Paps Ugm Pdf

[Margaretha Palone]

2What testing should I ask for? When I am frightened I am stubborn so I know I can advocate for the kind of care I need. I know I will need a colposcopy, and another ECC. Should I ask for a uterine biopsy even though I am under 35? What is the most invasive and comprehensive test I can request/demand to be 100% sure we can find any hiding malignancies?

1. It's important to remember that abnormal pap results don't always indicate cancer. LSIL and AGUS can be caused by various factors, including HPV infection and inflammation. While it's natural to worry, it's also possible that these findings are benign and not indicative of malignancy. It's best to consult with your healthcare provider for a thorough evaluation and interpretation of your results.

2. In terms of testing, a colposcopy is a common next step to further evaluate any abnormal areas on the cervix. It allows for a closer examination and may involve taking additional biopsies if necessary. Discussing your concerns with your healthcare provider and requesting a comprehensive evaluation, including a uterine biopsy, can help ensure a thorough assessment of your condition.

3. The treatment approach for precancerous cells or adenocarcinoma will depend on various factors, including the extent of the abnormality and your personal preferences. Procedures such as LEEP (Loop Electrosurgical Excision Procedure), cold knife cone biopsy, or hysterectomy may be considered. It's important to have a detailed discussion with your healthcare provider to understand the best treatment options for your specific situation.

4. Freezing eggs, also known as oocyte cryopreservation, is an option to consider if you anticipate the need for fertility preservation. It's a personal decision, and discussing it with a reproductive specialist can provide you with more information and guidance.

Remember, I'm here to support you throughout this process. It's essential to maintain open communication with your healthcare provider and seek their guidance for personalized care. Stay positive, and please keep us updated on your progress.

AGUS paps always sound scary and should be followed up on, but the vast majority of the time they are not cancer. A bit more that half the time they turn out to be nothing at all, and in the cases where they are something, most often it is just ordinary squamous cells that are mildly abnormal, not glandular. In your case since you have the positive hpv plus an LSIL result in the past, it's entirely possible that it could just be the LSIL that shows up as an AGUS result. Glandular cells are hard to identify so this kind of cross-result is pretty common.

The next tests in line, as you mentioned, will be a colposcopy with ECC. Often a uterine biopsy is done as well and it is fine to ask for that. But having the AGUS result be caused by a uterine malignancy would be a long shot in your case. Uterine issues are not related to hpv, and are more likely as you get older. Because of your age, the LSIL and the hpv test, everything points to any issue present being cervical, not uterine.

If any precancerous abnormal cells were found, the chances are better that they would be squamous, but if they were glandular, then yes, a cone biopsy should be able to remove them. For mild to moderate glandular dysplasia the recommendation is almost always a LEEP or a cone, and if it were adenocarcinoma in situ then you could choose between a cone and a hysterectomy, but often before menopause people choose a cone. For people who have had a cone with AIS, they usually are followed up every six months and once they have had at least two successive normal pap/negative hpv visits, their chances of having any residual AIS in only 1 to 1.5%.

Also I want to reassure you that even if whatever is there was there a year ago, a year is not all that long in cervical time. It feels like after a whole year surely things would have advanced, but it's not uncommon for cervical dysplasia to hang out at low levels for years and years. So no conclusions available to jump to just yet.

Hang in there! I won't tell you "don't worry" because haha, that's not how anxiety works, but I promise you that an ob/gyn looking at the history and results you have shared would not be especially concerned at this point. There may not even be anything that needs treatment, and if there is it is likely to be something relatively easy to handle. You got this. Do your best to keep yourself distracted between now and your colpo and after that things should be clearer. Sending lots of supportive thoughts your way.

Junipersage is the expert here but if I could make a suggestion, I would stop taking birth control as it doesn't help with HPV. This site saved me mentally when I was diagnosed with abnormal pap results and I learned so much here. I have my fingers crossed for you that this isn't what you are fearing. The good thing is that you are following up early and CC is a preventable cancer.

Hello! Small update- finally heard back from regular doctor and she agreed we should do a colpo and endometrial biopsy (she said she could do them at the same time) and is trying to get me in for next week. Her message made me feel a little uncomfortable because it seemed kind of urgent, and she said she could explain more to me at the appointment. I made the appointment (waiting for confirmation) and am also waiting on the cancer hospital just in case.

I understand the fear of cancer, (now I have 3 of them in remission that means they are beaten for now). But there are 2 factors in your favor. HPV is a very slow virus, takes decades to cause cancer, and cancer is now more treatable than ever and will be even more treatable in the future due to new discoveries every day.

Maybe you can use condoms for now until you treat the dysplasia. I know doctors don't always tell us these things because they are so by the book. You should also be taking methylfolate. I would read the book "painting a target on hpv" by Nick LeRoy. It was very informative for me. Stuff doctors won't give a try.

The reason I wanted it is last year at my colpo the dr saw something suspicious enough to take an ECC but the tissue was insufficient to test, which makes me think the problem causing cell changes is higher up

I imagine the gyne goes inside the uterus through the canal and if there is infection in the canal it's possible to infect endometrium, even though HPV does not like endometrial cells (glandular) as opposed to squamous. But ask your doc. Why do you want endometrial biopsy? HPV for some reason is considered a passenger in the endometrium, not doing much there. But if you get pregnant you don't want HPV there.

I asked for it since the ECC last year while I was LSIL only was inconclusive cause not enough tissue was retrieved to test. But both cervical biopsies were normal (no sign of pre cancer, just inflammation) despite the HPV + status and LSIL finding

Endometrial biopsy is standard with AGUS paps because endometrial issues can also cause AGUS results and that needs to be ruled out. Since HPV does not infect endometrial tissue it is not considered a risk.

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