Pap smears may not detect all kinds of uterine tumors


January 31, 1995|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: My doctor has just told me that I have a large tumor of the uterus and should have a hysterectomy. It is hard for me to understand how a large tumor could develop in my uterus when I have annual examinations and Pap tests. What is the danger of uterine tumors?

A: There are three major types of uterine tumors.

Most common are tumors of the muscle wall of the uterus, referred to as myomas or "fibroids." These tumors occur in premenopausal women in whom they are malignant only in very rare instances. If they are quite large or cause systems (excessive bleeding, pelvic or back pain or urinary symptoms) in women who do not desire to have children they are usually treated by surgical removal of the uterus (hysterectomy); in some cases a single tumor can be surgically removed (myomectomy) without a hysterectomy. Myomas tend to stabilize or grow small after menopause. When myomas grow in postmenopausal women not taking estrogens, a hysterectomy is often recommended because of the danger of a malignant change in the tumor.

Second in frequency are cancers of the endometrial lining of the uterus. Such endometrial concerns are most common in postmenopausal women. Though malignant, they grow slowly and usually can be cured with early diagnosis and treatment.

The third kind of uterine tumor is cervical cancer, a disorder that most often affects women between the ages of 35 and 50. Carcinoma of the cervix is a dangerous malignancy that requires early detection and treatment to prevent spread.

Regular microscopic examination of smears of the uterus (Pap tests) are extremely valuable for detecting cervical carcinoma, and have greatly reduced deaths from this form of cancer. However, Pap tests are not an effective way to screen for endometrial cancer, which requires an endometrial biopsy for detection.

Postmenopausal bleeding, the most common symptom of endometrial cancer, should lead to an immediate appointment with a gynecologist. Postmenopausal women who are taking TC estrogen replacement without a progestational agent are at increased risk for endometrial cancer and must have regular gynecologic examinations and biopsies of the endometrium to detect the earliest signs of an endometrial cancer.

Regular Pap smears are not useful in making the diagnosis of a fibroma and cannot be relied upon to detect endometrial cancer. It should be clear that the risk of a uterine tumor is dependent on the type of tumor. Fibroids are almost always benign; both cervical and endometrial cancers can be cured when detected and treated in their early stages.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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