What does squalmous cell carcinoma in situ really means?

Hi I am 47 year old. My pap says HSIL/ Moderate, Severe squamous cell dysplasia, and squamous cell carcinoma in situ/ CIN 2 and 3.

I am waiting for appointment for colposcopy and possibley biopsy afterwards. I need to wait like two more weeks.

Can anyone tell me what squamous cell carcinoma in situ means????

Am I in danger while I wait for the appointment? What should I while I wait?


PLEASE HELP..!

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Cacinoma in situ means "cancer in place", but this does not mean you have cancer at this point, just that it's likely/possible to turn into invasive cancer if left untreated.

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Thank you, Sillygoose.

I have one more question. Does pap with carcinoma in situ actually be diagnosed as cancer after biopsy?

Thank you in advance.

Manna

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Dear mannapray,

I hope you are under the direct care of a gynecologic oncologist because OBGYN's ARE NOT qualified to treat you. So, if you are not under the direct EXCLUSIVE care of a gynecologic oncologist for your cancer-in-situ, make sure that is the VERY next thing you do while you are "waiting" two weeks for whatever it is you're waiting on.

Let us know how you are doing, ok?

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Most laboratories in the United States use a standard set of terms, called the Bethesda System, to report Pap test results. Under the Bethesda System, samples that have no cell abnormalities are reported as “negative for intraepithelial lesion or malignancy.” (The word lesion refers to an area of abnormal tissue.) A Pap test result may also report certain benign (non-neoplastic) findings, such as common, harmless infections or inflammation. Pap test results also indicate whether the specimen was satisfactory or unsatisfactory for examination.

The Bethesda System considers abnormalities of squamous cells (the thin, flat cells that form the surface of the cervix) and glandular cells (mucus-producing cells found in the endocervical canal [the opening in the center of the cervix] or in the lining of the uterus) separately. (Glandular cell abnormalities are much less common than squamous cell abnormalities.) Samples with cell abnormalities are divided into the following categories, ranging from the mildest to the most severe:

Squamous cell abnormalities:

ASC—atypical squamous cells. This is the most common abnormal finding in Pap tests. The Bethesda System divides this category into two groups:



ASC-US—atypical squamous cells of undetermined significance. The squamous cells do not appear completely normal, but doctors are uncertain about what the cell changes mean. Sometimes the changes are related to HPV infection (see Question 12), but they can also be caused by other factors. For women who have ASC-US, a sample of cells may be tested for the presence of high-risk HPV types. If high-risk HPV is present, colposcopy will usually be performed. On the other hand, a negative HPV test can provide reassurance that cancer or a precancerous condition is not present.


ASC-H—atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion. The cells do not appear normal, but doctors are uncertain about what the cell changes mean. ASC-H lesions may be at higher risk of being precancerous compared with ASC-US lesions.


LSIL—low-grade squamous intraepithelial lesion. Low-grade means that there are early changes in the size and shape of cells. Intraepithelial refers to the layer of cells that forms the surface of the cervix. LSILs are considered mild abnormalities caused by HPV infection. LSILs are sometimes referred to as mild dysplasia (dysplasia means abnormal cells that are not cancer but have the potential to become cancer). They may also be referred to as cervical intraepithelial neoplasia (CIN-1). (Neoplasia means an abnormal growth of cells, and the number describes how much of the thickness of the lining of the cervix contains abnormal cells—only the top layer, in this case.)



HSIL—high-grade squamous intraepithelial lesion. High-grade means that there are more evident changes in the size and shape of the abnormal (precancerous) cells and that the cells look very different from normal cells. HSILs are more severe abnormalities that have a higher likelihood of progressing to cancer. HSILs include lesions with moderate or severe dysplasia or carcinoma in situ. (In carcinoma in situ, abnormal cells are present only on the surface of the cervix. Although they are not cancer, these abnormal cells may become cancer and spread into nearby healthy tissue.) HSIL lesions are sometimes referred to as CIN-2, CIN-3, or CIN-2/3, indicating that the abnormal cells occupy most of the layers of the lining of the cervix.



Squamous cell carcinoma. Cervical cancer is when abnormal cervical squamous cells invade deeper into the cervix or to other tissues or organs. In a well-screened population, such as that in the United States, a finding of cancer on a Pap test is extremely rare.

Glandular cell abnormalities:

AGC—atypical glandular cells. The glandular cells do not appear normal, but doctors are uncertain about what the cell changes mean.



AIS—endocervical adenocarcinoma in situ. Precancerous cells are found in the glandular tissue.



