Generally, when precancerous cells persist, further investigation is called for. To rule out the presence of invasive cervical cancer, doctors test the suspect cells for human papilloma virus (HPV), the sexually transmitted virus that causes cervical cancer. In addition, a colposcopy and biopsy of abnormal-appearing areas of the cervix and sometimes an operation to remove a portion of the cervix may be needed. Without further information about your specific case, it is difficult to know whether any of these steps has already been taken. If you have had a thorough evaluation to rule out the presence of cancer (which could be cervical cancer, or more rarely, vaginal cancer or endometrial cancer), and no cancer has been found, then a hysterectomy is unlikely to be recommended. If, however, you have persistent precancerous cells but no further evaluation has been done, you should definitely speak with your gynecologist about the necessary next steps. Occasionally, abnormal or precancerous cells in a Pap smear are actually coming from the endometrium (the inner lining of the uterus) rather than the cervix. If that is a possibility, an endometrial biopsy or a dilatation and curettage (D&C) may be recommended. You should discuss the exact diagnosis of your next Pap smear with your doctor, and specifically ask what your risk of developing cervical cancer is. Your doctor will use the exact Pap smear diagnosis, results of HPV testing, and other specific issues about your personal case to help determine whether you have a high risk for developing invasive cervix cancer. Then, with that information in hand, you can consider whether a hysterectomy would be the right step. A hysterectomy, however, is rarely recommended for a young, healthy woman with no evidence of cancer. As for the distress of continually receiving the news about having an abnormal Pap smear, it is likely that a frank conversation with your doctor about your specific diagnosis, and whether or not you carry an increased risk for cancer, might allay your fears. Q2. My daughter has been troubled for about 15 years with cervical dysplasia. She has had two “laserings” and recently a surgical removal of tissue. She’s about to be married for the first time and does not want to conceive now (I question whether she could). I’ve read that birth control pills should be avoided, but her gynecologist says not to worry about them. What is your opinion? If it is NOT to take birth control pills, which other contraceptive method do you think would be best? — Carol, Florida Cervical dysplasia is frequently managed with techniques such as laser surgery and cold-knife cone biopsy, which remove the abnormal (precancerous or dysplastic) tissue and provide a sample that can be examined to be sure that no invasive cancer is present. Such procedures rarely impair a woman’s ability to conceive, because the opening at the center of the cervix (called the cervical os) generally remains patent, or unobstructed, so sperm can pass through. If there is normal menstrual flow, then the cervical os is certainly patent, since the menstrual blood must pass from the lining of the uterus (the endometrium) through the os to the vagina. Your daughter is wise to assume that she is indeed fertile and, because she does not want to conceive now, to elect to use some form of contraception. She is also correct in seeking advice from her gynecologist, who is the right person to help her make the best choice for her specific situation. Birth control pills (oral contraceptives) are generally safe, and they are highly effective at preventing pregnancy. Among women with normal Pap smears, the use of birth control pills has not been shown to increase the risk of cervical cancer. For women under age 40 who do not smoke cigarettes, the risks of taking oral contraceptives are very low. Some data suggest that for women with evidence of persistent infection of the cervix with human papillomavirus (the virus that causes cervical cancer) and who also use oral contraceptives for a long time (more than five years), there may be some increase in the risk of developing cervical cancer. These results have been considered controversial. Q3. I have gone through menopause and haven’t had a period for almost 15 years. Now I’m having one. Why? Could I have cervical cancer? — Barb, Nova Scotia Bleeding from the vagina after menopause always requires medical evaluation. Although there are non-cancer causes for bleeding (menopause-related thinning of the vagina, called atrophy, is one), you will need some testing to determine whether the cause of your bleeding is a cancer. One of the most common causes of bleeding after menopause is endometrial cancer, a cancer of the cells that make up the lining of the uterus. Although other cancers such as cervical cancer, vaginal cancer, and sometimes ovarian or fallopian tube cancer may cause bleeding after menopause, endometrial cancer is the most likely cancer to do so. You should be seen by a gynecologist and have a pelvic examination. You probably will have a Pap smear (a screening test for cervical cancer). If the cervix appears potentially cancerous, you may need a biopsy of the cervix. Because of the possibility of endometrial cancer, your doctor will likely recommend a special sonogram where the probe goes inside the vagina (a transvaginal sonogram) to look at the lining of the uterus (the endometrium). Your doctor will also probably recommend an endometrial biopsy. If the endometrial biopsy shows cancer cells, you probably will require surgery. In this situation, you should discuss with your gynecologist the option of referral to a surgical specialist, a gynecologic oncologist, for further management. Learn more in the Everyday Health Cervical Cancer Center.
