TAH path report: CIN III

I had a TAH March 12. I went in originally for a LSH to remove the uterus because of heavy bleeding, pain and possible fibroids. My pap came back abnormal showing mild dysplasia and a positive HPV, then biopsy came back showing mild/mod dysplasia so they changed to a TAH since I have had 3 c-sections in the past and now removing cervix instead of just uterus. I'm really confused now because my pathology report came back today and found out that everything in the uterus looked fine, but my cervix had CIN III (severe dysplasia) and as the doctor said one step away from cancer. He kept saying he didn't think it was much on the cervix, but better take it now just to be on the safe side. So to hear it was severe and at a location that wouldn't necessarily show up in a normal routine pap, I'm just confused. My next appointment is April 21 for my follow-up. I understand it's not cancer, but not sure what type of questions I should be asking now. I was excited to hear that it was found and is out. I'm just bewilldered trying to figure out what exactly it all means. How can possible fibroids that were detected on the transvaginal ultrasound come back as not being anything. He said my uterus was enlarged, but the main problem area was my cervix. Sorry if it sounds like I'm rambling. I'm still on the pain meds and trying to focus. This is the first time I've EVER had an abnormal pap and then to have this all happen so quickly is overwhelming.

Thanks for any advice on how to talk with my doctor.

I had dysplsia when I was preg w/ my first son. They froze it off while I was preg, I always worried about it coming back, but it never did. It's hard hearing you have an abnormal pap, but at least they found it in time. I hope you continue to heal great.

So glad your doctor had taken care of the precancerous stuff.

A uterine fibroid is a 'beneign' growth, it is not cancer. It usually does not require surgical intervention unless it is causing problems. My 2nd Sister had a hysterectomy because of an enlarged Uterine fibroid when she was around 45. I also had three small ones. I decided on having hysterectomy after learning about my 2nd brother's colon cancer. Because my Mother already had had Non-Hodgekins Lymphoma and I myself already had breast cancer (twice), I decided I needed to take off my uterus and ovaries. The cervix part was just a 'why not?' decision since it's been very painful to get my Pap done.

Rest well and know that you've been fortunate to get rid of something that could cause trouble down the road.

Just a note that my fibroid turned into cancer because I was misdx by a nurse practitioner and not intervened by gyno, and was given Climara and everything escalated to a giant fibroid. I was also told fibroids were always benign and believed. We have to trust ourselves and get proactive.

pj

Fibroids are not cancer. But since it is inside of a confined space, it needs to be taken 'out' if it is causing problems.

Here's what the Georgetown Medical Center site says about the 'cancer risk':

Fibroids and the Risk of a Malignant Tumor

A common question is whether a large mass in the uterus, presumed to be a benign fibroid, could be a malignant tumor. The answer is yes, although these tumors, called leiomyosarcomas, are very rare. They occur in about 1 in 1000 cases. Based on recent genetic studies, it does not appear that these malignant tumors result from a preexisting benign tumor. It appears that they arise separately from any existing fibroids.

The problem is that it can be impossible to tell a benign fibroid from a malignant tumor without surgery. No imaging test, such as ultrasound or MRI, can reliably distinguish these tumors. There is no blood test that can detect them. By history, they are often suspected when a presumed fibroid grows very rapidly. However, the majority of rapidly growing "fibroids" are just that, benign fibroids.

Biopsy also cannot reliably distinguish benign from malignant tumors of the uterus, because the sample may be taken from a relatively benign appearing portion of the mass.

Unfortunately, the reliable means of detecting malignant solid tumors of the uterus is surgery. This would either be by removal of the fibroids alone (myomectomy) or hysterectomy. Hysterectomy, with surgical removal of lymph nodes near the uterus is the primary treatment for leiomyosarcoma.

I guess for me, I wasn't worried about the fibroids. There were just annoying causing the painful, heavy periods. That's why I wanted to have the partial hysterectomy. What really concerned me was the CIN III on my cervix which they found AFTER they removed it. I'm glad it's gone, but is it something I still need to watch since they left my ovaries? Am I supposed to ask my doctor more questions about it. All he told me was it was a good thing to have taken out my cervix and he called early in the morning (woke me up) and I wasn't coherent when I was talking to him. I'm not sure if I should ask more questions or not. It's hard to wait this long for an appointment and not really know what I'm supposed to be asking when I go in next time....

Have you requested for the free booklet "What 100,000 Women Know about Hysterectomy"? On page 18, it states that "If your ovaries are healthy, you may be better off now - and 20 years from now - by keeping them.... Keep healthy organ if possible! Talk frankly with your surgeon and discuss your concerns."

I chose to have 'everything' taken out because I'd already had 'chemopause' since late 2003 and I was approaching 50at the time of my hysterectomy, presumably very near to the time of natural menopause. Everybody's first reaction of finding cancer is to 'get everything out'. But the doctors often take it as a 'hysteric' reaction. [which really fit our situation! ] Please go to the Mayo Clinic site or the PubMed site to read about cervical cancer. After you are equipped with the information from trusted sources, you will be able to discuss the options with your doctor.

Doctors have their egos, so be courteous when you bring up your research to avoid any confrontation or misunderstanding.

Take a deep breath often. It always calms me down...

<http://www.nlm.nih.gov/medlineplus/ency/article/001491.htm>

From the above article, it looks like your doctor has taken care of the problem already.

CIN3 is cervical dysplasia, caused by hpv....of course, most women with hpv don't get dysplasia/cancer, and most women have hpv (without knowing it), and, CIN3 doesn't necessarily progress to cancer. hpv and cervical dysplasia don't impact ovaries, but hpv can impact the vaginal walls and vulva (as well as anal ands oral cancers). i'm sorry you were surprised to find a 'new' problem along with your surgery, i hope your recovery is going smoothly, and encourage you to learn more about hpv and ways to help your body clear the virus. knowledge is power!