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Cancer: Cervical & Ovarian Message Board

Cancer: Cervical & Ovarian Board Index

[QUOTE]They said my HPV test came back negative but it was abnormal again and I should wait 6 months then get another pap, that it can clear up on its own. What will they do if it doesn't go away, another LEEP? How many LEEPs can I have before it affects my ability to have kids? And how many LEEPs will they do before they try something else and what will they try.[/QUOTE]

Hi, Kate.
We're not medical professionals here, but I'll try to answer your questions to the best of my knowledge.
The fact that your HPV test came back negative is a great sign. It means your body has cleared the virus that was causing the abnormal cells to develop on your cervix (now you just need to ensure you don't get reinfected, which is very easy to do, because the HPV virus is very common).

You don't say how severe the latest abnormal PAP is, but I'm assuming it's mild, or they wouldn't take a "watch and wait" approach. It's probably just some residual abnormal cells, or it could even be caused by inflammation, a minor infection, or some other (minor) issue. it might not even be related to your previous HPV infection, and therefore not in danger of developing into cancer in the future. If I had to guess, I'll bet it [I]will[/I] have cleared up before your next PAP in a few months. The fact is, if you no longer have the HPV virus, then there is nothing to fuel these cells into dangerous, potentially malignant growth. Cervical cancer IS caused by the HPV virus. Period.
If you don't have HPV anymore, then your risk for developing cervical cancer is minimal to nonexistent. If there are still a few stray abnormal cells left in your cervix, your immune system will probably take care of them. Your doctor has ordered a repeat PAP in a few months just to make sure that they clear up.

How many LEEPs will they do, how many will impair your fertility? It varies, it depends. The reason is that not all LEEPs are the same. They take out different amounts of tissue, depending on how severe the CIN is. The more severe it is, the deeper they need to go and the more tissue they need to remove in order to get clean borders.
I've known women who have had several LEEPs and still gone on to have children.
Even if your cervix is severely compromised by LEEP or other surgery, there are still options if you want to have children.
When you get pregnant, the doctor can put a few stitches in your cervix (which is called a circlage), which will help keep your cervix from dilating prematurely and causing miscarriage.
So you see, while cervical surgeries might make pregnancy more complicated, they do not make it impossible. And only in extreme cases, where extensive amounts of tissue have been removed, would such interventions even be necessary. Most women who have one or two LEEPs have no trouble carrying a pregnancy to term, and very few women need more than two LEEPs in their lifetime.

What would the next step be, if the LEEPs fail?
Probably a cold-knife cone biopsy.
A coworker of mine recently had this procedure, after LEEP failed. She was very scared, but she was back at work after a few days and said the procedure was no big deal. She did get clean borders with the cone biopsy, so her CIN was cured.... and it had been very severe: already carcinoma in situ, which is only one step away from invasive cervical cancer.
My aunt also had a cone biopsy about fifteen years ago, and did go on to have another child after that, so I know that the procedure does not necessarily impair your ability to have children (although in my coworker's case, they had to take so much that she told me she probably would not be able to have more children, at least not without medical interventions).

But it doesn't sound to me as if you'll need a cone biopsy, seeing as how your HPV infection is gone. I think your immune system will clean up those few remaining abnormal cells, and you'll need no further treatment. Or if those cells don't clear up on their own, one more LEEP should take care of them, and it will probably be a very minor LEEP, where they only need to take the very top layer of tissue, which would not further compromise your fertility in any way.

Best of luck to you, and congrats on clearing the virus. That really is terrific news. I think you'll see that your troubles will soon be over, now that the virus that caused them is gone.

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