Adenocarcinoma. Such cancers can include not only endocervical cancer but also endometrial, extrauterine, and other cancers.



How common are Pap test abnormalities?
About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.

What if Pap test results are abnormal?
If the Pap test shows an ambiguous or minor abnormality, the doctor may repeat the test to determine whether further follow-up is needed. Many times, cell changes in the cervix go away without treatment. In some cases, doctors may prescribe estrogen cream for women who have ASC-US and are near or past menopause. Because these cell changes are often caused by low hormone levels, applying an estrogen cream to the cervix for a few weeks can usually help to clarify the cause of the cell changes.

Follow-up testing for some cell changes may involve a colposcopy, in which an instrument much like a microscope (called a colposcope) is used to examine the vagina and the cervix. During a colposcopy, the doctor inserts a speculum to widen the vagina and may apply a dilute vinegar solution to the cervix, which causes abnormal areas to turn white. The doctor then uses the colposcope (which remains outside the body) to observe the cervix. If colposcopy finds abnormal tissue, the doctor may perform endocervical curettage or a biopsy. A biopsy is the removal of cells or tissues from the abnormal area for examination under a microscope. Endocervical curettage is a type of biopsy that involves scraping cells from inside the endocervical canal with a small spoon-shaped tool called a curette.

If testing shows abnormal cells that have a high chance of becoming cancer, further treatment is needed. Without treatment, these cells may turn into cancer. Treatment options include the following:

LEEP (loop electrosurgical excision procedure) uses an electrical current that is passed through a thin wire loop to act as a knife to remove tissue.


Cryotherapy destroys abnormal tissue by freezing it.


Laser therapy uses a narrow beam of intense light to destroy or remove abnormal cells.


Conization removes a cone-shaped piece of tissue using a knife, a laser, or the LEEP technique.


What are false-positive and false-negative Pap test results?
The Pap test is a screening test and, like any such test, it is not 100 percent accurate. Although incorrect (false-positive and false-negative) results are uncommon, they can cause anxiety and can affect a woman’s health.

A false-positive Pap test result means that a patient is told she has abnormal cells, but the cells are actually normal. A false-negative Pap test result means that a woman’s cells are described as normal, but she actually has a significant abnormality that was not detected. A false-negative Pap test may delay the diagnosis and treatment of a precancerous condition or cancer. However, regular screening helps to compensate for false-negative results. If abnormal cells are missed at one time, chances are good that they will be detected the next time.

How are HPVs associated with the development of cervical cancer?


HPVs are a group of more than 150 viruses. Some types of HPV cause the common warts that grow on hands and feet. Over 30 types of HPV can be passed from one person to another through sexual contact. Some sexually transmitted HPVs cause wart-like growths on the genitals but do not lead to cancer. About 15 sexually transmitted HPVs are referred to as “high-risk” because they are more likely than other HPV types to lead to the development of cancer.

HPV infection is the primary risk factor for cervical cancer. However, although HPV infection is very common (about 6 million new genital HPV infections occur each year in the United States), only a very small percentage of women with HPV infections develop cervical cancer.

Who is at risk for HPV infection?
Infection with sexually transmitted HPV types is more common in younger age groups, particularly among women in their late teens and twenties. Women who become sexually active at a young age, who have multiple sexual partners, and whose sexual partners have other partners are at increased risk of genital HPV infection. Women who are infected with HIV are also at higher risk for being infected with HPVs and for developing cervical abnormalities. Most HPV infections are transient, or temporary, but sometimes an infection can remain detectable for many years.

Does infection with a cancer-associated type of HPV always lead to a precancerous condition or cancer?
No. Most HPV infections appear to go away on their own without causing any kind of abnormality. However, persistent infection with cancer-associated HPV types increases the risk that mild abnormalities will progress to more severe abnormalities or to cervical cancer. With regular follow-up care by trained clinicians, women with precancerous cervical abnormalities can have these abnormalities removed or treated before cancer develops.

Do women who have been vaccinated against HPVs still need to have Pap tests?
Yes. Pap tests continue to be essential to detect cervical cancers and precancerous changes, even in women who have been vaccinated against HPVs, because current HPV vaccines do not protect against all HPV types that cause cervical cancer. Therefore, it is important for vaccinated women to continue to undergo cervical cancer screening in accord with recommendations for women who have not been vaccinated.

How is HPV testing used in cervical cancer screening?
HPV testing alone is not useful for cervical cancer screening of women under 30 years of age because the rate of false-positive tests would be unacceptably high. That is, many women would be found to be infected with high-risk HPV, but in most of them the infection would clear on its own. However, the Food and Drug Administration has approved testing for DNA from high-risk HPV types in conjunction with Pap smears for routine cervical screening of women aged 30 years and older. A negative HPV DNA test increases assurance that there is very little risk of a serious abnormality developing over the next several years.

