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Cancer: Cervical & Ovarian Message Board

Cancer: Cervical & Ovarian Board Index

Hi JCA, may I ask how your doctor determined you have CINI in the canal? Did you get a copy of that pathology report?

It sounds like your doctor might suspect glandular lesions. If so, then that could account for the doctor being more aggressive.

I had a colpo with an ECC. The colpo was fine so the doctor didn't take any biopsies. The ECC was done "just to check." It came back adenocarcinoma in situ. Two weeks later I had a cold knife cone. It came back adenocracinoma Ia1. Two months later I had my hysterectomy (uterus and cervix only).

Glandular lesions grow differently than squamous cell lesions. Therefore the treatments are different (usually more aggressive).

Take care and write back! :)
THANK you both so much for replying. I am so upset right now because my doctor is not communicating with me obviously. The first time I had an abnormal pap was on 9/29/08, I has ascus and then was told because I have high risk hpv, to have a colposcopy ( which I had on 10/24). I have the test results they say the following :

Cervix, 3 oclock biopsy Low grade squamous entraepathelial lesion ( mild dysplasia)
Endocervizx curettage Low grade squamous entraepathelial lesion ( mild dysplasia)

I am so upset because first my doc said, well we can wait and see, then no freezing, then a mini leep, then I just found out he is going to do a cone biopsy on TUESDAY!!!

What should I do ? I don’t know how to find out about the gland thing you mentioned ?

JCA, I was diagnosed with cervical cancer (adenocarcinoma Ia1) back in April. I had my second cold knife cone the day before my hysterectomy (to stage my cancer and determine if the hyst we were planning was sufficient treatmetn).back in June. I've been to 2 post-surgery appointments and everything is clear of atypical cells. :happy dance:

Some doctors call the LEEP a cone biopsy. They both remove a cone shaped wedge of the cervix (basically enlarging the cervical os. The cold knife cone is done with a knife. It ensure cleaner edges to the sample's edge which helps the pathologist determine if all of a lesion has been removed (if a lesion is found). The LEEP removes the same basic amount of the cervix (though I think the CKC can remove more than the LEEP). The LEEP wire singes the edges of the sample that is removed and the remaining cervix. This is good as far as cauterizing so bleeding is minimal, but it also destroys the sample's edges so it isn't always clear as to whether all of a lesion was removed. *MY* doctor did a CKC then ran the LEEP wire over my cervix to cauterize the remaining cervix to reduce bleeding.

From what I've read, the LEEP is frequently diagnostic and treatment. Unfortunately for me, my CKC was only diagnostic (since it gave the adenocarcinoma Ia1 results).

Is your doctor going to do the LEEP in-office? under local anesthesia? Make sure you know. If that is the case, find out how your doctor is going to help with pain management. I'd also highly suggest you read up on the in-office LEEPS prior to talking with him.

LEEPs are frequently done in-office under local anesthesia (with only some ibuprophen for pain management). A CKC is done as part of day-surgery (out patient) under general anesthesia. Don't go into that appointment not knowing what to expect from an in-office LEEP.

I probably won't be checking in again until tomorrow evening (Monday evening). I hope you get a lot of information from your doctor when you talk tomorrow! And remember, you can always postpone the cone/LEEP for another week or so to allow you some time to gather information and better understand what and why things are happening. A good doctor won't push you. He/she would want you to be well informed.

Take care and I look forward to reading how the conversation with your doctor goes!
Wait! Before you submit to a cone for CIN 1 (!) ask him if he can visualize the entire lesion! If he can, there is no reason to get a cone! You can have a top hat ablation, as I did.

A cone and a LEEP are different. A cone is just that...removing a cone shaped portion of the cervix. It's the most invasive procedure short of hysterectomy. It can be shallow or deep, but it is still invasive.

A top hat LEEP can take care of some of the endocervix. A LEEP cone takes care of more endocervix still. And then there is the laser cone. What I had done was a shallow (hopefully not TOO shallow) top hat laser ablation. I also had ECC involvement.

