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Cancer: Cervical & Ovarian Message Board

Cancer: Cervical & Ovarian Board Index

Message bumped.

I think Cervicitis and CIN are two distinct situations meaning you can have one without the other. Cervicitis sounds like an infection of the cervix and infections can cause cellular changes and result in an abnormal PAP probably an ASCUS result. I don't believe the changes it would cause would result in CINII. Dysplasia which is categorized CIN I, CIN II and CINIII is usually caused by HPV. HPV is considered a sexually transmitted disease but is very common...I read as common as the common cold.

So probably what occurred is when your DR. did the colpo, he/she biopsied a few areas. When the pathologist looked at the biopsy, they determined that some of the abnormal areas were the result of infection (i.e. cervicitis) and the other abnormal areas were actually dysplasia (CINII).

With regard to progression to cancer. I don't believe Cervicitis would progress to Cancer. However, dysplasia (CIN II) can progress if it a) doesn't regress on its own or b)isn't treated via cryo, LEEP etc. . Progression is usually slow and with good follow up allows a great opportunity to stop the progression and remove the abnormal cells. So..keep up with your appointments and you'll be fine.

I would ask the Dr a few questions like: What is my HPV status? What were the results of my initial PAP? How many biopsies did you take? Did the biopsy include an ECC (Endocervial Curretage)? Can I have a copy of my pathology report? What is our plan to manage this?

Hope this helps. Take care.:angel: have TONS of information...GREAT! Sounds like the HPV (I agree its probably not gone in 4mos but then again who knows)is what is causing the CINII type cell changes. Also sounds like LEEP is the plan and hopefully that will get rid of the dysplasia.:angel: Follow up sounds similiar to what others have posted so thats good. There is a woman on another board I watch and she had CINII w/ HPV 5 years ago. They "LEEPED" her and she's gotten NORMAL results ever since so that's encouraging.

Please keep us posted and take care!
Cervicitis can be caused by other problems, most commonly trichomoniasis (sp) infection. (Look up "strawberry cervix.") They'd be able to call a trich infection on colposcopy, or by wet mount. But based on your test results, you can be sure the cervicitis is part of the HPV. Whether the cervicitis is causing CIN or the other way around really doesn't matter. It's like the chicken or the egg question. Your HPV status is most determinative of where your cervical issues will go.

As far as the ASCUS just months prior, you can be pretty certain that was HPV, too. But why the negative HPV results, you probably wonder? It's my personal opinion that the test, Digene Hybrid Capture II, is pretty darn close to useless if your pap shows any cervical abnormalities--which are almost always caused by HPV, and is useful only for women who have normal paps (it's totally possible, in fact common, to be HPV positive with a normal pap). The Digene test must have an astoundingly low specificity rate because I can't even count how many women have had koilocytes on pathology in the absence of HPV by Digene. (Koilocytes are caused by HPV, and ONLY HPV.)

I know it's very difficult to accept your HPV status. I practiced what I considered the most careful of sex next to abstinence, STD tests for my former partner and for myself (including hepatitis and other tests not even classified as STDs but with the potential to transmit sexually), and I had (still have?) hrHPV (and possibly lr, based on his history). It's partly because HPV is soooo common (my gyn-onco used the word "ubiquitous" to describe it), and partly because I succumbed to astonishingly poor judgment. Had the medical community bothered to come up with a test for men, lots of women wouldn't be in this situation.

Yes, there have been reports of getting a higher grade or even grades on leep than what was shown in pap or biopsy but this is uncommon. When it happens, the biopsy or leep result always trumps. This makes sense because the pap picks up the very thinnest, top most layer of cells only. Similarly, the biopsy is not nearly as invasive as a leep.

Sometimes, depending on the size of the lesion, the entire lesion can be removed by biopsy. Granted, it may be a larger biopsy than normal, but personally I'd prefer that to a leep. You may ask your gyn-onco about this. It sounds like you have a most through gyn-onco who is willing to answer your questions and who gives you good information.
It sounds like your doctor is on top of things. I always suggest an ECC if the doctor does a colposcopy, and your doctor has already done that.

Remember, the Pap smear is only for screening for atypical cells. The colposcopy looks for lesions (which can be biopsied). I think (though I'm not positive) the biopsies and ECC biopsy for dysplasia. The LEEP/cone biopsy/etc are used to determine how deep the atypia occurs.

I was diagnosed HPV/DNA positive for high risk in January. In March, I went for the colposcopy (no biopsy of the exocervix) and ECC. That came back atypical glandular epithelial lesions, chronic cervicitis, and adenocarcinoma in situ. About 2 weeks later, I had a cold knife cone biopsy. That came back with endocervical adenocarcinoma Ia1. The good news here is they caught the cancer at a VERY early stage. The only treatment I'll need is a hysterectomy (uterus and cervix). I'll be able to keep my ovaries, tubes, and all of my lymph nodes. I will not need chemo or radiation. As difficult as a cancer diagnosis is to deal with, it is a huge relief to know that my treatment is as simple as a hysterectomy.

I'm not saying this to scare you. I'm saying this because our stories sound very similar, though not identical. Take what I say as my experience. Know that there are many people who have been where you are and many of them visit here. We can share our stories, offer you hope, prayers, and encouragement.

