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Cancer: Cervical & Ovarian Message Board

Cancer: Cervical & Ovarian Board Index

Hi there, Completed. Just read your post and wanted to respond because I had the same questions you did after my AGC results. Mine came with high risk HPV and atypical squamous cells. And this was my first ever abnormal pap - last normal one was a year prior. You're right - it's hard to find people who ask a question about it, then come back and let you know how things went. I look at that as a good thing - it means they had a few more tests and everything was normal. No one posts about being fine and healthy it seems.

I started a thread a few months ago about my AGC journey - it's somewhere on here - page 1 or 2. But in answer to your questions: squamous cells and glandular cells are completely different. I'm sure occasionally there can be a mistake or a false postive, but probably not often. (Not a doctor, just regurgitating what I've learned in my few months of frantically researching this.) It's a fairly rare pap result, so I would imagine they'd be sure. Now, on to your gyno. Find a new one. The normal protocol with that result is a colposcopy (with possible biopsy if they see an abnormality), an ECC and an endometrial biopsy if you're over 35. For your doctor to tell you you could wait 6 months is ludicrous - and the 'I probably just got some glandular cells along with the squamous?' Even if that were the case, they still shouldn't be abnormal. Honestly, most gyns never see this pap result. I would recommend transferring to a gynecologic oncologist as they're the experts in this. I'm NOT saying it's cancer, but you want someone who is used to seeing these results - and that is the advice I got everywhere I looked when I got my AGC results.

If you have any questions, please let me know. I feel like I've read every published document on the internet on AGC.
Aw, no worries. I didn't feel pressured at all. I am just trying to do my best to help out anyone I see who has these results because I could have used that when I got mine! :)

I am so happy you had a good sit-down with your doc! And that's fantastic that he's doing his best to get you the colpo asap. Now on to your questions. ASUS (I believe that's ASC-US 'atypical squamous cells - undetermined significance' here in the US) is just that - squamous cells that look a little off for some unknown reason. Squamous cells are the type of cell that are on the surface of the cervix. ASC-US is the 'mildest' of abnormal paps. AGC is atypical glandular cells - the glandular cells are completely different. They produce mucus and are in the uterus and the opening of the cervix. So as far as I know, AGC is not a progression of ASC-US at all. Totally different cells, totally different results.

As far as the LEEP - it is not recommended for AGC results because it burns/cauterizes the edges of what they cut out. The pathologist then can't analyze that tissue and say whether or not they got it all. Cold knife cone biopsy is the standard. Of course, that should all be after a colposcopy and ECC. The ECC is the least invasive biopsy between the ECC, LEEP and CKC. They should do the ECC at the same time as the colposcopy so you have a good idea on what's going on. Wait - I just noticed you said colonoscopy. Typo or did I totally miss something else going on?

Whew. Hope I answered all of your questions. Let me know if you've got more - I really am happy to help. :)
Ok - got it. You are having a colonoscopy. That's a good start for your other symptoms. As far as the D&C and hysteroscopy - I don't know a lot about the hysteroscopy other than it's a close up look at your uterus, but I know a D&C can be done instead of an endometrial biopsy if he suspects the AGCs are coming from your uterus - which they can. I had an endometrial biopsy and it freaking hurt. No pain reliever, no anesthesia. But at least it was quick.

As I mentioned before, the colposcopy and ECC are the standard here in the US for the AGC result - the colposcopy will highlight any abnormalities on the surface of your cervix which the doc will then biopsy. The ECC is a biopsy of the endocervix - the opening of your cervix that leads to the uterus. That's where any glandular problems like to hide if they're not in your uterus. That's where my tumor was - and it was the source of the AGCs. So it sounds like he's got the uterine part covered, but I would ask him about the endocervical test as well. Better safe than sorry. Then if those show abnormalities, the LEEP would be used for squamous cell abnormalities, and the CKC (cold knife cone) would be used for glandular cell abnormalities. I hope that helps!
Sandy...Thank you for your response. I am not sure what is going on. I was suppose to have my ultrasound this week at the request of the doctor but they called today and can't do it till next wednesday. I guess I wait. Thank you for your response. I am still running a fever and pain is still there. I am thinking about hitting the ER again tomorrow.

UPDATE: I went today to see my ON/Gyno. He did an ECC and a colposcopy. He told me my ultrasound was clear and that it only showed a 5mm polyp on my cervix which he said is most likely a shadow and nothing to worry about. He did not do an endometrial biopsy and said he would if nothing showed on my other tests but I am too young to have anything else wrong. The polyp is in the lining of my cervix and he was unable to get a sample of it. He said everything looked good and would do a leep when the results came back.

Here are my questions: I have an appointment with my regular Gyno next week on Wednesday. I am definitely have issues though I am not sure what they are. He was going to set a date to do a leep, D&C, Hysterscopy and laprascope(spl). I am tempted to still have this done for my peace of mind. With my history of endometriosis I am wondering if perhaps this is a flare up. Is this the wrong thing to do?

My over all impression of the ON/GYNO was not good today. I felt like he rushed it and was just excusing everything away by my LSIL. I am torn on not ruffling feathers but I would like to know if there is anything else to worry about. UGH! So frustrating.

OH73: I will be thinking of you tomorrow! Best of luck and let us know how things go! All my positive thoughts and prayers are going your way.
With the ECC, they kind of swirl either the brush or the "spoon" type around the circumference of your endocervix. I had AGC and ASCUS on my pap, negative for HPV, and my regular gyn did colposcopy, ECC and endometrial biopsy. They all came back negative. I was still extremely uneasy that something was being missed, so I referred myself to a gyn /onc. He took one look at all of my testing this far, and said we need to get some answers. He will do a CKC and D & C on Wednesday, with a hysterectomy if he feels it is warranted. I liked the aggressiveness, because I am just so uneasy with the whole thing. Go with your gut. Your gut is telling you that you don't trust your gyn/onc. Maybe your gyn can give you a referral to another's gyn/onc? Do some doctor shopping until you find someone who takes your fears seriously, and at least does all of the testing to back up their theories.

Another thing that I found interesting was the gyn/onc told me that the ECC only gets a sample from about 1cm in, and he wanted to do a CKC because it got 5cm in. He also wanted to do a d & c to look at the whole endometrial lining, rather than just a small sample. While I am scared to have a possible hysterectomy, I just want to get rid of the omnipresent thoughts of cancer....

Keep us posted on what you decide! You know your body best! You are your own health advocate! you go girl!

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