Cone biposy or LEEP?

I am 36 and have no children, no pregnacies. Had ASCUS in 2006, PAP II in 2007 january, HSIL/CIN III in 2008, july. Colposcopy and biospy were done and diagnosis is the same: CIN III, atypia epithelii coilocytotica, epithelii gravis III. Had HPV test and it was positive, type 16. I have no faimly history of cancer. I smoke (trying to quit).

My doctor recommends cone biposy ASAP (Sept 5). I read from internet that LEEP is less invasive procedure and has less probability for premature birth etc. I want to have children and am worried that if I will undergo cone biopsy as more radical method I may lose ability to get childre. On the other hand, my doc perfers cone bipsy to LEEP, because it allows to remove more and analyse removed tissue better. Can anyone help me with advice?

With my diagnosis what is the preferred method if I want to have childern in the future? Is there a huge difference bwt the two methods (electrical knife for cone biopsy and electric loop for LEEP) in terms of likelyhood to have children?

Please help, I need to decide fast, as I have less than week until the operation. 

On 8/28/2008 Lontu wrote:

I am 36 and have no children, no pregnacies. Had ASCUS in 2006, PAP II in 2007 january, HSIL/CIN III in 2008, july. Colposcopy and biospy were done and diagnosis is the same: CIN III, atypia epithelii coilocytotica, epithelii gravis III. Had HPV test and it was positive, type 16. I have no faimly history of cancer. I smoke (trying to quit).

My doctor recommends cone biposy ASAP (Sept 5). I read from internet that LEEP is less invasive procedure and has less probability for premature birth etc. I want to have children and am worried that if I will undergo cone biopsy as more radical method I may lose ability to get childre. On the other hand, my doc perfers cone bipsy to LEEP, because it allows to remove more and analyse removed tissue better. Can anyone help me with advice?

With my diagnosis what is the preferred method if I want to have childern in the future? Is there a huge difference bwt the two methods (electrical knife for cone biopsy and electric loop for LEEP) in terms of likelyhood to have children?

Please help, I need to decide fast, as I have less than week until the operation. 

 

 

 

 

 

Thanks a lot for advice.

I talked to another gyn over phone, whom I have seen earlier and she said there is not much difference btw LEEP and cone biopsy (electrical knife) in terms of side effects and unwanted concequences (especially pregnacy). I am not sure that is so.

I forgot to say that it is written on my colposcopy diagnosis "RCI 4-5" - I do not know what it means, but I guess it refers to the size of dysplasia (4/5th?). If that is so, it is rather large area and may need cone biopsy instead of LEEP?

The problem is that getting 2nd opinion from another onco-gyneologist takes much more time than I have, because my doc wants to do it next week already.

Hi again,

sorry, I forget to add/ask in my previous psots, does anyone know:

1)  I have also genital herpes. I have heard that having herpes virus increases the risk of cervical cancer. I also read that inflammation casued by herpes may be mistaken of abnormal cells. What is the connetction btw herpes, HPV and likelyhood of developing cancer?

2) Shall I ask doctor to do endocurvical cutterage, that is take a specimen from inside of the cervixal wall to make sure the abnormal cell are not there? My doc is going to conduct a surgery what I believe is either cold knife or electric knife colonization - in any case, it is more radical than LEEP.  

Thank you.

Did your doctor not to an ECC during the colposcopy when she did the biopsy? She should have.

In the meantime, did you look at the actual lab report? Was it in the endocervical canal? Were the endocervical glands involved? That would determine which treatment option you should have done. What you do is entirely your choice. But I wouldn't trust a doctor who tried to push me into treatment that quickly. That did happen to me, and I regret the choice I got pushed into because it was wrong for my body. Getting the opinion of a GYN/ONC would eliminate any questions about what you have and what you need to do. If your case is urgent, and it sounds like it might be, you do need to act quickly. But let the new doctor's clinic know it's urgent. From personal experience, they will schedule you in quicker. If you do keep your current gynecologist, she should welcome a second opinion. But don't let her use scare tactics to push you into anything.