IMO unless you have had the canal involvement for a while (6+ months) and hrhpv for 2 years (what is your hrhpv status? I don't recall) a cone is totally unnecessary for confirmed CIN 1.
What is immunosuppression, hsv2? And how do you know if you are either ?

I just found out I am hrhpv ( a month ago), and this is the first abnormal pap I have ever had( I am 41). I just met with him. He said he could see in the canal (I just had two kids in under 15 mos), and that it was on the entrance in the transitional zone. He said he actually believes that he got it all when he took the piece out for the colposcopy. So, he said he is fine with me waiting, or doing a mini cone with a leep tool ( just hitting the side at 3 oclock ) and leaving the other side without touching it. He said my recovery would be 5 days basically and I could have sex after that. It seems very minor what he was saying…However, it would still be removing a piece of my cervix.

Any opinions? Does this sound right to either wait for 4 mos and do another colposopy or do this procedure tomorrow.

Thanks so much!!!Julie
Julie, I really think you just need to go with your instinct on this (if your doctor is giving you a choice). The only thing that makes me think to go ahead and go with the mini-leep is your age. After the age of 30, women have a more difficult time fighting the virus. Personally, I'd be worrying about it if I waited-and-rechecked.

When I had my hysterectomy for cervical cancer I had (basically) 3 choices.
1) radical hysterectomy right away
2) another cone biopsy, then the hyst (cervix and uterus only) the next day (sometime within the next 6 months)
3) wait 3 months, re-colpo with ECC, then maybe another cone (maybe not) and a total hyst (cervix and uterus only)
My doctor said she'd pick option 3, but I ended up picking option 2. I didn't want to wait, possibly STILL have to go through another cone, then have the hyst. I wanted to know upfront what was going to happen. It ended up that was the best option. My second cone showed another adenocarcinoma lesion.

Anyway, go with your guts. Let us know how you are doing, though, ok?
Julie, I'm a freak of nature, I guess. I've ALWAYS had my pap (since I was 19 and I am now 45) and I have NEVER had a bad pap.

How would you know if it is in the glands? The results would say "glandular something-or-other lesions" or it might say "columnar" instead of "glandular". Your results say "squamous", if I remember correctly.

Squamous cells are the outer 1/3 of the cervix (scraped during a pap and seen during a colpo). Then there is a TZ (transition zone - between the upper 2/3 and lower 1/3). Then, higher up is made up of glandular cells (upper 2/3). Glandular cells can be sampled during an ECC. Otherwise, a LEEP/cold knife cone can sample the canal, but those are more invasive than an ECC.

I hope that helps! I've gotta run . . . talk with ya'll tonight! :)
OMG I cannot believe how vigilant you were and you had that happen. That is ridiculous. Do the doctors have any explanation for that? Freak of nature would not sit well with me I would want an explanation. I mean basically everyone I have spoken to says no one gets cc except those who have not had a pap in 10 years etc…Jeeze. I am so sorry.

Thanks for the explanation on the glandular thing, you should be a doctor. So I guess it is ok if it didn’t say anything? It only had this to say :
Cervix, 3 o’ clock biopsy Low grade squamous entraepathelial lesion ( mild dysplasia)
Endocervizx curettage Low grade squamous entraepathelial lesion ( mild dysplasia).

So I guess I will wait and see what the colpo says in 4 mos. I will also have a pap. I am not sure if much can clear up in 4 mos, I guess you never know, but I can only just hope it doesn’t get any worse. At which point again it will probably be a wait and see game until the colpo….The research says about 85 % of the population clears it. I hope I am one of those. Julie
OMG I cannot believe how vigilant you were and you had that happen. That is ridiculous. Do the doctors have any explanation for that? Freak of nature would not sit well with me I would want an explanation. I mean basically everyone I have spoken to says no one gets cc except those who have not had a pap in 10 years etc…Jeeze. I am so sorry.

