Possible Cervix and/or Fibroid Problems

[onbrake]

I have recently gone in for my first pap in 10 years.  I had some blood in stool and had an abdominal CT scan which showed sigmoid diverticula.  All other organs appeared normal except I had a simple ovarian cyst and a mildly enlarged uterus.  When the gynecologist looked inside me, she immediately asked if I have intermittent bleeding between periods (I don't).  However, my cervix does hurt (I know they say it can't, but it does).  I also feel intense pressure from this enlarged uterus, urinate a lot, have heavy periods with blood clots and pain, etc.  The pap caused several hours of spotting afterwards, which I never had before, along with cramping and pain.  My question is this .. I am assuming my pap is not going to be normal, just because of my symptoms and the length of time since I've had a pap.  My cervix is still very, very sore even though I had the pap 4 days ago.  I am 46 years old.  In September 2004, I got severely swollen legs from the knees down, with pitting, and I went to my GP.  In the course of tests, I was diagnosed with Graves disease.  My levels are not quite regulated yet (I'm on Methamizole), but as I go from hypo to hyper, the edema changes.  Oddly enough, hypo helps the edema and hyper makes it worse (opposite of normal, I know).  Edema is better in the morning, worse at night.  After an illness with diarrhea, edema is nonexistent, and comes back slowly as I eat and drink and return to normal.  Here is my question.  In light of my recent cervical/uterine problems, I am now afraid that all this time, I've had edema because I have some type of cancer that has spread to the lymph nodes.  My CT scan, as I said, was normal except for the ovary and uterus enlargement.  I had a CBC with diff and a metabolic panel; all normal numbers.  If a person had cancer that spread enough to cause edema in the legs, could the person actually go almost 2 years without major cancer symptoms?  Does it sound likely that this edema could be caused by cancer and go on this long without causing me more trouble?  Is it possible that if I have uterine fibroids, they could press on things in the drainage system and cause edema?  Has my doctor done the right thing by simply doing a pap and making me wait for that result?  What about the uterine enlargement?  Shouldn't she be doing something to evaluate that?  Can cervical cancer be visible to the naked eye?  Would a CT scan detect lymph node involvement or spread to other organs?  Would my bloodwork or CT be abnormal if I had metastasis to other organs?

[Kevin Pho, MD]

If cancer is a concern, the presentation can vary from patient to patient.

There are many causes of edema other than cancer - specifically kidney disease and heart disease.  A blood test to evaluate the kidney function and an echocardiogram would be a good place to start.  

Uterine fibroids can be seen during a CT scan.  A more thorough test would be a transvaginal ultrasound which can give a more detailed examination.  

Waiting for the Pap smear is reasonable.  I would also consider the ultrasound if the symptoms continue - it can also evaluate the uterus as well.  

Yes, it is possible that cervical cancer to be seen during a speculum exam.  

A CT scan would be able to determine any enlarged lymph nodes that may be caused by cancer.  

Blood work may be normal if cancer is present - thus more tests are needed to confirm any cancer diagnosis.

These questions should be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b