[Question #4876] Could they be missing my cervical cancer?

25 months ago
Hey everyone I am 26 years old and so for the past 4 years I have been having alarming symptoms. 2 periods a month unless I take my birth control. The moment I stop taking birth control I go back to heavy bleeding that lasts for 2 weeks. Occasionally bleeding between periods, sometimes pain after sex and during. Lower back pain. Every textbook symptom you can think of. I have had numerous pap smears come back negative (like 6 tests) back to back as well as negative HPV tests. I have also had an transvaginal ultrasound and a pelvic cat scan that showed nothing. The pelvic cat scan was supposed to be a relief for me but the doctor told me they are not really able to see the cervix on a pelvic ct scan for whatever reason. I had this done in the emergency room by the way due to extreme pain in my lower abdomen a few months ago. But I am still not convinced. A part of me thinks by now I would have been dead if I had cancer after all these years. But another part of me thinks this cancer is slow growing and they just havent caught it yet. I am going to request a colposcopy because my anxiety is getting the best of me. By the way I do not have any fibroids or any growths or cysts anywhere. My gynocologist tried to tell me he thinks I have PCOS and that my testosterone levels were a bit high. But I thought PCOS included having cysts on your ovaries doesnt it?? Which I do not have at all. What do you think? Could they be missing the cancer?? I do not know if I could trust these tests. My fear is me having Adenocarcinoma and that it is too far up in the cervical canal and the pap tests are just not picking it up. My fear is that these abnormal cells are just growing more and more out of control as time goes by and Im going to end up with a cancer diagnosis when it is too late. For instance I had sex last night and my inner walls still hurt as well as abdominal pain. I just feel uncomfortable and am going tomorrow to my gyno to request a colposcopy becausr I am not convinced. E
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome back to the forum, but sorry you found it necessary.

Some questions cn be answered accurately based on the opening quesion itself. Having not even read any detaiils, based only on "Could they be missing my cervical cancer?":  Almost certainly not. If direct observation of your cervix during a pelvic exam is normal, and if you have had a normal pap smear recently, then there is no chance of missing cervical cancer -- no matter what symptoms you may have had.

Now I have read the details of your question. Guess what?

This really isn't an STD probelm at all -- and STDs are the only issues we address on thiis forum. If you were in my STD clinic, we would refer you to a gynecologist for further evaluation. I'll just say there are many causes of unexplained abdominal or pelvic pain. Among them, cervical cancer is an unlikely one:  for the most part, it is painless. (The main symptoms usually would be vaginal bleeding and perhaps abnormal vaginal discharge.) In any case, it is not possible to have cervical cancer with the negative tests you have had. 

Therefore, I'm glad you are scheduled to see your gynecologist. I have no way of predicting whethe PCOS or other gyn problem (or other abdominal problem) might be causing your symptoms, but I am confident it isn't cervical cancer. I'm also confident your gyn will agree with all I have said.

Sorry we can't be more helpful, but I hope these comments ease your mind about cervical cancer. Best wishes to you.

HHH, MD
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25 months ago
Hi Dr Hansfield thank you for your answer. My concern is I have heard that Adenocarcinoma of the cervix is harder to diagnose with a traditional pap smear rather then sqamous cell carcinoma because it is higher up in the cervical canal. My concern is that I could have cancer higher up somewhere. I know during my pelvic exam everything looks good but that is my outer cervix which is not my concern. Do you think they would see any evidence of cervical adenocarcinoma even if it starts higher up? I would also like to know about the HPV dna test. My test keeps on coming back negative. Does it matter where in the cervix they take it from? Or does it make no difference where they take it from? I was also reading about a HPV threshold. That you can have HPV buy as long as its under a certain threshold it will still show up as negative? I am just alarmed because everything was completely normal up until 4 years ago but after that my reproductive system seems to be giving me a whirlwind of problems.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
As best I know, it would be equally improbable for you to have adenocarcinoma as squamous cell cancer. But that's not an STD issue, and I have zero expertise in this area. This forum is only for STD related information. Sorry.

It is definitely true that someone can have HPV and have negative test results for the virus. But that applies only to asymptomatic infection. If HPV is causing any sort of health problem (warts, cancer, pre-cancerous growth, etc), the virus is always detectable in large amount. So your negative HPV tests are strong evidence that your symptoms have nothing to do with HPV.
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25 months ago
Thank you Dr Handsfield. When I purchased the question it asked me which board to post in and I could of sworn I had chosen HPV as my option which is the std that causes cervical cancer. Thank you anyway I appreciate your expertise and knowledge it is very reassuring! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
STD experts generally do not treat or otherwise manage advanced HPV infections, especially HPV related cancer. (This is no different than for many other medical specialties. For example, you would not expect a GP who advises her patients not to smoke, or a public health expert who designs public anti-smoking campaigns, to treat people with lung cancer or emphysema caused by smoking. Similar deal for HPV and cancer.) But because of my STD/HIV expertise, I am confident your problems are not due to HPV or any other STD. Since they are not, this forum can't help any further than we have. As I said in my initial reply above, I am confident your gynecologist will agree with all I have said.

That concludes this thread. I hope the discussion has been helpful in helping you understand that your problems have nothing to do with HPV -- or, for that matter, with any other STD or with any past sexual decisions or partnerships you might have had.
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