Monitoring adenocarcinoma in situ of the cervix

Christina S. Chu, MD
Last Modified: January 13, 2002

Question:

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!

Answer:

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.

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