Had my LEEP today. I thought it was a very easy procedure -- only bothersome thing was the anesthetic, which made me feel like I was having a heart attack.
Anyway, I'm left wondering about something. Before the LEEP, I asked my doctor if I had any abnormal cells in the canal. He didn't know!!! He hadn't looked at the chart to find out! So, he took a look and the lab report showed that I may have dysplasia there. So, during surgery, he also took tissue from the canal, as well as two other spots on my cervix.
So, I guess my question is -- does anyone know how bad abnormal cells may be in the canal if moderate dysplasia is the general diagnosis? I'm scared to death that the dysplasia may be higher up and that the loop didn't catch it all. Anyone else have any experience with this?
May I ask what type of diagnosis you had that made your doctor decide to do a LEEP?
The good news is that the LEEP cuts a cone shaped piece, basically making the canal larger. So the doctor will have a good sampling of the cervix - canal and all.
The cervix is made up of two basic types of cells: squamous and glandular/columnar.
The squamous cells are on the outer part of the cervix. This is the area that is scraped during a pap and looked at during a colposcopy. Something like 80-90% of cervical cancer is of the squamous cells. Squamous cells make up the outer 1/3 of the cervix. Lesions of the squamous cells grow outward and fairly slowly. If there is cancer in those cells they are referred to as carcinoma.
Glandular cells are the upper 2/3 of the cervix. This area cannot be sampled during a pap, nor is it seen by a colpo. The only nonsurgical way to sample the tissue is with an ECC (endocervical curettage). The LEEP and cold knife cone biopsy are surgical ways to identify the condition of the cells in the cervical canal. Lesions of the glandular cells might skip over healthy cells and grow somewhere else. They also grow more rapidly than squamous cell lesions. This is one reason that lesions in the cervical canal are treated more aggressively than squamous cell lesions. Cancer of the glandular cells is adenocarcinoma.
Just because a woman has one type of lesion/dysplasia doesn't mean she has the other. I had adenocarcinoma and no carcinoma. Most women who receive a cancer diagnosis have carcinoma, not adenocarcinoma.
I hope this doesn't scare you. I hope to just give you a quick rundown of the layout of the cervix. The good news is that for many women who have a LEEP (or cold knife cone) the procedure is treatment and diagnostic. That means they don't need further treatment (just to continue paps as directed by their doctor).
Thank you for the thorough response! I think I just learned more from you than I had from my doctor or from the internet up to this point!
To answer your question, my most recent diagnosis from a biopsy two weeks ago was CIN II.
So, can a person have either squamous cell dysplasia OR glandular cell lesions in the cervical canal? That's my understanding. From what my lab report showed, I might have some sort of dysplasia in the canal, but they were not sure. The doctor said he got a good sample from that area (but didn't go too deep as he wants to preserve my cervix as much as possible) so he should be able to tell whether or not the LEEP got it all. I really, really hope it did. Knowing that there may be an issue in the canal gives me a very uneasy feeling.
You are welcome Elizabeth, I've done a LOT of research on adenocarcinoma (and glandular lesions/dysplasia) since last April. My doctors didn't explain a lot either. And just so you know, I tried to stick with reading information from CDC, National Cancer Institute, and major medical hospitals/journals.
It is possible to have squamous and glandular lesions/dysplasia, but I haven't read of any woman having that (here at HB and I've posted here for 10 months and read back threads on "glandular" "columnar" and "adenocarcinoma going back several years - I don't recall any mentioning of having both).
The squamous cells are the outer third and the glandular cells are the upper 2/3 of the cervix. Between the two there is an area called the Transition Zone (TZ). This is where the glandular cells turn into squamous cells (though I don't understand that process). Squamous cells are not further up than the TZ and (as far as I know) glandular cells are not below the TZ - except when found in a swab (I'm assuming because of shedding - but again, I don't know for certain).
When did your doctor say your results would be back? My doctor had said 2 weeks (and that's when I set my follow up appointment). I started calling on the 4th work day after my CKC, the results were back on the 5th day. I prefer calling to get the results than waiting for them to call me.
I'm heading to bed, I'll check back sometime tomorrow (Sat). 'night!
Well, the nurse said the results would be back in ten days, but the doctor said seven. I may call if I have not heard anything by Friday.
I assumed they would have me back in a couple of weeks to make sure things were healing well, but the nurse said "no." I guess they just assume everything is healing okay unless they hear otherwise from me. The doctor said that if the lab results show clear margins, he will see me back for a pap in four months. If there are not clear margins, he said I'll come back in three months; however, I'm not quite comfortable with that length of time, but I'll deal with that if it happens.