I actually understand how/why my cancer (or even dysplasia) wasn't detected. It is because of the type of dysplasia/cancer.

The pap only detects something like 80-90% of cervical changes. It is only a screening tool, not a diagnostic tool.

The pap test scrapes the excocervix. I like to talk about the cervix like it is a frosted donut. The pap scrapes the frosting. A colposcopy looks at the outer 1/3 , plus it can see down the donut hole, but only as far as the layer of the frosting. The outer 1/3 of the cervix is made up of squamous cells.

The upper 2/3 part of the cervix is made up of glandular/columnar cells.

The area between the squamous and glandular areas is called the TZ (transition zone) where glandular cells mature and turn into squamous cells.

The only non-surgical way to sample the cells in the cervical canal (cervical os or endocervical canal) is with the ECC (endocervical curettage). A colposcopy can't see that high up.

Squamous cells grow more slowly than glandular cells. They are also easier to detect. Squamous cell dysplasia grows from one cell to its neighboring cell. Atypical glandular cells grow more rapidly than atypical squamous cells, they are more difficult to detect, AND they may grow a lesion here, then skip over good/healthy cells and start a lesion elsewhere. It is called skip-cells. I think of it as a ping-pong ball bouncing around in the upper cervix.

Atypical glandular cells are rarely found on a pap. Sometimes they are, but not often. My gyn/onc said that most women who have adenocarcinoma have a history similar to mine. It is only because of the HPV/dna test that more women are being diagnosed with adenocarcinoma at earlier stages.

Cancer of the squamous cells is called carcinoma. Cancer of the glandular cells is called adenocarcinoma.

So, I've decided to tell as many women (as will listen to me) as I can that paps don't detect all cellular changes, to ask for the HPV/dna test if a woman is over 30, to ask for an ECC if the doctor orders a colpo, to be proactive in your healthcare. Don't wait for the doctor to call you, you call them. Go to your appointments armed with as much knowledge as you can gather, and take a written list of questions (with space to write answers), AND to support other women who could potentially be in the same place I was in. I didn't join the healthboards until I had been diagnosed with adenocarcinoma in situ. I had to go through the steps to diagnosis of cancer alone, pretty much.

Thank you for the compliment (and saying I should be a doctor). I like to chalk up my explainations to the fact that I am a teacher and that I like to share what I know.

Julie, I hope you are one of the women who clears the virus, too. But please, even if you get an all-clear, PLEASE keep up with your paps every year and be proactive in finding what your options are if something ever comes up. And spread the word!

I think I'm rambling and I've been interrupted about 6 times while typing this. I hope it makes sense! :)
[QUOTE=jca916;3792550]And, it also is bad that doctors say that women who get cc only get it b/c they have not been to the OB in 10 years or more…[/quote]
I sure hope no ob/gyn or family practicioner says such things! The pap is only a screening tool - it isn't a diagnostic test. I tend to hear that type of comment more from women. And honestly, I use to think the pap detected ALL cervical changes and that absolutely is not true! The pap only detects cervical changes at the location the doctor swabs during the pap. The doctor doesn't swab all of the exocervix, much less be able to reach the endocervical canal! So, help spread the word that paps don't detect all cervical changes. They only detect (and I think the percent is accurate) about 80% of changes.

I've even heard of women who think paps detect uterine cancer, ovarian cancer, etc.

I'm glad to know you are helping with the information about paps and cervical cancer! :)

How am I? Well, I had my 3 month post-op exam in September. She did a vault smear (no more pap smear since I don't have a cervix - instead, she swabs the vaginal cuff) and it came back "no evidence of malignancy." :happy dance: She removed some little spots called granulization. It is the beginnings of scar tissue. When she picked them off, she sent them to pathology just to check. They came back as normal granulizaiton. Yay!

I go back next month for my 6 month. So far there is nothing abnormal. I don't know if I can be called "cancer free" or have "no evidence of disease (NED), but that is what I think I am! I plan to ask when I go in next month. I want to be able to declare that to everyone I know! ;) LOL

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