In addition, as described above (see Question 8), HPV DNA testing can help in deciding which ASC-US abnormalities need treatment. Doctors are usually able to use some of the cells collected at the time of the original Pap test for this test, so it is not necessary for a woman to undergo a second cervical cell collection procedure if her Pap test result is ASC-US.

# # #

Related NCI materials and Web pages:


National Cancer Institute Fact Sheet 3.20, Human Papillomaviruses and Cancer
(http://www.cancer.gov/cancertopics/factsheet/Risk/HPV)
National Cancer Institute Fact Sheet 4.21, Human Papillomavirus (HPV) Vaccines
(http://www.cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine)
Understanding Cervical Changes: A Health Guide for Women
(http://www.cancer.gov/cancertopics/understandingcervicalchanges)
What You Need To Know About™ Cervical Cancer
(http://www.cancer.gov/cancertopics/wyntk/cervix)
How can we help?

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Hi rkh,

I had my pap test last Jan 29, 2011. The result is( LSIL) then the doctor wasn't satisfied with the result and she wanted to examin further. Then I had a thin prep sometime in March and the doctor found CIN 3 so without any second opinion because I was becoming paranoid, I decided to undergo the LEEP procedure last month May 22. First time in my life to be in an operating room but it was very quick. I was able to get back home in late afternoon.

I have to go back for another pap test on the 26th this month.

After a month of LEEP is it possible to have another pap test or wait for 3 months which is which??

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Hi simplyness,

What was the results of your LEEP in May, you didn't say? Honestly, If I were you, I would consult with a Gynecologic Oncologist, for my next Pap and post-LEEP consultation. That would be the VERY NEXT thing that I would do without a doubt about it! OBGYN's do not have the expertise to identify and treat severe cervical dysplastic disease like Gynecologic Oncologist do. I am not trying to scare you at all, so please do not take it that way! What I am trying to do is to share with you my own nightmare experience with my so called highly reputable OBGYN after a CIN 3 diagnosis which turned out to be invasive cervical cancer, stage 1b1. It was then that I truly learned the scope of their qualifications. If I had let my OBGYN do a hysterectomy on me as he tried very hard to do, I would have a much more grim prognosis for a future. There are other women here who are victims of unqualified physicians. Chances are very good that you do not have cervical cancer, but why not be assured you are seeking the appropriate medical advise through a consult with a Gynecologic Oncologist?

This is a heads up for you to take your LEEP results for a consultation with a Gynecologic Oncologist. I hope you take my advice. Please let me know what you decide and how you are doing, ok?

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Dear rhk,

I have a question from what you wrote. What do you mean by "If I had let my OBGYN do a hysterectomy on me as he tried very hard to do, I would have a much more grim prognosis for a future. "? If you were actually stage 1b1 and had hysterectomy, isn't it taking the further measure and more preventive of future trouble? Forgive my ignorance.. Thanks. Minnie

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Hi rkh,

Well after LEEP she printed it out and showed. Diagnosis multiple foci of CIN 3associated with HPV infection.
Ecto and endocervical margins are free of dysplastic cell.

I am going this 26th for another pap test I will keep you posted. My OB told me already to have a hysterectomy if there are still abnormalities found this 26th but I'm not going to do that. Before letting her do major operation in my body I have to go to the expert as what you say. Thanks and I'm sure I'm going to have a second or even 3rd opinion.

thanks

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Hi Mannanpray,

To answer your question; no, a standard hysterectomy would not be a preventative measure at all! There are different types of hysterectomies; specifically speaking with regards to cervical cancer, these surgery's should ONLY be performed by a Gynecologic Oncologist. Gynecologic Oncologist have additional years of training specifically for the purpose of treating gynecologic cancers and OBGYN"s do not! It makes me very frustrated and angry that OBGYN's are not forwarding their patients to Gynecologic Oncologist for the appropriate care and treatments they should be receiving. I'm sorry, but in my opinion, and I'm sure of it, its because they don't want to loose the business, there really is no other explanation for it.

I too was like you and learned first hand from my Gynecologic Oncologist that by not letting my OBGYN do an inappropriate standard hysterectomy on me was one of the smartest decision's I have ever made this far in my health/life, he told me this verbatim. What he was saying basically is, OBGYN'S are not trained to identify cancers. So, while an OBGYN is operating on a woman and that woman does have a gynecologic cancer, the OBGYN may actually spread the cancer to other areas within the body during surgery from their lack of expertise at identifying it. Also, it is guaranteed that the woman will need chemo and radiation after the standard hysterectomy and may not have needed it had that woman been under the right care with the right doctor to begin with. The appropriate treatment I needed was a Radical Hysterectomy; and again, my OBGYN was not trained to do.