When I asked the doctor what would happen if they hadn't captured everything in the canal, he totally avoided my question. Does that mean a cone biopsy would be next in most cases?
Well, I got my results over the phone from the nurse last Thursday. What she told me was that nothing was found in the cervical canal and that of the two lesions I had on the outside of the cervix, only a small portion was moderate dysplasia. All margins were clear.
Fast forward to today. I started to get concerned about the yellow discharge I was having over the weekend. I called the doctor and the nurse said to come in to be checked out. (Thank god I had Presidents' Day off of work!) So, I'm sitting on the table and the doctor walks in and says, "Good thing we took tissue from the canal during your LEEP." I replied, "Why? Things were clear there." Well, then he goes on to inform me that they found severe dysplasia in the canal -- "severe endocervical glandular dysplasia" to be exact. However, the nurse was correct in telling me that the margins were clear.
How worried should I be about this? I am freaking out that I just found out I had HPV in November and now it's already CIN III and in the canal. I mean, hopefully it's all removed now, but I keep worrying that some cells were missed. The news just keeps getting worse and worse with this situation.
(((Elizabeth)))) Did you get a copy of your report? If not, you might want to ask for one. It will give you more info. What did your doctor say the next step would be?
I can't remember how old you are or what made your doctor send you for the LEEP (maybe you never said)?
I know that doctors tend to treat glandular dysplasia more agressively than squamous cell dysplasia - because of how the dysplasia grows.
I just want to give you a little comfort. It is very likely that this didn't develop this quickly (since November). It is much more likely that it was just discovered in November, and they are just determining the extent of the damage HPV has caused. It seems like it is growing this quickly because you (probably) didn't know you had it. I had similar feelings last year when I was first diagnosed with HPV.
I know this is difficult to deal with. We are here for you to help you as best we can. (((((hugs))))
Thank you for the prompt response; really means a lot to me. I did get a copy of the report, however, it really didn't tell me anything more. The doctor said the next step is a pap in three months and another scraping of the canal.
I'm 33. I was given a LEEP because a colpo showed that I had CIN II.
Thanks -- I guess maybe I've had this for years -- especially since paps wouldn't catch the grandular part. Is the only way to keep an eye on the canal to do the ECC? How would they catch something further up in the cervix but not in the canal area?
The best way I can answer your last 2 questions is to explain the cervix a bit.
The cervix is actually just the lower portion of the uterus.
The cervix is kind of like a frosted bagel (ok, bear with me - I use to say donut, but the bagel has a smaller hole - so it works better for my example). The bagel is face down and the doc looks up at it. During a pap the doctor views the frosting (exocervix) and that is what he/she scrapes. During a colposcopy, the doctor views (and can sample) the same area. The doctor can also see a little further into the canal where some of the frosting might have oozed into the hole. There is a line in the cervix called the Transition Zone (TZ) where, the outer cells (squamous) and cells from the upper cervix (glandular) meet. This is basially where the frosting ends. The doctors can see (and sample) a bit of the TZ, sometimes and to some extent. The only nonsurgical way to tell what is going on in the canal (beyond where the doctor can see) is to do an ECC. Otherwise, a procedure like a LEEP or cold knife cone is done to remove a larger sample of the cervical canal to determine what is going on.
The only other advice I have for you, right now, is to suggest that you get an appointment for a second opinion - perhaps even a gyn/oncologist. Glandular cells dysplasia isn't something you want to wait and watch for long periods of time. My gyn/onc didn't take patients who had less than CIN II, so if you were to go to her, she would most likely see you (especially with the glandular cell involvement). It never hurts to seek another opinion.
Thanks -- I will see if there is an onc/gyn in my area. If not, even a second opinion from a regular gyn might make me feel better. I know the report showed that the LEEP got all the bad glandular cells, but my doctor has kinda lost my trust at this point and I don't totally feel comfortable with his recommendation to just wait another three months.
This has really been worrying me all day. I did find one oncologist for gynecology in my area, so I will see if I can get an appointment with him. Even if the LEEP lab report showed that the margins were clear on the glandular cells, do you think I should still be alarmed? I really don't know how to think about this.
Elizabeth, all I can tell you is I was one worried-mess prior to getting in with my gyn/onc. I understood things SOOOO much better once she sat down with me an explained things.
I don't think you should worry, but like someone else just said that is like telling someone to not breath. So the best I can say is learn what you can about your pathology reports, but don't read people's horror stories. Stick with the medical pages. It gets so overwhelming seeing all options, for all disease processes, for various types of diseases.
Try to focus on something other than these test results. The worrying won't speed up the results, nor will it change the outcome of the results.
Do what you can to pleasantly occupy your mind (as best you can) and come back and let us know how things are going! (((((hugs))))))