Monitoring adenocarcinoma in situ of the cervix
Dear OncoLink "Ask The Experts,"
I was wondering what is generally considered to be the most effective way to follow-up and monitor adenocarcinoma in situ of the cervix after a cone biopsy with negative margins. My doctor is going to schedule me for quarterly Pap smears. I have read conflicting information that Pap smears are ineffective for detecting adenocarcinoma. In fact, neither a Pap smear nor a colposcopy revealed this. It was detected after a LEEP (loop electrocautery excision procedure) in my case. My doctor is not an oncologist, and I just want to make sure that she will be using the most effective diagnostic tools.
Thank you for your time!
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
You are correct that Pap smears may be negative sometimes when adenocarcinoma is present. However, the good news is that more and more studies suggest that a cone biopsy with negative margins may be adequate therapy for adenocarcinoma in situ. About 8% of women with negative margins may have persistent lesions compared to about 60% of women who have positive margins on their cone biopsies. Some studies suggest that a cone biopsy by the cold knife technique is more effective than LEEP because the latter tends to have more positive margins and a higher recurrence rate. No screening technique is perfect, and the best technique we have is Pap tests with follow-up colposcopy and endocervical curettage for abnormal findings. Even though you said that your Pap and colposcopy did not pick up your adenocarcinoma in situ, I suspect there were some abnormal findings that were concerning enough for your physician to perform a LEEP. Remember that a Pap test is a screening test, meant to detect abnormalities that should lead to further investigation.
Once you are no longer interested in childbearing, you may want to discuss a hysterectomy with your physician as a definitive way to treat the adenocarcinoma in situ.