Jefferson University Hospitals

Frequently Asked Questions

Discovering cervical abnormalities early through regular pap smears has been shown to significantly decrease the chance of developing cervical cancer. The growing number of women who get yearly pap smears today accounts for a significant drop in cervical cancer in the United States over the last 25 years.With early detection, precancerous changes in the cervix can usually be treated before they develop into cancer.

Who needs a pap smear?

Getting an annual pap smear is the best prevention for women against cervical cancer. The American Cancer Society recommends that women get a pap smear three years after they become sexually active or when they reach the age of 21, whichever comes first. This simple diagnostic procedure involves the removal of a tiny sample of cells from the opening of the cervix for laboratory testing. Pap smears are typically done during an annual gynecological check-up or routine physical.

Pap tests may detect abnormal cell changes long before they turn into cancer. In rare cases, a cervical abnormality may be missed on a pap smear. For this reason, all women should be alert to the possible symptoms of cervical cancer, which include persistent bleeding and bleeding after intercourse. If you have these symptoms, call your doctor, even if your last pap smear was normal.

What does an abnormal pap smear mean?

An abnormal result indicates that the cells on the outer layer of the cervix have changed in an unusual way. This does NOT mean you have cancer. Precancerous cell changes are 10 to 20 times more frequent than true cervical cancer. Sometimes, though, these unusual cells develop into preinvasive or precancerous lesions called “dysplasias” (dis-play-shas). If the dysplasia is severe, your physician will recommend removing the cells. Untreated, dysplasia can develop into cervical cancer.

An abnormal pap smear may also indicate the presence of the human papilloma virus (HPV), a common sexually transmitted disease also known as genital warts. Once a woman has been diagnosed with HPV, she needs to get pap tests more regularly because HPV is associated with the development of dysplasia.

Other times, abnormal pap smears are caused by infections that can be treated with medication.

How do I find out if the abnormal pap smear is linked to cancer?

If your pap smear shows an abnormality, your physician may suggest you have another diagnostic test called a colposcopy (col-pas-co-pee). This test provides a more specific and reliable indication of precancer or HPV infection than the pap smear. In a colposcopy, the physician applies a mild, vinegar solution to the cervix making any abnormal cells more visible. Using a binocular magnification device called a colposcope, the physician looks for abnormalities on your cervix and takes biopsies (small samples of tissues) from the most abnormal area. These samples are then sent to the laboratory for examination.

How are serious cervical abnormalities treated?

If you are diagnosed with moderate or severe dysplasia, you might need to have an additional biopsy performed after a colposcopy to rule out cancer and to remove additional abnormal cells. Your physician may perform either a cone biopsy or LEEP (loop electrocautery excision) procedure, depending on which is more appropriate in your case.

The cone biopsy is performed in a surgical outpatient unit under general anesthesia. The physician removes a cone-shape piece of the cervix with a scalpel. The LEEP procedure is performed under local anesthesia and employs a wire loop supplied with an electrical current to remove the tissue. Both diagnostic techniques are also used to treat some precancers that are restricted to the lower portion of the cervix.

If your physician detects a lesion elsewhere on the cervix, laser surgery may be recommended. Here, a beam of light is directed on the abnormal area and the heat kills the cells.

What happens if I don’t seek treatment for an abnormal pap smear?

Precancer is a warning that you are at risk of developing cancer. Therefore, if your pap test suggests a precancerous change in the cervix, it is in your best interest to seek further evaluation as soon as possible. Close, careful monitoring through pap smears and colposcopy is essential in preventing precancerous lesions from progressing to invasive cancer.

Invasive cervical cancer is treatable through radiation and/or hysterectomy. However, these treatments are both more complicated and more prolonged than the treatments for precancers described above. Cure rates are also lower, depending on the extent of the cancer.

If you detect and eliminate precancerous lesions promptly, your chances for a cure are excellent. From 90-95 percent of women treated by cone biopsy, the LEEP procedure, and laser are cured. Five percent of patients need retreatment.

