Oncology (General Cancer)/pap smear results, atypical glandular cells
QUESTION: Hi DR. Higby,
First let me thank you for any help you can give me regarding my question.
I am a 51 yr old post menopausal woman. My last menstral period ( 12/11/2011) lasted over 25 days which resulted in my gyno doing a D & C - pathology results were no atypia or malignancy identified. Then a couple of months later a sono showed I had a 1.4 cm mildly complex ovarian cyst, left side, that was no longer detected at 8 month follow-up sono.
I got my first period at 13 yrs. old. My periods were always uneventful. I do not smoke or drink. I have never engaged in sex outside of my 25+ yr marriage. I am just slightly overweight. I took Lo-Ovral birth control pills off and on for about 15 yrs, stopped about 7 yrs ago.
I had 3 children, 2 vaginal births and one c-section.
All my previous pap smears were normal until the last two. The first abnormal pap taken mid January 2013, results were ASC-US. Follow-up pap taken mid July, 2013 show Atypical Glandular Cells of Endocervical Origin. Epithelial Cell Abnormality. Endocervical/ transformation zone component present. Partially obscuring inflammation. My gyno has me scedualed for a D & C, colposcopy and biopsynext week. Needless to say I am beside myself with fear. Are the pap findings common? Are they worrisome? What are the statistics regarding these findings? If my gynocologist is worried, she is not showing it. Should I look for a gyno/oncologist at this point? I am most likely facing a future of cancer anywhere in my reproductive system or beyond due to these results? Again, thank you for your help. Connie
ANSWER: First of all, stop worrying. What you have is usually very treatable, and the appropriate treatment is what you gyn is planning. It may be that the tests she does will show nothing serious, or the D and C will remove the tissue in question. If not, there may be recommendation for a hysterectomy, which nowadays is often done with robotic surgery so that recovery is very rapid. It is highly unlikely that you actually have cancer, or that if you do, it is advanced. So take a deep breath and go through step one, which is what she recommends, and let me know what the outcome is. It's too early to see a gynecological oncologist; most gynecologists are skilled in handling this abnormality. Hope this helps.
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QUESTION: Thank you Dr. Higby, for such a quick response. I do have a few follow-up questions. What is it that I have? What are atypical cells of endocervical origin? What is epithelial cell abnormality? What does partially obscuring inflammation mean? What are the causes for these test results?
Could it be possible that the problem is higher up in my cervix where what my doctor is going to do will not detect/reach, and cancer could be hiding there even now?
What are the non-cancer reasons for all my test results? Thank you again. I cannot tell you enough how your service to all experts is a beyond kind.
ANSWER: Endocervical cells are those which grow inside the cervix and merge with the uterine lining. Some of them are glandular cells, which contain material that can be seen under the microscope. The patholigist called them "atypical" which means they are slightly to moderately different from normal. Epithelial cells are generally flat and look pretty much the same as each other. They occur on the outside of the cervix. He is saying that these look abnormal as well. Both of these problems can be caused by inflammation, and the pathologist notes inflammatory changes, which means that he saw ordinary white blood cells in the tissue from the pap smear, which isn't normal. In fact, everything largely points to chronic cervical inflammation, which can be non-specific or due to some mild infection with yeast or a virus. I'm sure she will investigate that with the next procedure. Yes it could be that there is a problem higher up in the cervix, and that she might not detect with a D and C. But that is highly unlikely, as a D and C samples the entire uterine lining. Hope this helps.
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QUESTION: Hi Dr. Higby,
My Ob/Gyn did colposcopy today. In my earlier correspondence I said that she would be performing a D and C. She did not. While performing colposcopy I asked her if she saw anything concerning? She answered that she was taking 2 "random" biopsy samples to be tested. She explained that "2" "random" biopsy samples would be better for the lab techs to analyze??? Also she did the curettage 2x, again implying that there would be plenty of cells for the techs to work from??? She told me not to worry, that atypical glandular cells of endocervical origin do not mean cancer, but they are more concerning than squamous cells, and they must be further investigated. From what I thought ASG cells are a precursor to cancer? I asked if I should be tested for HPV. Also, I told her that I was having intermittent clear mostly odorless discharge (sometimes it has faint smell of iron?). She did not seem concerned. She said something like when techs are examining my cells and biopsy they will look for HPV???, or something like that. My last HPV test 11/2011 was negative. Also, that my vagina is getting dry inside due to hormones, thats why I am having occasional clear discharge. She said that most of the time the colposcopy results come back normal. That sometimes these cells changes have no explanation.
If my 5 month earlier pap showed ASCUS, and now it is AGC of endocervical origin, doesn't that mean that I most likely do have cancer and it is spreading fast, especially if it is not HPV related? Are AGC cells LGSIL, HGSIL?
She said that if results come back normal I will have to do follow-up Pap in 3 months. She told me not to worry, she would have results within 2 weeks. Easier said than done.
Also,shouldn't she be sending me for a -Cone Biopsy- no matter what the test results are???
Sorry to bother you again. THANK YOU SOOOO MUCH. I will let you know what the outcome is once I get the test results. Connie
When we talk about "pre-cancerous" conditions, there are several scenarios. One is that what you see will lead to cancer. Another, and the situation in your case, is that what you see is caused by something that could also cause cancer. An example is the effect of the drug tamoxifen on the uterine lining. Changes take place which almost never lead to cancer; but if the changes take place, there is a higher chance that the woman will get cancer than if they had not. As for HPV, yes, a pathologist can tell if there are signs of HPV in the cells, and that is routinely looked for. To do further studies to confirm this would be based upon what is found. As for the vaginal dryness and the intermittent discharge, those two events are certainly hormonally related, and occur together in a lot of post-menopausal women. The discharge is probably due to slight changes in your levels of estrogen (yes, you still make some). Ask your gyn about using some topical vaginal cream to prevent vaginal atrophy -- after the results of the tests come back. I suspect that when she inspected your cervix, she may have decided that a cone biopsy was overkill, and wanted to just take a couple of random biopsies. Random biopsies essentially mean that everything looked the same (and not abnormal), so she didn't have a target to biopsy. Cone biopsies essentially remove the lining of the cervix, and that is a treatment as well as a diagnostic test. All in all, I think she is on the right track, and please stop worrying about cancer. I honestly don't think you have it. Keep me posted.