Dear OncoLink "Ask The Experts,"
I had a total hysterectomy several years ago. I recently had a Pap smear that returned with HGSIL, yet I do not have a cervix. All of the information I find on the web discusses treatment modalities for cervical HGSIL, but not if located in the vaginal vault. Can you tell me what I can possibly expect for further diagnosis and treatments?
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Unfortunately, women without a cervix may still suffer from dysplasia of the vagina.
The evaluation is generally the same; high-grade findings on a Pap test require a colposcopic examination of the vulva, with biopsies of abnormal areas. Biopsies verifying the presence of high-grade dysplasia may require treatment. In general, treatment options for vaginal dysplasia include excision (sometimes called upper vaginectomy), laser, or treatment with Effudex (a topical chemotherapy agent).