Do I need a second opinion?

I am 25 y.o. and went into my dr with a dx of uterine prolapse and he recommended a hysterectomy which was fine and a treatment that agreed with me as I have had all the children I care to have(and tubal ligation).
I had a routine PAP before the surgery and went in 1 week later to have a pre-op exam. The dr then told me I had an abnormal PAP(my first abnormal ever) and needed a colpo and cancelled the surgery. We did a colpo and biopsy that day. He said he saw very little and maybe just 1 tiny spot and that's what he biopsied. The results came back CIN 3 dysplaysia and he recommended a LEEP and scheduled that along with a pre-op and the surgery. He said as long as the borders of the LEEP biopsies were clear we could do the surgery. I went for the LEEP and the results came back with the dysplasia on the interior and exterior borders of the biopsy suggesting that the cells go deeper than he originally thought. Now he has cancelled my surgery again and says I need a cone biopsy because if he takes my cervix out and the precancerous cells have spread beyond the cervix there is no safe way to treat it. He says I need my cervix to deliver radiation safely. So my questions are - How did the cells spread so fast? Do I have cancer yet? and Why can't he just give me the hysterectomy if it is just precancerous cells, wouldn't that fix the problem of cervical cancer if there was no cervix to have the cancer???

Ummm honey my advice is RUN, run away from that doctor as fast as you can! go see a Gyn/Onc (gynecologic oncologist) DO NOT let that man touch you again!!!

I don't know anything about the procedures you've been through (except colposcopy - but that was a long long time ago).
A second opinion is always good, especially when abnormal cells are present or suspect. Get one from a gyne/onc.

Hi Sarah, I would call the doctor and leave and message for him to call you. Then ask him all of these questions. I do this with my doctor and it helps me alot.

It sounds like he first must address the dysplasia (pre cancer) first before proceeding to the uterine prolapse issue. Ask him about that too.

Sounds like he is following ASCCP guidelines. He probably wants to do the cone biopsy to see if the dysplasia extends a little higher up into the endocervical canal. It just takes a little bigger sample and can excise the area. This can sometimes be all you need and then you just go back to follow up paps.

Yes - you should seek a second opinion. Seek a a gyn-onco or a least someone who is a member of American Society of Colposcopy and Cervical Patholgy. see asccp.org, click on member services, then on find a member.

Here is a link to OBGYN.net where Dr. Toub answers a questions about Cone biopsy and cervical dysplasia. It doesn't address the uterine prolapse issue but it may make you feel more comfortable with what he's doing. But - again I would call him and ask your questions. See the question from Vicki regarding cervical dysplasia and hyster. 3rd question down on the following link

http://www.obgyn.net/women/women.asp?
page=/ah/ATE_0799

A big hug to you Sarah.

hello, sarah. i'm sorry to hear that the leep did not have clean margins. this must be very scary for you, and frustrating when you were ready for your surgery to treat a different condition.

from what you're describing, you have dysplasia, which is sometimes called 'pre-cancer', and is not cancer. it's still serious and needs to be addressed. you ask about how cells have spread so fast, but it sounds like the dysplasia has just been diagnosed, and dysplasia is considered very treatable and curable. i'm not sure why your doctor is mentioning radiation as i've never heard of radiation being used for dysplasia.

yes, i think you should get a second opinion, and would suggest it be that of a gynecologic oncologist - they're the experts with gyn cancers and dysplasia. and, a good doctor will welcome a second opinion.

and, i, too, would ask why the hysterectomy would not be a 'treatment' for the cervical dysplasia. i'm not sure why you doctor even did the leep prior to the hysterectomy, so those are all questions to be asked.

i'm sorry you're in this situation with so many unknowns, and i hope you're soon on a path that is more clear.

	Quote:
Originally Posted by sarahsmile25 He says I need my cervix to deliver radiation safely.

Sarah:

I would definitely get a second opinion. Just based on his statement that you "need your cervix to deliver radiation safely". I don't know much about the tests you've discussed, but I do know that you don't need a cervix to deliver radiation.

I had uter ca, had a TAH/BSO and my cervix was removed. And I still had rads "safely" if you can call having toxic radiation pumped into your body safe!!

Please get a second opinion, preferrably with a gyn/onc. They are the specialists and know what to do and what to look for.

Hugs.

I'm sorry you having these issues right now. From what I've read (and from the discussions I've had with my own gyn in the past), it sounds as if your gyn is following recommended procedure. The reason he's going back in again is to be absolutely certain there's no cancer. Since the first LEEP didn't get in deep enough to get a true sample, he really does need to go in further to make sure everything is still precancerous further up in the canal. If for some reason there would be cancer in there, your surgical procedure might be done differently. Better to know before surgery what you're dealing with. If your pathology report comes back after surgery showing you have cancer, well, then it could mean additional surgery or an additional treatment. So, he seems to be following a very conservative course of action.

I'm not sure about the cervix and radiation comment though. Lots of women have a TAH, lose the cervix, and then still have radiation.

I do, however, think a second opinion is a great idea! Certainly a gyn/onc is the specialist is this area and they are highly trained in the most current treatment and surgical techniques for female cancers and precancers.

Good luck! I hope all goes along well for you and that you are able to get this behind you quickly.

Yep, you should definitely see a GYN/ONC before you have ANY more procedures. They are the experts when it comes to cancer/pre-cancer issues, and you deserve THE BEST!


monami