confused phase of learning about CC and just trying to get all the thought processes from those experienced in dealing with it. I am setting myself up for the worst so that I can approach any oncoming diagnosis (maybe lack thereof?)with better questions for my gyno. Thanks so much!!! And great to hear you have been cancer free for two years! :)

I had bursting ovarian cysts since I was 17.  Lots of trips to the hospital but I wanted to have kids.  At 27 I had my first child and at 29 my second.  During my 2nd pregnancy, a pap came back abnormal.  My OB told me about the possibility of something being wrong then but I was in my 6th month and did not want to risk anything.  After he was born, I had another pap done.  It came back normal.  So after 6 months, I had another and it was abnormal.  THEY CAN CHANGE from pap to pap.  All paps are not correct.  Do not let anyone fool you.  The (then) OB stated that he would just "watch for the next pap".  After about 2 years of abnormal and normal paps, I was sick of hearing wait til the next one.  I finally went to a specialist.  He, an OB as well, suggested a "leep"  I went through that after I had a biopsy.  Both had come back inconclusive.  Another Leep further up my cervix and another inconclusive.  He cut straight to the chase and insisted I have a hysterectomy.  My mom was in her 30s as well.  I agreed.  Many years of rupturing painful cysts and many years of painful monthly periods.  After the surgery he called and told me to come in.  I had squamous cell carcinoma.  I was only stage 1 but it is scary.  That was the best decision I ever made.  Even after all the tests, biopsies, and leeps, noone ever detected the cancer until the Lab called with the results of my hysterectomy.  I remember the words he used right after my mother and I sat down.  He said "Well, we received the pathology test back and all I can say is I saved your life".  I just looked at him like WHAT?  I was puzzled.  Then he told me.  My mom and I just held each other and cried.  About a week later, we celebrated.  Not the fact that I had cancer but this wonderful Dr. saved me in time.  Please e-mail me at j --Message edited by CancerCompass staff. For personal protection, email address removed. Consider private reply. Please review CancerCompass Member Guidelines at http://www.cancercompass.com/common/guidelines.html--if you have any questions.  After you e-mail me I can give you my # if you need to talk.  The whole ordeal for me was confusing, scary and I too had alot of questions.  Believe me, I needed someone to talk to when I was going through it that had a similar diagnosis.  Unfortunately, I did not.  Any question you have is NOT dumb or ignorant.  Been there done that.  I am here if you need me.