I'm looking for feedback & advice regarding my situation... Here's my Hx: I had an abnormal Pap in October, with a positive test for High Risk HPV. A month later my Dr (a GP, as I live in a very small town w/ no specialists) did a colposcopy with three biopsies from two areas and an ECC. The biopsies confirmed low-grade dysplasia, and the ECC showed affected cells in the endocervix. My Dr consulted with an OB-GYN regarding this situation (because of the +ECC) and was told I have two options: 1) cryotherapy or 2) LEEP. The LEEP has a possibility of cervical incontinence in pregnancy, but is more likely to "get it all." (I'm 26, no kids, would like kids in the future.) If I go with cryo, they will do a repeat Pap in 4 mos, and if there is no change or digression, they will do a LEEP anyways. I spoke with a nurse at the OB-GYN I had in Austin, TX when I lived there years ago, and she stated they don't do cryo there, and they would take a wait and see approach. (In other words, the exact opposite of what my Dr and the consult OB said.)
I am scheduled for cryo in 6 days, but need to decide what to do. I would need to travel 3.5 hours (one way) to see an OB-GYN for a second opinion, and am afraid I would hear yet a third version of what I should do in this situation, thus confusing me even more! My main concern is that from what I've read, the cryo won't do anything about the endocervical cells they found, which are apparently the biggest concern in this situation.
Do any of you have experience with the +ECC, and what did your Dr recommend/do? Thanks Ladies!!
Lagirl is the perfect person to answer these questions but I can tell you my opinion right now based on what I have learned.
I'm currently debating the leep v. cryo approach too. The problem with cryo, besides not getting it all, is an inverted cervix later, where the TZ disappears up the canal making future colpos (if needed) difficult sometimes impossible. (called an "unsatisfactory colpo" due to inability to visualize entire region)
Therefore, based on the info given, I would probably opt for as shallow a leep as possible, since there is ECC involvement, as it seems more "definitive" albeit a bit aggressive for CIN1.
Is there such a thing as a shallow cone, since I think cones are used when there is ECC involvement? Also, sometimes ECC involvement is really contamination from other sites--esp. if low grade, so are you sure this is the case (was he able to SEE ECC involvement)?
Do you have a picture of what it looks like? If the affected areas are close together, I might opt for cryo. If they are spread out, leep is more favored, I would imagine, but I am not an expert.
The disappearing TZ/inverted cervix "just" means that if a colpo is needed in the future, they may need to dilate the cervix or use means other than a colpo (sometimes more invasive) to get the samples/views they need, right? Or, are there more far reaching consequences & results?
My Dr was unable to visualize the endocervix at all in the colpo, so I don't believe she was able to see any ECC involvement directly; She didn't say one way or another whether the +ECC could be a "cross-contamination" issue.
The affected areas on the cervix itself were both in the same general 12 o'clock area, so I believe they are close together.
I think right now I'm leaning towards the cryo, but want to confirm with my Dr that they will be taking care of the ECC cells as well, and have a way to test the ECC later at the FU appt.
Thanks for all the additional info/things to consider - these forums have been a great help to me in the last couple of weeks!
Yes to the inverted cervix question, as far as I know, although I am not quite sure as to the repercussions, if any, to future procedures (such as leep) if cryo didn't eradicate it. Sorry, I am finding this difficult to visualize. I'd prefer cryo, if only it didn't cause the TZ disappear! This is why many doctors have abandoned cryo in favor of the (albeit more invasive) leep, however, my gyn-onco seemed to favor cryo first for mild dysplasias. If I hear more, I'll let you know.
I am not even sure if they can clearly see the ECC of a "virgin" (unoperated) cervix. So, the best results are probably from the ECC curettage, rather than sight alone (I'm waiting for mine, and sort of question his ability to peer into that small canal, even with the 'scope).
I understand you are pressed for time, but I would reschedule my cryo if I was not 100% sure. If you can, read posts from lagirl, Timber, and others, they have been so helpful to me.
Are you on any vitamins/supplements or a naturopathic regimen?
My Dr recommended Folic Acid - that's the only vitamin/supplement I have added to my usual regimen (Woman's Multi-Vitamin, Vitamin C, Zinc, Cranberry) for this.
I decided to get the cryo done yesterday by my GP Dr. She used a cone tip, as opposed to the cylinder tip, so she could get into the endo-cervix and freeze the cells there as well. (I had some very nice ice-balls, apparently, which should provide very favorable results, she said!) The repeat pap will get cells from the cervix & endo-cervix to re-evaluate. If the cryo didn't take care of all the abnormal cells, I'll be sent to an OB-GYN to get LEEP.
So now it's a few weeks of inconvenience/discomfort and four months of waiting! Thanks for all the advice/help!
Hi kaberg, thanks for your reply. Did your gyn say anything about the possibility of an inverted cervix from cryo? Perhaps that doesn't always happen? I hope. I'm considering cryo before leep in March.