need advice on wife's abnormal pap

[sambo]

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I'm a 2nd year med student, and my wife got pap results today that said she had endocervical atypical glandular cells. I know that's more serious than squamous abnormailities, and she has an appointment tomorrow, I'm assuming for a colposcopy She's 23 and takes ortho tricyclen, but has always had regular periods, and is not pregnant or obese. Is there anything else I should tell her to get besides a cervical biopsy and an endocervical curettage? Also, can anybody tell me their clinical experiences with this type of pap result? Any info would be greatly appreciated.

 

[Diane L. Evans]

endocervical atypical glandular cells need a pathological diagnosis. Colposcopy will only look at the cervix under a microscope. A endometrial sampling needs to be done to see why those cells are present and if they are cancerous. If cancerous then a surgery to remove them will need to be performed. Most prefer to do a cold-knife excisonal procedure to remove all atypical glandular cells. However since she is 23 and I assume you may want children most people will not do this (I would advise against this) but rather refer to an expert-- A gynecological oncologist. I would advise you to see one soon!!!

If the biopsy comes back benign and the expert advises waiting and take the see what happens approach you may want to ask them if you can start the child bearing process now if you want children. The reason for this is because most AGC (Atypical Glandular Cells) with no neoplasia on biopsy will be followed in 4-6 month intervals by repeat cytology and progression may take 2-5 years. This may come as a shock but thinking about your options now is best.

If the biopsy comes back cancerous (and it depends what grade of cancer)there are options beside cold knife, a LEEP procedure (laser cautery with extension into the canal). If this removes all atypical cells, a cerclage (purse string suture into the cervix to keep it closed) may be needed in pregnancy. If the biopsy comes back cancerous--there is a new radical surgery being done to remove the entire cervix and prevent hysterectomy especially in those that want children. If this is the case email me and I will put you in contact with the specialists that performs this new procedure. [email protected]

Good luck

 

[sambo]

Thanks so much for the reply. We went to the family practice clinic on campus today, and I'm very glad I skipped class to go with my wife. The nurse (who thought she knew everything) hadn't even scheduled a colposcopy and said that she would have the doc do another pap, even after reading the AGC result. I told her that with AGC we need a colpo TODAY with the whole nine yards of biopsies. She went to the doc and we were bumped to the front of the line and put right into the procedure room (Thank God I'm a med student). The colposcopy showed some areas on the cervix that didn't take up the iodine. They took multiple cervical biopsies from these areas, and also did an endocervical curettage and an endometrial biopsy (which evidently is not indicated in pts <35 w/o a history of vaginal bleeding, but I was insistant). They also did a bunch of cultures to be on the safe side. We should know something in a couple of weeks. Regardless of the results, I will ask about a referral to a gyn-onc.

 

[Diane L. Evans]

I am glad you were persistant. Biopsies take about 7-10 days for results especially if sent off for frozen sections. I would get hold of a ob/gyn professor at your school and ask him about the gyn-oncs in the area and which one he refers patients to. I would then call confirm your insurance covers this doc, then call this gyn-onc and set up an appointment. It typically takes 2-4 weeks to be seen as a new patient, by then the results should be back.

Another thing your wife should do is question her mother if she had DES exposure while pregnant with her. And if your wifes mother or your wifes female siblings (if she has them) had any cervical, uterine, or ovarian cancer. ANother good piece of information is if colon or prostate cancer runs in the family. All these cancers re linked on the same gene.
Good luck
Diane