I thank god every day that I got a second and third opinion. It is ALWAYS neccessary for a patient with CIN 3 to see a Gynecologic Oncologist, ALWAYS! I don't know if your OBGYN will be offended, maybe so, mine was, but I simply don't care! This was not about his ego, this was about my life. Also, just because you have CIN 3 doesn't mean you will need a hysterectomy at all, period.

Let me know how you are doing!

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Hi simplyness,

I am glad that you will be seeking the advise of a Gynecologic Oncologist, it really is the wisest thing you can do for your health.

I hope others here will chime in on this discussion about the appropriateness of a womans physician:)

Keep me posted!

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Hi simplyness and Mannanpray,

I tought it was important to give you this website as a source for finding a Gynecologic Oncologist in your area. www.sgo.org/ SGO Stands for The Society of Gynecologic Oncologist. Read, very important and interesting.

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Dear rhk,

Now I understand what you meant. Thank you so much. I tried to follow your link to look up gyn oncologist in my area but got lost.
Do I have to be a member to look up the doctors in my area?
Thanks in advance

Manna

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Hi Manna,

No you don't have to be a member. You should see a drop down box to the right of the SGO home page right after you clicked onto the website link that says find a Gyneclogic Oncologist. I believe all you have to do is type in the state and zip code and a list of Gynecologic Oncologist should appear. Let me know if that doesn't work:)

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Hysterectomy is NOT recommended as primary treatment for CIN 3 (including CIS, carcinoma in situ) according to the guidelines set forth by the ASCCP (American Society for Cervical Cytology and Pathology).
Run out of that office and seek opinions from other doctors, preferably, as rkh points out, gyn-oncologists - even then, get more than one opinion!
Hysterectomy is done far too much in this country (USA) for benign conditions and gynecologists make a lot of $ from doing them. You need to learn more about your body, your options and side effects before making any kind of decision that will affect your life permanently. Have you gotten your medical records? That's a good place to start. You can also visit HERS Foundation on the web as well as HysterSisters, though, HERS offers much more patient education as to what a hysterectomy is & does to the female body, describes and explains the female anatomy (truly, something every woman should know about her own body and that the uterus does much more than carry babies). HysterSisters approach is more of a support group for women going through hysterectomy - I'm not so sure the goal is to prevent an unnecessary one, especially with all the 'crowns' and 'wands' and fairytale endings - there can be some serious, life altering side effects from a hysterectomy which is major surgery and frankly, I personally find attaching a 'princess' mentality to it is downright de-meaning and debasing what the female anatomy was intended to be.... that's me. I had an unwarranted hysterectomy, more surgery later to try to correct a resulting prolapse because of the hysterectomy (not good success with that either - overall 30% failure rate), so I feel like anything but a princess. I used to be intact, and I used to function fine - not anymore. Please do your homework so you are informed before making a decision, which by the way, is yours to make, not your doctor's, as you will be required to sign a form stating that you understand and are informed. By the way, the informed consent you sign legally protects your doctor and hospital from being sued by you, not the other way around, so make sure you are informed and understand what you are signing - it's irreversible surgery. Also, it's important to know that side effects may not happen right away - it may take years but it is well documented - do your homework - research it.

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Hi rhk, yes it worked and i appreciate it! What I have gotten done so far is a only a pap. I know you said briefly that pap can hardly detect cervical cancer. Does that mean with CIN2,3 and CIS from pap, it can later be later diagnosed as cancer stage 1 or 2 or etc?
Do you think I should go to gyn oncologist from the start? Like from colposcopy and biopsy? Thanks again.

Thanks, faith2 for sharing your story. I will try to educate myself more. I feel so much better after I began reading here and actually communicating with ppl like you.

God bless,

Manna

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@ rkh and mananpray the link for finding a GYN Oncologist is under the tab "Resources for Women" on the www.sgo.org website. I REALLY appreciate being able to find this link here. It has been a great resource for me. My ongyn has been noting if not confusing at this point so I've known for a bit that before anyone takes my "useless" uterus I'm going to be darn sure of condition

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Sorry it has taken me awhile to respond, been very, very busy. Please just consult with a gynecologic oncologist from here on out, it really is in YOUR BEST INTEREST! Let me know if you did, ok?

God Bless you too!

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