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Old 05-22-2008, 11:17 AM   #1
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LEEP vs Cold Cone Biopsy

In December I had LEEP for low grade dysplasia and the results showed clear margins. I just had my four month follow up pap and that came back as low grade dysplasia again, so I am going back for another colposcopy in a week.

I am past menopause, and even though I know this is low grade I am still finding myself upset. I had no problem with the LEEP and would prefer to have that done again if necessary, but fear that my doctor will recommend the cold cone biopsy. I really don't want to have the general anestheia and the problems afterwards with bleeding and cramping etc.

I think part of the problem here is that it might be high up in the cervical canal so can anyone answer a few questions?

Is LEEP as effective as a cold cone biopsy even if it is high up?

Why would the follow up PAP test be bad again? Didn't get it all even given that the margins were clear?

I had cryosurgery done about 18 years ago, but all PAP tests have been fine since so why now is it showing up again after so many years? Does HPV stay in your body forever?

Thanks for any help or sharing of experiences you might have. I know many have faced worse and that this is not life threatening. It just has me upset again!

glowing4

 
Old 05-22-2008, 02:31 PM   #2
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Re: LEEP vs Cold Cone Biopsy

Quote:
Originally Posted by glowing4 View Post
I think part of the problem here is that it might be high up in the cervical canal so can anyone answer a few questions?

Is LEEP as effective as a cold cone biopsy even if it is high up?

Why would the follow up PAP test be bad again? Didn't get it all even given that the margins were clear?

I had cryosurgery done about 18 years ago, but all PAP tests have been fine since so why now is it showing up again after so many years? Does HPV stay in your body forever?

Thanks for any help or sharing of experiences you might have. I know many have faced worse and that this is not life threatening. It just has me upset again!
Hi,

I'm sorry to hear that you have deal with this all over again. I'm not sure if I can answer all your questions but I will try to help you out with my experience.

I can't say for sure if the LEEP is as effective as a CKC. All I can tell you is that I had severe dysplasia and it was also high up in the canal so I had a CKC done at the same time I had my LEEP done. That was 20 months ago and I've only had one pap come back negative (at 9 months) and when I had the colposcopy I was told I was all clear.

Paps can come back bad at any time. Just because the margins were clear doesn't necessarily mean that some new cells didn't grow after the fact.

I'm assuming you have HPV? If that is the case, yes, it does stay in your system. It can lay doormant for years and sometimes different triggers like stress (or in my case, pregnancy) can bring it out. Could it be it came back due to your menopause? There is no cure for HPV so even if they get it all in whatever method they use it can always come back. That's why the follow up paps are so important.

I hope I was able help. Please keep us posted with your story. I wish you all the best!

 
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Old 05-22-2008, 04:59 PM   #3
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Re: LEEP vs Cold Cone Biopsy

Thank you so much for your response. I really, really appreciate it. I doubt that it was menopause that triggered it, but I do think that stress had a lot to do with it - way too much of that this year!

Having been through this before, I guess I was just hoping that this would end things for awhile. I am not ready to worry all over again. It is really disturbing to me that HPV can lay dormant for so many years and then rear its ugly head. You would think that having been married as many years as I have and faithful on both of our parts that this would be a thing not to worry about any longer. But, I do agree, that stress can play a large part in so many things going on in our bodies and I guess I just have to get through another phase. Hard to get your body back to normal though when stress after stress keeps flying at you!

Thanks again for your most kind response. I will let you know how it goes. I am sooooo ready for some positive news!

glowing4

 
Old 05-22-2008, 05:17 PM   #4
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Re: LEEP vs Cold Cone Biopsy

Hi Glowing4!

I had a cold knife cone April 4th under general anesthesia. I was nauseated at the hospital, but they gave me meds for that right away and I was ok in about 30 minutes. I don't remember any more cramping than a regular period's cramping, and I don't normally cramp very much. I bled for 2 days, then I "oozed" (ok, medical lingo is "had a discharge") for about 2 weeks.

My doctor did a cold knife cone (CKC) because I was diagnosed with atypical glandular cells; they were further up into the endocervical canal. My doctor said the CKC preserves the edges of the biopsy. This means the doctor knows if the margin is clear or not. LEEPs and LLETZ (is that the correct abbreviation - I don't know the words for it, sorry!) singe/burn the edges of the sample so they can't tell about the margins. When my doctor did the CKC she also did a LEEP afterwards to cauterize where she cut. She did/had planned to put a tiny stitch or two in if she needed to cut off further bleeding. I also think the cone can take a larger sample than a LEEP.

Now, why did I have the CKC? I was diagnosed high risk HPV in January 2008. I was sent to a gynecologist for a colposcopy and possible biopsy. The colposcopy looked great and she didn't need to take any samples. Since everything looked good, but she knew I was hrHPV, she did an endocervical curettage (ECC). This scrapes the endocervical canal and samples for atypical cells. That came back adenocarcinoma in situ (highest stage of precancer). From that my gyn said I needed the CKC.

I've since been diagnosed (from the CKC) with endocervical adenocarcinoma Ia1. If feel blessed that my doctor did the ECC which allowed her to diagnose my cancer so early. My only treatment will be a hysterectomy (uterus and cervix only). I keep my ovaries and tubes. I don't need any chemo or radiation.

My suggestion to you is to ask your doctor about doing an ECC with your next colposcopy. I also suggest you ask about the doctor doing a LEEP after the cone to reduce the bleeding (if he/she chooses the CKC).

Did you ever know what your diagnosis was, especially your most recent one? You can still ask for your biopsy report. It may help make things make more sense.

My best to you. Please check back with us and let us know how things go!

 
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