[Question #3648] Could this be cervical cancer??

36 months ago
Hi Dr Handsfield or Dr Cook I know your both the best so Ive came to you. In 2009 is when I first became sexually active. I have had a handful of partners about 6 since then. Im now 25 so Id say I became active around 17. My first pap was in 2012 which came back ASCUS but my gyno said everthing looked normal and it was due to a bacterial infection. 2013 and 2014 my paps were also normal. The beginning of 2015 began my nightmare where I started having lower back pain every day, bleeding in between periods and pelvic pain. I went to my gyno in 2015, 2016 and 2017 all came back negative for HPV DNA and normal paps. My gyno says I have PCOS which he is blamimg for everything. This has been going on for 3 years and still no answer. I also had an abdominal and pelvic ultrasound which came back normal. My only concern is could this be an Adenocarcinoma and maybe it is too far up of a tumor for the paps to pick up? I have heard horror stories of peoples tumors being missed. Ive had normal periods my whole life. Up until 2015. Now I have been spotting between periods and after sex and lower back pain all the time. No one has any answers except they blame my hormones and my weight gain on all my irregularitys. Could you realistically see a 25 year old girl have full blown cervical cancer within only 5 years of having sex? This all started around me being 22 years old and I am now 25 and I really think it could be an adenocarcinoma but my Dr keeps saying that Im "too young" and that the tests would have picked it up and that upon visual pelvic exam everything looks normal as well.  Im at a loss as to what to do??
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Welcome to our Forum. I will try to help.  My sense is that since 2015 you have had daily back pain, Intermenstrual bleeding and pelvic pain and your questions are, what might this be? and could this be an STI, particularly HPV.  You are worried that this could be adenocarcinoma and your doctor is thinking this is PCOS.  My comments, making these assumptions are:

1.  You are of an age by which you should have had the HPV vaccine.  If so, your risk for HPV is very, very low.
2.  Like your doctor, I doubt that this is HPV disease- you really are too young, on a statistical basis and while there are persons who get complications of HPV (i.e. cancer) at a young age and, IF this were the problem (unlikely) your regular GYN check ups really should have detected it. 
3. Among HPV-related cancers, adenocarcinoma is very rare and occurs typically in women older than you (BTW, you may have been on the internet looking for clues- if so, please stop, this is a place where the internet is far, far more likely to led you astray than give you useful information).
4.  PCOS syndrome is usually pretty easy to detect using tools such as ultrasound.  If your doctor is considering this, you should have had an ultra-sound. If it showed finding compatible with PCOS,   Then (with appositive ultrasound) that is a relatively likely diagnosis, as opposed to HPV related disease which seems unlikely.
5.  Finally, your questions seem to raise the question of whether or not your problems might be related to an STI.  If this is a concern and you have seen a gyn regularly, you should have been tested for other STIs.  testing would have detected such a problem.  If you have been tested and the tests are negative, other STIs should not be a problem.

I hope these comments are helpful. if I have missed something or my comment lead to additional questions, please don't hesitate to ask.  You have two follow-up questions.  EWH
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36 months ago
Hi Dr! It is a pleasure seeing you have replied so quickly. My concern is could my paps and transvaginal ultrasound not be picking up an actual tumor? I fear that over the years I could have had pre-cancerous cells far up in the cervical canal that were not picked up by the pap. My.HPV test keeps coming back negative too. What does this mean exactly? Could I still have HPV infection but its coming out negative? I have heard something.about the DNA test and a threshold but I never really understood it. My symptoms alarm me every sti/std have been ruled out but I still continue to spot between periods pain after sex and lower back pain consistently. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
I comment on the PAP smears below.  I will also comment of your ultrasound but think that the latter question would be a better question for your GYN.  In both instances, I should emphasize that the fact that the combination of negative tests, the fact that a highly trained professional (your GYN) sees no evidence of cancer, and that your characteristics (age, symptoms duration, etc.) do not fit those of cancer  suggest that your symptoms are something other than cancer all are much, much stronger evidence that you do not have cancer than there is any reason for thinking that you do.  I find myself wondering why you continue to worry and have not accepted and pursued much more likely explanations, including the possibility of PCOS.  I hope it is not because of something you have seen on the internet.

As for your PAP.  While a single PAP can miss cancer, with repeated PAP smears it becomes more and more unlikely that cancer is being missed and when you add consideration of the ultrasound, it is time to look for other explanations.  There are lots of reasons for spotting and pain after sex.  My advice is to continue to work with your GYN to determine what  yours might be and to accept that it is not due to cancer.  EWH
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36 months ago
Dr Hook if not cancer as a trained medical doctor yourself do my symptoms sound like anything to you? I have had 1 gardasil shot when I was 13 but I dont think I completed the whole series of shots I needed for that. By the way doctor I have one more question for you I had excessive bleeding as well like getting my periods twice a month when all this started in 2015 but then my gyno put me on Al Yacen birth control to try and regulate my periods. It has been working for the most part. The issue is I tried getting off it one month in like 2017 but the excessive bleeding and long lasting period came back. My question is can birth.control stop bleeding that is caused by cervical cancer? And this will conclude all my final questions. Thank you so much doctor!!
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
As I mentioned above, your questions are more appropriately directed at your gynecologist who has the advantage of being able to examine you, take a more extensive history than I and to see and order tests.  This forum is dedicated to STIs and your tests (including those for HPV) have been negative and therefore the most appropriate next steps are to look for other causes and not worry about things that your tests show you do not have (like STIs or cancer).  Your symptoms could be related to problems like PCOS or endometriosis but again, I emphasize that the origin of your problems is best dealt with directly with your own doctor.  If you are unhappy with your doctor, you should try a second one for a 2nd opinion.   I can tell you that in some instances, starting the birth control pill can be quite helpful in controlling non-cancer menstrual abnormalities.  OTOH, oral contraceptives would not be expected to help with cancer symptoms.

As you point out, with this third reply, this thread will be concluded and closed in the next few hours.  Take care.  EWH
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