Can I prevent cervical abnormalities?

You can reduce your risk of cervical cancer and other precancerous abnormalities by getting routine pap smears and protecting yourself against the HPV virus. Limiting your sexual partners and using condoms will reduce, but not eliminate your risk of HPV. If you smoke, giving up cigarettes will also cut your chances of cervical cancer.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.

By participating in a clinical trial you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.

Why would I choose a minimally invasive procedure instead of a traditional surgery?

In many cases, minimally invasive procedures offer some significant advantages. Those advantages include less trauma during surgery and fewer complications after. With minimally invasive procedures, you typically enjoy a shorter hospital stay (or none at all), a faster recovery and less scarring. In fact, with many of these procedures, surgeons use Band-Aids® for dressings!

Why should I choose Thomas Jefferson University Hospital for my minimally invasive procedure?

Jefferson surgeons have been performing – and pioneering – minimally invasive procedures for over a decade. Today, we have many of our surgeons have extensive experience in minimally invasive diagnostic and treatment procedures covering a wide range of medical specialties. We have experts in advanced endoscopy in our Division of Gastroenterology and Hepatology. We have leading urologists who routinely use da Vinci® Surgery for prostatectomy. And our Jefferson Hospital for Neuroscience team includes surgeons who use minimally invasive techniques to treat hard-to-reach tumors of the brain and spine using stereotactic radiosurgery, cranial base surgery and endoscopic neurosurgery.

What is the difference between laparoscopic surgery and keyhole or Band-Aid® surgery?

The terms "laparoscopic surgery," "keyhole surgery" and "Band-Aid® surgery" are interchangeable. All refer to a family of minimally invasive procedures that use small incisions and some kind of laparoscope, or high-tech camera, to guide surgeons in performing the procedures through the tiny openings. These techniques can be used for a number of procedures, including common operations like removal of the gall bladder, removal of part of the colon and removal of the kidney.

How have Jefferson operating rooms been updated for minimally invasive procedures?

Jefferson has a range of surgical suites that have been outfitted with the tools and technologies needed for minimally invasive procedures. Jefferson Hospital for Neuroscience, for example, has state-of-the-art equipment for stereotactic radiosurgery. Similarly, the Jefferson Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery Center uses the latest digital operating rooms – the first of their kind in the Delaware Valley.

Ovarian cancer is the rapid growth of abnormal cells in the ovaries of the female reproductive system. The ovaries are the two small egg-filled sacs on each side of the uterus which produce estrogen and play a key role in conception and menstruation. Cancer can occur in one or both ovaries. When there is a malignancy, the ovaries typically enlarge, and cancer cells may fall off the ovary's surface and implant themselves throughout the abdominal cavity. Each one of these seedlings can then grow into a separate ovarian cancer tumor nodule.

Who is at risk for ovarian cancer?

Each year, more than 20,000 American women will be diagnosed with ovarian cancer. The disease most often affects post-menopausal women, although women of any age may develop it. While scientists have not uncovered the cause, women in any of the following categories are known to be at higher risk: those who are infertile, who have never been pregnant, who bore children at a later age, who have had breast cancer, and women with family members who have had ovarian cancer. You cannot transmit the disease through physical or sexual contact.

Taking birth control pills reduces your risk for the disease. Women who have had tubal ligations are also less likely to get ovarian cancer. And the more often a woman has been pregnant, the less likely she is to develop ovarian cancer.

What are the symptoms of ovarian cancer?

Cancer of the ovaries often develops with no early warning signs. The first indication of the disease may be a swelling or feeling of fullness in the lower abdomen. Ovarian cancer can also cause indigestion, unusual bowel or rectal pressure, and abdominal pain or discomfort. Persistent digestive problems such as stomach discomfort, distention and gas might also be symptoms.