If you have any questions, please ask. I'll do my best to answer your questions. Take care!
My understanding of epithelium is that it is skin/surface cells. There are 2 major types of cells in the cervix: squamous (closer to the vagina) and epithelial (closer to the uterus). This "minute fragments of glandular epithelium and squamous epithelium" sounds to me like they have a sample of both types of tissue. "Scanty" makes me think the sample size wasn't very large, but I'm not a doctor nor do I play one on TV. ;)

I think, maybe, what your doctor meant by "there is no way to know how much of the cervix is involved" means that they only know at the biopsy site(s) whether that tissue is atypical. They don't know if it is elsewhere and to what extent. I say this because atypical [I]glandular [/I]cells do not spread from one cell to another cell, they skip over cells. I think of it as a ball bouncing around in the cervix; the atypical cells can be here, there, and way over yonder. Atypical sqamous cells (as I understand it) grow to neighboring cells, and grow more slowly. A conization or leep are more certain to get more atypical cells because they take larger tissue samples especially compared with a punch biopsy. My oncologist told me that she will take my cervix and uterus because there is no way to know if/where other glandular lesions are.

Something like 90% of the women who have atypical cells on cervical biopsies have atypical squamous cells. Squamous cell atypia grows slower and more systematically (the way I understand it) than glandular cell atypia.

Mel, I am 44 and do not have children, partly by choice and partly by chance. I've never gotten pregnant and I was only on birth control pills for about 7 years.

I've had a pap every year since I was about 20 (so for 24 years) and I've always had good paps. I had my pap in December. My results came back in January. Pap was good, HPV was positive for high risk HPV. I was so freaked out my doctor waived the "wait 3 months and retest" and sent me to a ob/gyn for the colposcopy. The colposcopy looked great; the doctor didn't need to take any biopsies from the exocervix. Because of my age, the positive hrHPV, and the clear colposcopy, she did the ECC. That came back atypical glandular epithelial lesions (with chronic cervicitis) and adenocarcinoma in situ (highest level of precancer). Two weeks later I had the cone. The cone biopsy came back with endocervical adenocarcinoma Ia1 (cervical cancer Ia1). My results never showed atypical squamous cells. That right there is one very big difference in your situation and mine. I *only* had glandular lesions.

It is really weird to say this, but I feel like God answered my prayers! Before going into the gynecologist for the colpo (and while on the table) I prayed that the doctor have "clear eyes, a sure hand, and found whatever needed to be found." She did.

I hope you are doing well!
[QUOTE=melgreeneyes;3559570]Thanks for the feedback - I appreciate it.

Just curious - why would you prefer a biopsy vs. a leep?

Leeps are the only way he treats this. And they say that typically it cures the dysplasia and it RARELY returns. I also think that since I had some abnormal cells on my ECC - that the LEEP would be best. Either way just removing the one spot is not an option for me.

They perform tons of these procedures - they consider it standard procedure.

He also said given my age - he would NOT recommend a watch and wait - that this procedure is his recommendation. :([/QUOTE]

Obviously it depends upon the situation, but sometimes, if a lesion is small enough, a biopsy can remove it entirely. An acquaintance had several lesions, and some were small enough for a biopsy to completely eradicate. There is also some evidence that a biopsy can induce regression, but I am not convinced. By no means should you tell him you don't want leep. Follow his advice, he sounds like a good gyn-onco. At your age, if you're done having kids...there's no reason not to err on the side of caution.
I'd say my situation unusual/atypical but it can't be unique. There are most likely other women out there who have had their cancer discovered so early because their doctors did as mine did. I want to share that story with other women so that hopefully other women might be as "fortunate" as I have been. (weird saying that)

My hysterectomy will be June 18th. She is taking all of the cervix and uterus because the atypical glandular cells can be anywhere (because they skip around).

I'm sorry this is so short, but I'm running late tonight, but will check in tomorrow.
Thank you Mel. :)
[QUOTE=melgreeneyes;3561338]So 'inducing regression' would mean the biopsy caused the lesion to go deeper?

I still have to speak to my doctor again. The first time I met him was the day of the colposcopy and biopsy - when we were done he met with me and boyfriend and discussed what he did and the next steps (leep) if necessary. But I think at that point I was so relieved that the biopsy was done, and I really didn't think I would need a LEEP - that I can't recall what all he said exactly.

But I think the point of the leep is to not only remove the area he biopsied with very clean margins - but probably to do a pass over the entire cervix with the wire loop because technically there might be microscopic areas that he didn't see with the colpo - - then again the colpo is suppose to show everything I think. But maybe it is just to be safe - and then everything goes off to pathology for analysis to be sure he got clean margins.

You are right about my age being a reason why he wants to go in with aggressive treatment - and I feel good about his experience. He's an Assistant Clinical Professor of Clinical Obstetrics and Gynecology at Columbia University in NYC as well as being a private practioner where I see him in NJ.
He has also won numerous teaching awards at University of Michigan and Columbia.

I'll be sure and post back with my results.

Thks for the response![/QUOTE]

No, inducing regression means the opposite--it would cause the lesion to regress (instead of progress), as in go away.

I see what you mean about the point of the leep. I do think that a correctly-done colpo SHOULD highlight all bad or potentially bad areas, INCLUDING HPV-infected areas that haven't progressed to dysplasia, but you are right, it doesn't always and it is not an exact science.

Practitioner affiliated with a teaching hospital is best because they are generally more up to date on the latest research and advances. Sounds like you are in good hands!
I see what you mean about the point of the leep. I do think that a correctly-done colpo SHOULD highlight all bad or potentially bad areas, INCLUDING HPV-infected areas that haven't progressed to dysplasia, but you are right, it doesn't always and it is not an exact science.

The colpo can only highlight cells that are visible at that magnification (colpos have 3 magnifications, I think) AND are visible in that part of the cervix or vagina. This excludes the endocervical area and the uterus. My precancer cells were found in the endocervical canal. My colpo looked so good the doctor didn't take a biopsy of the exocerix. The precancer was actually cancer.

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