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CIN 3 / glandular involvement?? CIN 3 / glandular involvement??

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  #1  
Unread 04-11-2003, 02:01 PM
CIN 3 / glandular involvement??

I had an abnormal Pap (CIN 3) at the end of January. I had a LEEP on 3/4/2003. My doctor called with results and said that biopsy results were CIN 1, 2 and 3 and that I needed to come back in to "shave off" a little more, which I'm assuming meant that the margins weren't clear.

I went in Monday morning and as the doctor walked in he said "so you are planning on having more children?". I said no (I have a 6 yr old and 4 yr old and have my hands full) and then he started saying that he highly reccomends a hysterctomy. Because he is concerned that the dyplasia had advanced really far in a short period of time (prior to this I had normal pap smears except for a bout with HPV 15 years ago) and that if I was "his wife he would want me to have a hysterectomy".

The pathology report indicated the carcinoma - in- situ with 'glandular involvement'. I was surpsrised and concerend about the hysterectomy reccomendation because he had specifically said at the previous appoitment that it wouldn't be needed.

I had the 2nd LEEP and we are waiting for biopsy results. In any case, he wants to schedule a Vaginal hysterectomy in six weeks.

Anyone have an experience similiar to this? Do you have any information on what "glandular involvement" indicates? I trust my gyno but am concerned. My mother had a vaginal hysterectomy at about my age for severe dysplasia.

Thanks in advance for any information.


34 years old/ married 2 children
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  #2  
Unread 04-11-2003, 02:54 PM
CIN 3 / glandular involvement??

Kehau,

Sorry to hear that you are dealing with these nasty surprises all at once! There are a lot of women here who have been through almost the exact same thing that you are going through right now, you've come to the right place!

I first had dysplasia in '92 or '93, which was removed with the cryo procedure. Later, I had two cone biopsies, one in 2000 followed by normal paps until 2002, when I had another cone biopsy. The pathology from that indicated that I had adenocarcinoma, which means I had cancer in the glands. I ended up having a trachelectomy (removal of the cervix only).

The reason your doc may be expecially concerned is because it is very difficult to detect glandular cancer on a pap smear (as opposed to the squamous variety). So that may be why he is suggesting a hyst., in order to be absolutely sure that the glandular dysplasia does not return, or worse, turn into undetected cancer.

One suggestion I have is to visit a gyn/oncologist if you can. They are specially trained with dealing with this type of thing and another opinion may help you to further understand what all of the treatment options are.

I'm sure there will be others along who can share their experiences as well. Good luck and keep us posted.

Beth
  #3  
Unread 04-11-2003, 07:25 PM
CIN 3 / glandular involvement??

's Kehau!

Welcome to Cancer Concerns! I'm sorry you are having this issue to deal with right now. It is such a difficult position to be in. Especially when at one appointment you heard that you wouldn't need a hysterectomy, and now you are hearing that you do.

There's a fair chance that the glandular involvement is what made your doctor change his mind. It can be so difficult to detect glandular involvement. As Beth indicated, glandular cells are pretty high up in the cervix, so it can be difficult to get a sample of those cells to see if there are any problems. Squamous cells cover the outside of your cervix and the lower part of the inside of the cervical canal. Most women with dysplasia have squamous cell involvement, a smaller percentage have glandular involvement. Some have both.

I had my first bout with dysplasia in 1987. Then I did well for 10 years before it just kept on coming back until really my only option was the hysterectomy. I had a family, but I wasn't totally sure I was finished having children, so it was a very difficult decision for me. However, I was tired of worrying all the time, and I was tired of having one procedure after another, and so the decision was made. Two years later, I'm still having normal PAP's.

I agree with Beth's suggestion that you try to see a gynecologic oncologist. They really are the experts when it comes to female cancers and precancers, and they know all the most current procedures and surgical techniques. It is an appointment worth making--just to hear someone else's point of view.

Remember that you can have the hysterectomy and still keep your ovaries. You are still quite young and you might like to have some natural hormone for a while. There is no link between cervical and ovarian cancer. I have my ovaries and feel great!

Another important thing to remember is that it will be very important for you to keep up with your PAP schedule--even if you decide to have the hysterectomy. HPV can recur on the vaginal wall (it's rare, but it happens), so it's important that you be screened regularly.

Good luck with your decisions. Make a list of questions to take with you when you see your doctor again. In the meantime, regardless of what you decide to do, remember to take good care of yourself. Eat well. Get regular exercise. Take a good multivitamin (include folic acid which is believed to help keep HPV at bay). Pray and/or meditate. These things can all help improve your immune functioning to get you into the best possible health.

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  #4  
Unread 04-11-2003, 08:12 PM
THANKS!!

Thanks Jeanine & Chicklet for your wisdom and advice!

I am hoping to have more answers next week when we get biopsy results in. At my last appoitment I was just so surprised by the Hytorectomy reccomendation and nervous about the LEEP that I didn't ask all the questions that I should have. Therefore I so appreciate your clarification of "glandular involvement" and advice.


Thanks, Kehau
  #5  
Unread 04-12-2003, 08:24 PM
CIN 3 / glandular involvement??

I had a hysterectomy after my Leep indicated that I had adenocarcinoma in situ. It did turn out to be stage 1a cancer but adeno is higher up in the cervix and much more difficult to diagnose. If you are finished having children, having a hysterectomy is not a bad option. You will no longer have to worry about abnormal paps, periods or birth control. The abnormal paps are obviously of the most concern. I would go see a gyn oncologist to get another opinion either way.
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