Your doctor may notice an ovarian cyst or other growth during your regular pelvic exam. Cysts on the ovaries rarely turn out to be cancerous, especially in women under 40. Most of these growths are normal and related to the menstrual cycle, but your physician will want to watch you closely to be certain the cyst resolves.

Can ovarian cancer be prevented?

Women who have annual pelvic exams increase their chance of early detection and a better treatment outcome if the disease is discovered. If any family relative has had cancer of the ovaries, your physician may advise you to have checkups more frequently. The genes for ovarian cancer are not “sex linked,” which means that the gene for the disease can be inherited from either your mother or father.

What if my doctor detects a growth on my ovaries?

If your doctor suspects cancer of the ovaries based on your symptoms and on a pelvic examination – a number of diagnostic procedures can help determine whether the abnormal growth is cancerous. Frequently, growths on the ovaries turn out to be nonmalignant cysts.

To determine whether the tumor is malignant, you may be referred to a gynecologic oncologist (cancer specialist) for one or a combination of the following tests:

  • Ultrasound – a painless, non-invasive sound wave technique that enables your doctor to examine the inside of your abdomen and the ovaries
  • Lower GI series – produces an X-ray of your colon to determine whether pressure from an ovarian tumor is changing the shape and position of the colon and rectum
  • CT or CAT Scan – an X-ray procedure that provides detailed pictures of cross sections of the body. The pictures are created by a computer
  • Laparotomy or Laparoscopy – these surgical procedures involve making an incision in the abdomen to biopsy the suspicious ovarian tissue. The surgeon removes the entire affected ovary so that the disease, if present, doesn't spread. You may wish to obtain a second opinion from another physician before scheduling a laparotomy.

What are some questions I need to ask my physician if ovarian cancer is diagnosed?

  1. Have you had special training in the management of gynecologic cancers or can you refer me to such a specialist?
  2. Has the cancer spread?
  3. What are the surgical options?
  4. Will I need chemotherapy or radiation, too?
  5. What are the potential side effects of the recommended treatments?
  6. Will I be infertile after treatment or are there other options?
  7. Can I work and continue my normal activities during treatment?

How is cancer of the ovaries treated?

Treating ovarian cancer requires inpatient surgery, usually performed by a gynecologic oncologist. After confirming a diagnosis of cancer, your doctor will surgically remove the affected ovary. Most often – as a precautionary measure or because the cancer has spread – your doctor will remove both ovaries, along with the fallopian tubes and uterus. In addition, the surgeon will also take samples of nearby lymph nodes, and other internal structures including fluid from the abdomen to determine whether the cancer has spread.

After surgery, most patients receive chemotherapy (anti-cancer drugs) for approximately six months to destroy any remaining cancer cells.

What are the side effects of treatment?

For several days after surgery, a woman may have problems emptying her bladder and having normal bowel movements. Doctors generally advise patients not to have sexual intercourse for 6 to 8 weeks after surgery. Removal of the ovaries also triggers menopause immediately. Symptoms such as hot flashes may be more severe than when menopause happens naturally.

The side effects of chemotherapy depend on the drug that is administered. Each woman will also respond differently to the medication. Typical temporary side effects may include lowered resistance to infections, loss of energy, loss of appetite, nausea, vomiting, hair loss, hearing problems, mouth sores and tingling or numbness of the fingers or toes.

What is the prognosis for ovarian cancer?

Follow-up care is important. You will require regular pelvic exams and lab tests to be sure the cancer has not returned. Your physician may recommend a "second look" laparotomy after completion of therapy to ensure the treatment has been successful. Women treated for ovarian cancer also have an increased risk of developing other types of cancer later in life and need special monitoring.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.

By participating in a clinical trial you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Jefferson also offers a number of cancer support and education programs as well as a Buddy Program in which survivors of cancer provide support and encouragement to patients who are newly diagnosed and an active cancer advocacy group. You'll find information on the Jefferson web site about these programs or by calling 1-800-JEFF-NOW.

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.