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Precancerous Cells Return Less Than One Year AFTER Total Hysterectomy:
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LovesALatte posted:
I am confused about this. I had the Radical Hysterectomy to remove all precancerous cells. Less than a year now, and they are back. I have already had two bad PAPs and am now scheduled for a colposcopy with the doctor that performed my hysterectomy. I don't feel that I have been well informed by my treatment team, on this matter. I don't know where they are "seeing" the cells. What do I have left for the cells to grow on, since having my "girly" parts removed? What are they taking the PAP samples from? What organ? I really don't know. Can you answer this for me? Thank you...
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georgiagail responded:
Because you no longer have a cervix, the physician is taking samples at the top of your vagina. This is the area he/she is swabbing for the Pap.

Gail
 
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someonewhocares3 responded:
I didn't think a pap smear of vaginal tissue had any relevance. Also, the false positive rate of pap smears is about 40% so it's possible both tests could be wrong. The non-profit HERS Foundation at www.hersfoundation.com may be helpful in understanding this. There's a lot of info on their website and they're available for phone consultations.

I wish you the best!
 
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wellnessmom4 responded:
Jane - can you weigh in on this? I had a discussion last month with a gyn/oncologist about colpos. I get regular colpos due to a couple of vulvar abnormalities. Internally, all of my paps and exams have been normal. I had noticed that my gyn(s) sometimes did full colpos - internal and external - but then sometimes did external only, so I asked the gyn/onco which I really should be having. What does this have to do with you (Loves)? The gyn/onco told me that the pap smears done now are very sensitive and, in addition to picking up cervical abnormalities, also pick up dysplasia in the vagina. Now, I don't know if that's true or not; it seems a bit random to me - like the swab may or may not pick up any vaginal cells (?) - but that's what he told me. Maybe Jane can weigh in and tell us what she knows about the sensitivity and extent of pap smears.
 
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Jane Harrison Hohner, RN, RNP replied to wellnessmom4's response:
Dear All: LovesaLatte, Gail is correct. When the cervix is removed the broom or spatula scrapes cells around the area where the incision is at the back of the vagina. It is possible for dysplastic cells to be present, especially if the original lesion was a squamous type (as opposed to glandular/columnar tissue which lines the cervical canal).

Someonewhocares is right too, a PAP smear is a screening test. The newer liquid based methods have better sensitivity and specificity than the older slide type, but the gold standard for diagnosis is a tissue biopsy. Biopsy sites are determined by exam with a colposcope after an acetic acid wash.

I have the exact statistics in my office, but right now I am in a very remote part of the mountains in North Carolina using a erratic satellite computer set up. These questions would make a good topic for a blog (which I will write after I return).

Wellnessmom, makes a valuable point. One can have dysplasia of the vulva or vagina (as well as cancer in these areas). Often a GYN will do a colpo of all areas--especially if there has been a history of vulvar or vaginal lesions. Certainly if a woman has had a complete hysterectomy for cancer or severe dysplasia one continues to do PAP smears of the vaginal cuff ((back wall where cervix was removed). If a PAP shows an abnormality, colpo would be likely rather than just repeating the PAP. One would need to check visually under magnification using the colposcope.

Lastly, while it does seem random given the area of the vagina, shed skin cells from a dysplasia can be "picked up" by a random PAP sample. Among postmenopausal women, we can find cancer of the lining of the uterus because cells are shed and wash down into the cervical canal where a routine PAP finds the problem. I even had a woman who had ovarian cancer cells picked up on her PAP smear!

Yours,
Jane
 
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LovesALatte responded:
Wow, thank you so much everybody for all of your help. I had the colpo and my gyn says I have low grade squamous cells that we'll have to keep an eye on. So now I am seeing him again in November for another look. Now, he gave me an Estrogen cream to start using 6 weeks prior to this Nov. appt. What is the deal with that?

Wellnessmom4, I had no idea there was an internal/external colpo. Now, I'm really confused. Thanks. Ha Ha. I don't know how to answer you on this. I'll have to ask my gyn what he has been doing...
 
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wellnessmom4 replied to LovesALatte's response:
The colpo is all one procedure, but the extent of it seems to depend on your Gyn's perception of your risk area(s). I've had very extensive colpos and also fairly minimal colpos where just the vulva was swabbed and examined. Gyns (at least in my practice) seem to rely on the PAP to make the determination. My Gyn has told me that, as long as my PAPs remain normal, she does not feel that colpo'ing the cervical area is necessary. Jane - would you say that this is sound reasoning and general practice? I have no doubt that my Gyn would colpo everything if I asked her to, but, if she says it's not necessary, I generally defer to her judgment.
 
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donnamae responded:
have had a total hysterectomy a two year ago now he say i have a bad pap now i have to get a colposcopy tomorrow low grade dysplasia should i be concern
 
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junev responded:
I have the same questions except it has been 2 yrs. My cancer in my endometrium was staged 3. I assume that I had a total hysterectomy also. I have PRE-cancerous cells in my vagina & my OB GYN Oncologist says the cells are NOT cancer. I've had colposcopies after the abnormal papsmear, then I go for surgery with the lazer for vaginal dysplasia. I had radiation after my hysterectomy, no chemo. He usually see's me every 3 months. I also have had 2 colonoscopies where they found a large tumor that was removed. My doctor doesn't sugar coat things but I still feel I know enough. I am a nurse. I am not frightened. I have had to research on the internet because I am not happy with his answers.
 
