Abnormal Pap Smear and Uterine Fibroids: What You Need to Know

Abnormal cervical smear with concurrent uterine fibroids?

Hello Doctor: A few years ago, I was diagnosed with adenomyosis, and I have been having regular check-ups.
During my recent visit, I found that my CA-125 level increased from 29 to 47.
Because of this, I underwent an ultrasound and a Pap smear.
The ultrasound revealed a 3 cm fibroid, and the Pap smear report showed atypical squamous cells (ASC-US).
I searched online and found that while ASC-US is considered a precancerous condition, I already have a tumor (fibroid).
With both of these findings, along with the abnormal CA-125 level, I am very concerned that this may indicate a high likelihood of malignant sarcoma.
Thank you very much, and I would like to know your thoughts on this matter.

A Tao, 50~59 year old female. Ask Date: 2022/02/11

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, an ASCUS result from a Pap smear indicates that the findings are uncertain regarding any abnormalities.
You may consider undergoing a cervical biopsy or continuing with Pap smear follow-up, and further testing can be done if issues arise.
As for the elevated CA-125, it may be related to fibroids, and a 3 cm fibroid can also be monitored.
Therefore, my recommendation is to proceed with monitoring.
Wishing you good health.

Reply Date: 2022/02/11

More Info

Understanding the implications of an abnormal Pap smear, uterine fibroids, and elevated CA-125 levels can be quite concerning, especially when combined. Let’s break down each component to provide a clearer picture.

Abnormal Pap Smear (ASC-US)
An abnormal Pap smear result indicating Atypical Squamous Cells of Undetermined Significance (ASC-US) means that some squamous cells from the cervix appear abnormal but do not clearly indicate the presence of cancer. ASC-US is often considered a "gray area" in cervical screening. It can be caused by various factors, including inflammation, infection (like HPV), or other benign conditions. While ASC-US can be associated with precancerous changes, it does not automatically mean cancer is present.

Uterine Fibroids
Uterine fibroids (leiomyomas) are non-cancerous growths in the uterus that can cause various symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms. The presence of a 3 cm fibroid is significant but does not inherently indicate malignancy. Most fibroids are benign, and the likelihood of a fibroid being cancerous is low, especially in premenopausal women.

Elevated CA-125 Levels
CA-125 is a protein that can be found in higher concentrations in the blood of women with certain types of cancer, particularly ovarian cancer. However, elevated CA-125 levels can also occur due to non-cancerous conditions, including endometriosis, pelvic inflammatory disease, and even uterine fibroids. A CA-125 level of 47 is elevated (normal is typically below 35), but it is essential to interpret this result in the context of other findings and symptoms.

The Combination of Findings
Given your history of adenomyosis (a condition where the inner lining of the uterus grows into the muscular wall of the uterus), the presence of a fibroid, and the elevated CA-125 levels, it is understandable to feel anxious about the possibility of malignancy. However, it is crucial to remember that:
1. ASC-US does not equal cancer: While it warrants further investigation, it is not a definitive diagnosis of cancer.

2. Fibroids are usually benign: The majority of fibroids do not turn into cancer, and the risk of a fibroid being malignant is relatively low.

3. CA-125 levels can be elevated for various reasons: Elevated CA-125 alone is not diagnostic of cancer, and further evaluation is necessary.

Next Steps
1. Follow-Up Testing: It is essential to follow up with your healthcare provider for further evaluation. This may include a colposcopy (a closer examination of the cervix) and possibly a biopsy to assess the abnormal cells further.

2. Imaging Studies: If there are concerns about the fibroid or other pelvic masses, imaging studies such as an ultrasound or MRI may be warranted to assess their characteristics.

3. Monitoring CA-125 Levels: Your doctor may recommend monitoring your CA-125 levels over time to see if they change, which can provide additional information about your condition.

Conclusion
While it is natural to feel worried about these findings, it is essential to approach the situation with a clear understanding of the facts. The combination of ASC-US, fibroids, and elevated CA-125 levels does not automatically indicate a high risk of malignancy. Regular follow-up with your healthcare provider, further testing, and monitoring will help clarify your situation and guide appropriate management. Remember, early detection and intervention are key in managing any potential issues effectively.

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