Help with understanding report

Hello again...

I had received the result of a colposcopy punch biopsy as carcinoma in situ, I was told the results over the phone. I only just now was able to get my hands on the actual copy of the report and was looking for some help with the terms...

Colposcopic findings:

Lesion measuring 2-5cm from 4:00 to 8:00

Grade 2 (major): rapid appearance

Grade 1 (minor): thin epithelium

Lesion inside of the T-zone

Occupies 2 quadrants of cervix and occupies 20% of cervix 

Specimen biopsy sent to pathology: CIN3 cannot exclude CIS

I've been waiting a long time to even get a treatment plan or see a doctor after I received the CIS result, and they seem to be taking a long time because I am young. They even suggested no treatment for 6 months... though I've gotten a second opinion that I believe I'm having a cone biopsy done within a month or so (this is all because Canada has a very slow healthcare system with no private options...)

Anyway, I'm just wondering if anyone knows what all of this means? 2-5cm seems really big, and the grade 2 inside transformation zone has me a bit worried.

Any insight on what these things mean would help me very much.

Thank you for your help on this and all the other thousands of questions I ask here.

Hi serhunt

im hope I can help shed a little light on this report for you...

the tip of the cervix where it opens up is called the transformation zone. The most common area that cells can change. Think of this area as a clock. Your leasion starts at 4 and ends at 8. So, if this clock was cut into 1/4 then 2 quadrants have abnormal cells. They can tell that part of this leasion has grade 2 major changes and parts have minor changes. The area just around the opening probably has the most changes and those are major. They have been able to detirmine from the pathology reports that the abnormal cells are CIN3 and they cannot exclude CIS. Probably because it was just a punch biopsy.  The levels go as follows. CIN1, CIN2,CIN3,CIS,stage 1a1,etc. 

A cone procedure is also just like a lletz but it will remove a bigger area then a lletz can more safely. It will remove the tip in an angled way. Just as the description implies:Cone. 

I am actually also in Canada and we follow the same guidelines as the uk in time management of cervical Gynae issues and procedure. Yes, you may have a conservative dr who,  because you are young is hesitant to be aggressive with this as he is trying to make certain you needs these procedures as he could potentially cause you future problems in fertility or pregnancy. 

in 90% of cases a lletz or cone will solve the issues and you will be ok. Unfortunatly, I was not in that 10% and was diagnosed with cc. 

as for the time line, waiting a month is pretty standard to have your cone procedure as your gynae will have to book a hospital day surgury room as most do not have the equipment in their offices and they only are allowed a certain number of days per month for procedure such as this. 

From my biopsy I waited 8 days for results(may 10 to May 18) then my lletz was June 9 so that was a month. Waited till June 20 for results which showed cancer and then started chemorad a month later. July 18. 

there is no rush as your cells will not change drastically from what they are now to have the cone done. And if by bad luck you don't get the all clear after that things will progress a little faster. Although from diagnosis to start of treatment was a month I had so many test done that it would actually be crazy to have started earlier. If it Is cc they have 2 weeks to get you in to see an oncologist by law. 

Try to stay calm as this is a process and like all of us you just want it dealt with asap but it doesn't work like that. Even if you had a private dr there would still be paperwork and such that slows things down. 10-15% of the female population has cervical changes to some degree. dr are crazy busy with so many people and your situation doesn't require a work done and completed within a week. I know that this is kind of harsh and upsetting but it is indeed a fact. Stay busy, think nice things. It will all work out in the end and you will forget how much the waiting and worrying sucks. 

Sending positive vibes. Good luck

Thank you so much for your help and clarification Lolli!

I'm so sorry for everything you've had to go through...very unfair

I went to see my doctor for what was supposed to be an app to find out the date for a cone biopsy. She instead apologized to me and said she had called the gynae at the hospital adjacent to her office and that they said they wouldn't give me a cone until the 6 months mark from my punch biopsy (punch was in March). They said the procedure would cause 'significant gestational issues' in the future. She said the doctors there said the chance of anything spreading or becoming invasive in the next few months is very unlikely so they wanted to wait. I asked her straight up if I had any say in this, and that I wanted to go right ahead with the procedure as I'm having pretty horrendous and uncomfortable symptoms and she said that she doesn't think theres anything she can do. 

She also did another internal and said there is still significant inflammation and bleeding on the cervix and tried to reassure me that everything would be okay. This is the second doctor doing this, even with the CIN3/CIS being confirmed.

I dont know what to do at this point, I'm so uncomfortable with the thought of waiting to see.



im not really sure what the standard is for waiting after a punch biopsy to a cone. I had a biopsy and then a lletz which is a little less invasive then a cone. I hope you can have some questions answered. maybe start a new post and ask how long people waited from punch to cone and someone else can help. 

Good luck

I know I wouldnt be happy waiting. Can you push to be seen sooner? Xx

From my experience I don't think there's any need to wait long between a punch and a cone. I had a punch biopsy on a Wednesday, and my cone biopsy was the following Tuesday, but I believe that was just because that was my surgeons operating day.

Hello everyone.

Thank you again for your responses, it really helps to know I'm not acting crazy by pushing to get things done sooner.

The hospital that did my biopsy apparently found out I sought another opinion. Maybe the doctor I saw called the previous gyno to ask why she wanted to wait? Anyway, the nurse practitioner called and did not seem very happy with me... she asked me what the symptoms were that caused me to worry/seek another doctor and why I was uncomfortable about waiting to treat the cis/cin3 and then she started acting concerned; but still very short and snappy with me nonetheless. They made me an app at the hospital for the beginning of July, but no one has told me what it is for...