options

I had a coloscopy done; the results of 8 tissue samples were either cin II/III or cin III. The sample were taken from various clock positions 12, 3, 5, 6, 7, 10 and I have tested positive for one or more of the high risk HPV types. I am 36 and no longer wish to have any more children. My doctor (who is anti-hysterectomy)is suggesting that I have a cone biospy under general anthesia. I would prefer a simple hysterectomy and given the results (and painful cycles) that the dysplasia is found in all sectors of the cervix I would rather not mess around. I think I need second opinion. How do I make my case for surgery?? Thank you for any advice.

Hi Sdeleve,

I think a 2nd..even a 3rd opinion would be a good idea. I got two opinions myself.

From what I understand, a Dr. makes the case for a hyst with an insurance company. With me, I did not have insurance at the time of my hyst, and I agreed with my 2nd Dr's opinion about having a LSH and we proceeded from there.

A 2nd or 3rd opinion can possibly give you more information also so you will be able to make a good choice for yourself.

Best wishes,

Mary

I agree that a second opinion is a great idea. However, I will tell you that it is standard (and recommended) medical practice that an abnormal PAP is then followed by a colposcopy/biopsy. If that comes back abnormal (which yours did), then it is standard practice to do a cone biopsy or LEEP. The cone biopsy is really a very important part of this process for a couple of reasons:

1. the cone will give the most accurate picture of the extent of involvement. This is important because if their is greater involvement than the biopsy has indicated (it's rare, but once in a while a woman learns she actually has invasive cancer and not just dysplasia)your treatment options may change. This is not to frighten you--it doesn't happen often. However, if there's any cancer there you want to know before surgery because the surgical precautions taken might be different. And it's best to do the surgery right the first time.

2. The cone does actually remove the abnormal cells and essentially cures 80-90% of women with dysplasia. This means that many women truly don't need to undergo such a big procedure as a hysterectomy. With approximately 10% of women, some abnormal cells remain after the cone. Some of those women undergo a second cone, some of those women will have a hysterectomy.

3. Some insurance companies will not approve a hysterectomy until less invasive procedures have been attempted (such as a LEEP or cone), unless there are other gyn issues involved as well.

Just because your doctor is not suggesting a hysterectomy right now does not mean s/he is anti-hysterectomy. It might mean that your doctor practices conservatively and prefers to have all of the necessary information before making such a big decision. A hysterectomy is major surgery. Most women appear to do well and have no problems. Some women face life-long changes as a result of their hysterectomy.

Most women get their second opinion after their cone biopsy is completed because then all of the information is available for review. I'm sure, though, that you could go see a different gyn who may or may not suggest a cone biopsy before determining if a hysterectomy is your best treatment option.

You might also like to discuss your concerns with your doctor to learn why s/he is not recommending the hysterectomy right now and under what circumstances s/he would recommend one. And also discuss other important things such as ovaries (keep or remove) and what to do about hormones if necessary.

Good luck! I hope all turns out well for you!