could I have two separate problems going on?

[hvnlylori]

Hi, I have two things going on with me, and I am curious if they can be related. I have a history of having an ovarian cyst, and severe endometriosis when I was 25. I had a large dermoid cyst removed by laparotomy (they thought it was cancer, but it wasn"t), and they found endometriosis everywhere (I had no symptoms of this). Anyway,for the past 6 months or so I have been having really bad problems with bloating (it is causing GERD, and making me really congested), and some pelvic pain around the area of my right ovary, which tends to swell up about twice a month. This was one of the reasons I wound up in my GYN's office, and it was there that the other problems surfaced with the abnormal pap smear.
I had an abnormal pap in June, and was scheduled for a colposcopy and biopsy for high grade squamous epithelial lesion, severe dysplasia (both endocervical and squamous metaplastic cells present). Long story short, I keep bleeding (not severe bleeding-it is actually pretty light, but none the less, it never really stops). My GYN finally threw his hands in the air, and scheduled me for a cone biopsy and D&C next week, because they couldn't do the colposcopy. I have been having other issues to (more related to hormone issues I think), but I am worried that the cone biopsy will show something more invasive. I was super bad, and did not follow-up with some minor dysplasia I had in my 20"s (I am now 44),  Anyway, my question is this, should I get a second opinion by a gynocologic oncologist if something does show up? My doctor told me today at my pre-op visist that he was recommending that I get a hysterectomy, because trying to constantly follow this would be a real hassle, and he believes it will turn into cancer if it hasn't already.I am also wondering should I suggest to my doctor to do a CA 125 test, and I am wondering if I could have two totally seperate issues going on, that are not related to each other?  

[hvnlylori]

thanks for the comment. Yes I did have a pelvic and transvaginal ultrasound done in June, mainly because I really felt that I had another ovarian cyst because of my symptoms. Believe it or not, it did not show anything out of the ordinary, other than a small 1/2 centimeter fibroid, and and thickening in my uterus. I figure that is way to small to cause problems, especially the amount of bloating, and discomfort I am having. When I had my pelvic exam and pap smear, my doc could feel something abnormal by my right ovary, and said sometimes ultrasounds miss them. Right now he seems more concerned with the other issue surrounding the dyspasia, and the ongoing bleeding issue (I bled for 3 days following my pap smear). I talked to some other people, and depending on what happens with the cone biopsy, then I will probably seek a second opinion and/or follow-up with a gynocologic oncologist

[Annekathryn Goodman, M.D.]

Hi There
good questions.
Your doctor is doing the right thing which is to get more information.
I would also suggest a CA 125 blood test.It is elevated in endometriosis but it can be helpful to track it. Also did you have a recent pelvic ultrasound.

if your doctor discovers cancer on the cone biopsy, then you should be referred to a gyn oncologist. If your cone and D&C are normal and the pelvic ultrasound is not worrisome for a tumor, then a simple hysterectomy because of endometriosis and bleeding by your regular gynecologist is reasonable

cervical dysplasia is a very different disease than endometriosis

good luck with everything!
best wishes