WOMENS-HEALTH Messages for August, 2001: Second cone- update with new info and new questions

Second cone- update with new info and new questions

From: CC (anonymous@obgyn.net)
Fri, 31 Aug 2001 01:33:15 -0500 (CDT)

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Hi, Posted before on this, have update and need advice. History: had cold cone 11/00, large, 2cm^2 sample taken, also endometrial samples taken. Dx= carc. in situ (squamous) in endocerv. area with glandular involvement, margins clear; Ectocerv. margin involved with mild dysplasia. Endometrial samples normal. Follow up pap 4 mos post op was normal. Another follow-up pap 3 mos later showed HGSIL moderate. Colpo performed by Gyn-Onco. She took 2 biopsies- one from ectocerv, one from polypoid area in transformation zone. Ecto sample still showed mild dysplasia.The other biopsy was scar tissue, no dysplasia. She sent the pap and biopsies out for second pathology opinion from the super-duper pathology expert at UCSF. Well, he agreed with both original readings.

Question: what to do now? She wants to do another cold cone since a leep would be too small and we have no idea where the HGSIL is coming from.. but all ECCs have been NORMAL. I am 33 with no children, want to preserve fertility, but don't want invasive cancer either. I am confused since I was told that the chance that the endocervical portion would recur was less than 3% with clear margins. And I lead a healthy life, never smoked or anything! I know a second cone could cause pregnancy/fertility problems, so I really need help in deciding what to do. 2 questions:

1) what would you DRs do in this case? I was told that follow up paps can be a risk since if there is a remnant of glandular lesion present, it might not shed cells and be detected. 2) what happens if she takes another cone, and it comes back negative????? Then what?????

I appreciate all insight since I have to make a very big decision here.

Thank you drs, CC

Next message: Willow: "Simple endometrial hyperplasia without atypia and chance of progression?"
Previous message: EJ: "pelvic pain and bleeding midcycle"

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