Friend Worried About Cervical Cancer

Laura,

Most likely your friend is being referred to a gynecological oncologist?  (First trained as Ob-Gyn, with added training in cancer of cervix, uterus, ovaries)

I've seen something on line (http://en.allexperts.com/q/Oncology-General-Cancer-978/cervical-cancer-8.htm)  which leads me to believe that in recent years, ob-gyns are no longer routinely treating abnormal pap smears in their offices with cryosurgery, coloposcopy,  LEEP (loop electrical excision procedure)  -- but that these procedures are more and more being performed by gyn oncs who are specializing in the treatment of cervical dysplasia from the very earliest stages.

When I had cervical dysplasia 30 and 20 years ago, regular gyns did the coloposcopy and cryosurgery in the same office where I'd had my Pap -- but I don't think that's always the case anymore.

Anyway, how soon is your friend's appt?  (The sooner it is, the easier it may be to tell her to "stall" on thinking the worst.  The longer away it is, the more you can say "they wouldn't make you wait that long if they thought it was almost certainly cancer.")

Did her gyn relay the "grade" of the Pap, like CIN I, CIN II or CIN III?  (see: http://www.gynalternatives.com/cervical.htm)

I think if there has actually been a diagnosis of cervical cancer, her gyn would have been legally obliged to tell her, and not just say it's "bad" and give her a referral.

Given that she only has a cervix, perhaps her regular gyn thinks it is safest to refer her to Gyn-onc who specializes in cervical biopsy procedures.

I would offer her all these possible explanations, and tell her not to cross the "cancer" bridge before she receives a biopsy-proven diagnosis.

Ann

Hi Laura -- sounds like your friend's gyn could use some lessons in communication.  To just say "it's bad" and "I'm referring you to an oncologist" is simultaneously Too Much and Not Enough information.

I hope she gets her appointment soon -- and I think it must be a gyn-onc, which is a more surgical subspecialty -- very different from the medical onc we with BC generally don't see until AFTER lumpectomy or mastectomy.  I think the doctor your friend has been referred to is probably more the equivalent of the breast surgeon that we all get referred to after abnormal mammo or palpable lump.

Good luck to her (glad she has such a good friend in you)!

Ann

Ann is absolutely right about gyn oncs being the preferred specialists for those of us having regular abnormal Paps or even a family history of a gyn cancer. I've been seeing one for many years. So the referral doesn't necessarily mean that your friend has cancer.

Though we all understand the terror of a cancer dx, if she does actually have it, you can be somewhat reassuring in being able to tell her that most cervical cancers can be completely eradicated, often without even extensive surgery, especially when they are detected very early.

~Marin

My daughter had a pap smear to come back "bad" when she was about 20 yo.  I took her to Duke.  She went in the same clinic I do when I saw my onc.  Anyway, the gyno did a biopsy, cryosurgery, etc.  She had to see him about every four months until things cleared up.  She's had no problems since and has had two children!

Shirley

Well, if it is precancerous cells in her vaginal epithelium, that is different from cervical dysplasia, and it is much rarer.  But still treatable.

I don't think a secondary in the vagina that metastasized from somewhere else would be showing up as "precancerous cells" on a Pap.  If it is truly vaginal and not cervical, the fact that it showed up on a Pap as "precancerous" makes me think it is likely vaginal intraepithelial neoplasia (VAIN).

From ACS (http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_is_vaginal_cancer_55.asp):

About 85% to 90% of vaginal cancers are squamous cell carcinomas that begin in the epithelial lining of the vagina. They tend to occur in the upper area of the vagina near the cervix. Vaginal squamous cell carcinomas do not appear suddenly; they develop over a period of many years from precancerous changes called vaginal intraepithelial neoplasia (often abbreviated as VAIN).

It looks to me like your friend may have read the very bottom of the same ACS webpage, where it says mets to the vagina are more common than primary vaginal cancers -- but still, I can't imagine something like that would show up on a Pap as "precancerous."

Glad she has her referral appt soon -- because I think the news from the doctor will be a lot less dire than what she is imagining.

Good luck to you and her, Jen!