FREQUENTLY ASKED QUESTIONS (FAQs) ABOUT CERVICAL CANCER AND OTHER FEMALE CANCERS

By

DR. MRS. Meenal Kumar, M.D. senior gynecologist and menopause consultant, sector 20 civil dispensary Chandigarh

DR.R.KUMAR M.S., OPHTHALMOLOGIST AND HEALTH COLUMNIST, 232 SECTOR 16 CHANDIGARH

• Can I get pregnant after treatment of pre-cancerous stage?

 The pre-cancerous stage or dysplasia itself shouldn't cause infertility, but treatments to the cervix for cervical dysplasia, such as conization by cold knife, LEEP (loop electrical excision procedure), laser or cryosurgery (freezing), can negatively affect the ability to get pregnant. After a year of trying to get pregnant unsuccessfully, it is recommended that you see a physician for diagnosis of secondary infertility.  If you have a cervical factor causing infertility such as the glands destroyed by past cryotherapy, you may need artificial insemination.

• How do cervical cells change?

We don't know for sure. Many doctors suspect that viruses play a role and stimulate cervical cells to have more nuclear activity. If left alone over many years, that nuclear activity may turn into malignant invasive growth if it progresses.

• Is cryotherapy required as treatment?

Probably you had a cervical biopsy that showed early cancer. The Pap is only a screening test and what is actually on the cervix can be more abnormal (more severe) than the Pap smear suggests or less abnormal or the same. But all treatment is based on what the colposcopically directed biopsy shows. Usually there are 3 grades; mild, moderate and severe. If the biopsy is a low-grade squamous intraepithelial lesion consistent with mild dysplasia, then cryotherapy isn't really needed at this point. Most of those lesions will regress to normal on their own over- time. It just needs to be followed with every 3 months Paps, but if it progresses then some treatment would be indicated. If you want to get pregnant in the near future. If you had a good colposcopically directed biopsy in which the physician was confident that the worst appearing area was biopsied and it returned as moderate dysplasia, I would put off treatment with cryo until after you get pregnant. Just follow-up each 3 months with the doctor to see that it doesn't get worse.

• What are Atypical squamous cells of undetermined significance?

The condition is not serious and one need not get worried over this big name. In this case the cellular changes seen are thought to be mostly a response to some cervical inflammation or irritation, however, some of the inflammation may be due to the human papilloma virus (HPV). HPV usually goes away on its own after a year or two as your body develops immunity to the virus. There are some strains of the virus that are thought to be more aggressive and if left for a long time, may promote more severe changes called dysplasia and even cancer. That is why the Pap changes need to keep being checked, to make sure they don't get worse over time.

• If a colposcopy is done, is a biopsy necessary?

Atypical squamous cells of undetermined significance (ASCUS) are usually treated by just repeating the Pap smear in 3-6 months. Colposcopy is usually not done unless there are 2 or 3 ASCUS reports in a row. Colposcopy only allows the doctor to see which area of the cervix is giving the abnormal cells so that a biopsy can be directed to the worst area. The biopsy is the "gold standard". Most of the time it needs to be done although sometimes if you've had previous biopsies that are consistent with colposcopic visualization and that visualization has not worsened, a biopsy can be avoided.

• There is a higher incidence of ASCUS Pap smears progressing to dysplasia in women over age 50,is it true?

 Most of the time (70-85%) ASCUS Pap smears revert to normal on their own over time. Women under age 50 have a higher progression of ASCUS pap smears to dysplasia than do menopausal women, but the rates vary considerably depending upon the population studied and the accuracy of the laboratory used. One study has noted that ASCUS Paps over t

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