Q) I am a 30 yr old. I am married with 2 children. My doctor wants me to have a PAP test done! But I am absolutely fine!
A PAP test is done on women who are married to screen for cervical cancer. Normally women are healthy and do not have symptoms. A PAP test helps to detect any abnormality in the mouth of the uterus at an early stage and can be treated immediately.
Q) I am 56 years. My period stopped 4 years ago. Of late, I have some bleeding – normally spots. On one occasion I had to take a pad. Do I need to consult a doctor?
Yes you do. Any bleeding or blood stained discharge after menopause is abnormal.
Q) I want to give my daughters the vaccine against cervical cancer. But they are only 12. Why give them the vaccine so early, if the disease is not until later?
Vaccine given at early age (in this vaccine not before 9 yrs) elicits a better antibody response.
Q) My mother had cervical cancer. I am 30 years of age. Can I reduce my risk of having cervical cancer?
Yes you can – by having a PAP test. You can ask your doctor about liquid based cytology (LBC) which has a higher sensitivity.
Q) I have had a PAP test which says there is moderate dysplasia or CIN II. What should I do now?
You should have a colposcopy and a colposcopy guide biopsy/ excision. This is done in the out patient, does not require a general anaesthetic and you can go home the same day. If you want more information on colposcopy please see the section on cervical cancer screening.
Q) I am 40 years old. I have bleeding in between periods and bleeding after intercourse. Am I suffering from cancer of the womb?
No. But the bleeding must be investigated – a colposcopy/ PAP smear and an Ultrasound examination of the womb to check the thickness of the uterine lining. Depending on this, the doctor may order a hysteroscopy and endometrial biopsy and/or a colposcopy guided excision of the mouth of the womb.
Q) A 40 year old patient underwent a hysterectomy for abnormal bleeding in Chittagong, Bangladesh. Her biopsy report shows she has “clear cell carcinoma of the uterus, involving less than 50% of the uterine muscle. The size of the uterine tumour was 4cm”. She was referred for an opinion to a gynaecological oncologist in Kolkata.
This is an unfortunate situation where a hysterectomy has been performed assuming the cause of abnormal bleeding to be benign. Her cancer was aggressive (clear cell) and the tumour size greater than 4 cm. These tumours behave in a fashion where it is likely to involve lymph glands in the pelvis and above. She requires re-exploration to remove the ovaries (if they have not been removed), omentum, and lymph glands. This entails a second surgery. This would enable correct staging and treatment planning.
Q) My 19 year old daughter has been diagnosed with a 13 cm complex mass in the pelvis, on ultrasound. Her doctor has suggested that this mass should be removed through a laparoscope. What should I do?
If there is a suspicion of malignancy then laparoscopy should not be done.
The difficulty is to diagnose malignancy preoperatively. Certain features are seen in ultrasound and your doctor must discuss these findings with the sonographer. Certain tumor markers may also be done to predict malignancy. But if they are negative, it does not mean that the tumor is not malignant.
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