Abnormal pap smear - bleeding after menopause


Q: I had an abnormal pap smear returned as CIN 3. I have had a biopsy - waiting for results. What does all this mean I am really scared.

Symptoms:  Post menstrual bleeding - especially when straining. Cramping and muscle spasms along the groin area and back. Feels like a disc is out or something triggering nerve pain

A:   Hello,
Thanks for the query to ATD for an opinion,
As your Pap smear returned with a CIN 3 report, it means that you have cervical intraepithelial neoplasia grade 3. CIN 2 and CIN 3 are recognized potential cancer precursors, although CIN 2 is associated with significant spontaneous regression. Evidence suggests that approximately 40 percent of CIN 2 cases regress over two years, whereas regression of CIN 3 is too rare to measure accurately.

As a consequence, immediate treatment of CIN 2 and CIN 3 with excision or ablation in nonpregnant patients is recommended. This means that first a colposcopy is to be done after the biopsy report to look for the area of spread and then cervical cone excision or a LEEP excision procedure may be undertaken to remove the lesion from the cervix. This shall be re-subjected to histopathology to confirm clearance of margin by 5mm.
Then follow up of 3 monthly PAP smear may be undertaken for first 2 years then yearly for next 3 years to watch for the recurrence.

In the absence of other indications, hysterectomy is not the initial treatment of choice for patients with CIN 2 or CIN 3. Hysterectomy may be considered for treatment of persistent or recurrent CIN 2 or CIN 3 or when a repeat excision is indicated but technically unfeasible. If excision is indicated, it should be performed (where possible) before hysterectomy to rule out invasive cancer.

This may be too technical for you, in simple terms this is onset of cervical cancer and presently has to be managed by cervical excision. If there is no recurrence in 2 years then you stand treated else repeat excision or a hysterectomy may be required.
As fertility is not a concern in your case, i suggest you should get a hysterectomy done before things spread further.

I hope i have answered your query,
Wishing you good health,

Comments / Follow Ups

Patient: Can I request a LEEP excision be done instead of a hysterectomy? Why would I need to have a CT scan at this stage?
Doctor: Hello,
Ct scan is required t known the actual extent of the disease in and around the cervix if there are any adnexal seedings. Hence there is no harm in it.
Also , at your age, i feel if LEEP can be undertaken depending on the biopsy histology report then you shall undertake it but the concern is follow up and chances of recurrence. When the fertility is not a concern and ovarian function has stopped, and if the reproductive organs are getting diseased, and at the initial stage at present, so its better to kill the disease completely as retaining uterus or ovaries would hence serve no purpose. I understand it has a psychological implication but considering your age , you should consider hysterectomy with removal of both ovaries and tubes as well.
Even though this is an opinion, choice is yours. One has to wait for the histopath report anyways.

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