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Jane Harrison Hohner, RN, RNP replied to junev's response:
Dear junev and donnamae: Thank you both for adding your experience to this topic. Donnamae if your PAP smear showed low grade dysplasia (also known as CIN 1) that is the least worrisome type of precancerous cells. My best GUESS is that they are being very conscientious with you because of your prior history--hence the colposcopy. Hope the colposcopy showed nothing to biopsy, or that any biopsies continued to be low grade dysplasia (also known as LGSIL).

Junev, thanks for pointing out that your abnormal PAP smear showed abnormal cells that were not cancer. If those cells were squamous type that would suggest that the origin was vaginal skin tissue not columnar/glandular type which suggests endometrial cells. Thanks also for empowering other women who read your post to ask their GYNs more questions and/or do their own research to educate themselves. You are right, being afraid can be paralyzing; taking some control can be powerful.

In Appreciation,
Jane
 
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junev replied to junev's response:
Jane, this is junev again. My doctor just said the cells were pre-cancerous. If my endometrial cancer was staged as '3', would my vaginal dysplasia be staged? If so, would it be considered stage 3 also? How are vaginal cancers staged? Thanks you for your timely response. jvh
 
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Jane Harrison Hohner, RN, RNP replied to junev's response:
Dear junev: Vaginal cancers are staged as well. Here is a brief summary:

VAGINAL CANCER STAGES
I vaginal wall
II sub mucosal
III pelvic sidewall
IV bladder, rectum, distant mets

Here's a link to more detail on vaginal cancers:

http://www.asccp.org/practicemanagement/vagina/vaginalneoplasia/tabid/7489/default.aspx

In your specific case (vaginal dysplasia) these abnormal cells are not staged as they are not cancer ("neoplasia") and certainly they have not invaded tissues. There is a separate way to categorize dysplasias or VAIN in the vagina (as contrasted to CIN on the cervix):

VAIN 1-- mild abnormal changes
VAIN 2--moderate
VAIN 3--severe, may also be called High Grade

Do let us all know about your actual results and treatment plan once your has shared this information with you. Also, I would be curious to know if your abnormal cells were squamous or glandular (can also be called columnar cells.)

Yours,
Jane
 
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Brunnels replied to Jane Harrison Hohner, RN, RNP's response:
I had abnormal cells in 1985 & 1990 and had successful freezing of the cervix. Had partial hysterectomy in 2001. Now in 2012 I'm having abnormal paps again. I have been frozen and then Monday my gyn used acid in the vagina. Biopsy came back mild dysplasia so she wants to freeze again. What was the purpose of treating with acid? It just really burned the outside of vaginal area and rectum area. If freezing doesn't work...what will next step be for treatment??
 
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Jane Harrison Hohner, RN, RNP replied to Brunnels's response:
Dear Brunnels: It is not clear to me if the abnormal PAPs of 2012 were from the vaginal cuff (no cervix) or from the cervical stump (uterus removed but lower cervix was left). Thus this will be a more general reply, OK?

In terms of an acid used in the vagina, my best GUESS is that she used a dilute solution of acetic acid (vinegar) prior to the colposcopy and biopsy. The dilute vinegar solution causes possible abnormal areas to look bright white. This gives a clue as to where a biopsy should be taken.

The biopsy, which is considered a more exact diagnosis, found mild dysplasia (also known as CIN 1). The area had been "frozen" (cryo-therapy) so it sounds like the biopsy was a follow up to be sure no further abnormal cells were present. Given that CIN 1 was present on the biopsy she wants to redo cryotherapy. Hope I am tracking you correctly.

According to the most recent guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP), CIN 1 which has not been proceeded by higher grade abnormalities gets aggressive treatment only it persists for two years. Obviously your GYN knows all your GYN and PAP history so they are in charge of making the best treatment decisions. The point being that CIN 1 is expected to regress and/or not progress rapidly to something more worrisome. Among women aged 20 or less, a single CIN 1 just gets a repeat PAP smear in a year, according to ASCCP.

If you should need treatment beyond cryo-therapy there is LEEP (if cervix was still in place),or other forms of excision. One would hope and expect that this would not be necessary.

Yours,
Jane
 
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Brunnels replied to Jane Harrison Hohner, RN, RNP's response:
The 2012 abnormal cells were from the vaginal cuff. I have no cervix. i had the freezing done again today and it was soooo painful I almost passed out. I've never had that type of reaction before. Today she stained my vagina and saw a place that needed to be treated but was concerned because when she touched it before treatment it started bleeding. What might that be about? I go back in 3 months for a check up. She mentioned that if this didn't work we might do the laser procedure where I would have to do outpatient and be put to sleep....what's that procedure called and what does it involve.? Thanks!!!!! Becky


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