Christina S. Chu, MD
Last Modified: December 10, 2001
Dear OncoLink "Ask the Experts,"
I recently was diagnosed with Carcinoma in Situ of the cervix with both squamous and adeno cells. I never had an abnormal pap before this and have had pap smears every year. I have chosen to have a total hysterectomy. Am I at greater risk to develop other GYN cancers? I am worried about the virulence of the particular strain of HPV that I have due to the fact that the CIS developed so rapidly.
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
There are some details about your diagnosis that are important. If your pap smear showed squamous cell carcinoma in situ with glandular involvement, that is a slightly different situation than squamous cell carcinoma in situ and adenocarcinoma in situ which implies at least two separate lesions. In any case, a pap smear is only a screening test, and colposcopic examination with directed biopsies and an endocervical currettage is recommended after an abnormal result. Colposcopy serves to provide a definitive diagnosis, to assess the extent of the lesions, and to rule out any invasive lesions, which might require more extensive surgery than a simple hysterectomy.
You did not mention your age, but while hysterectomy is one option to manage carcinoma in situ of the cervix, cone biopsy is certainly another option for patients who still want to have children or retain their uterus. Any patient with an inadequate colposcopic examination, high grade dysplasia on the endocervical curettage, adenocarcinoma in situ, a significant discrepancy between pap smear and biopsy findings, or a colposcopic examination concerning for invasive cancer (even if biopsies show only carcinoma in situ) should have a cone biopsy prior to hysterectomy to preclude the presence of an invasive cancer.
If your pap smear did show evidence of the HPV virus, you should be aware that you may be at increased risk of developing vaginal or vulvar dysplasia. I would recommend yearly pap smears of your vagina even after hysterectomy.