The doctor who told you there isn't much difference between LEEP and cold knife was right. But to give you an idea of what the difference actually is, it depends on how the different "knives" are used. In a standard LEEP, about .8 cm is removed from the ectocervix. If a "top hat" conization is needed, a loop of about 1 cm deep to 1.5 cm deep is used. With cold knife, a little more is removed during the conization. But according to the medical guides on LEEP, if the lesion extends into the canal more than 1 cm or if the distal end can't be seen, the doctor is supposed to do cold knife. Again, it depends on what you have as to which method you would need. A good doctor will work with you in deciding what is best for your body.

Hi Lontu,

First, take a deep breath and slow down a bit.  Give yourself time for a second opinion, it's the best thing for you to do so in the future you will not regret your informed decision.

See if you can contact Tori Hudson, N.D.  (hopefully the info below is current) and besides asking her office maybe they know somebody in your area who can better inform you. Her number is (503) 222-2322 Dr. Hudson was a professor and then academic dean at the National College of Naturopathic Medicine.  Dr. Hudson is the author of "Gynecology and Natuopathic Medicine: A Treatment Manual" (TK Publications, Aloha, Oregon, 1992) and since 1992 has been a regular contrbutor on women's health issues to "Townsend Letter for Doctors and Patients."

also, regarding the herpes virus: try to avoid the amino acid "tyosine" (found occasionally in energy drinks) because it exacerbates (sp?) the herpes virus. But if you do get an outbreak try putting some Bee Propolis on it, this really helps.  Also, cut down your stress levels.

Thanks for all for all your help.

In recent weeks I have educated myself via internet, reading all I could find on cold knife/cold/electric knife/LEEP biposy.

What turned out, according to abstracts from medical journals, the differnece btw using knife versus loop is in the size of cut and piece that is taken out. That is the greater the cut, the bigger the removed piece of your cervix, the more greater is the risk for complications (like infection, bleeding, difficulty to get pregnant and keep pregnancy etc).

Also, unfortunately or fortunately, I don't know, with my diagnosis (CIN III), the method used in this country is electric knife colonization.

I did ask my gynecologist why did she not take ECC and whether the lesion exceeds to the canal (endocervic). She said, yes, she could see that with colposcope.

The bottom line is that in my country, they don't do ECC. She said that in any case, with my diagnosis, CIN III, suspected carcinoma in situ (not confirmed by any lab repost, as biopsy report read "moderate-severe dysplasia, CIN III, although I admit it cannot be excluded, it can be excluded only after the affected area is removed and histologically studied), the only method recommened and used in this country is knife.

I really must trust doctors, because I have no education to judge how huge the affected area is etc.

In the end of the day, I decided to go ahead and do it by electric knife. I just understand (after talking to 3 gynecologist and one GYN/ONC that in my country, the practice is:

1. not do ECC (colposcopy and exocervical biopsy is considered enough)

2. they all recommened knife colonization as more radical method

After studying in internet the difference btw LEEP and electric knife colonization, I formed an opinion that if i tell my doctor that I want to have children and ask to remove as little as possible, that is the most I can do in my country.

Perhaps in the US it is different, obviosly it is. But here, doctors say that they prefer more radical methods, because their 1st goal is to prevent cancer, and ability to maintain fertility is secondary.

Therefore, LEEP is done only with mild or moderate dysplasias.

PS I had two years ago ASCUS, and my gyn (different one than now), did not suggest me to do HPV test, or repeat PAP every 6 months. My current severe condition (CIN III) could have been avoided if doctors would do they job and inform me earlier. They did not. They let the condition to develop into serious one, and now they urge urgent colonization!

Unfortunately, I have no choice now, though as one can imagine, I am rather bitter. If I had know as much as I know now two years ago, I would most likley not be in my current situation (operation in two days).

But, the moral is - always learn yourself about your medical condition, spend time, effort. It is not wasted, even though you may have to follow the original plan offered by your doctor, but at least you will be aware what is possible and where you exactly are and where you could end up.

Good luck to everyone, and hopefully our lessons are not too hard :-) Wish we all will cure and put it behind us.