What does a Pap smear result of PapNILM (Pap Negative for Intraepithelial Lesion or Malignancy) with negative HPV (Human Papillomavirus) mean, and what is the plan for a possible Total Laparoscopic Hysterectomy (TLH) for an abnormal cervix and potential BSO (Bilateral Salpingo-Oophorectomy) pending evaluation of the ovaries at the time of surgery?

From the Guidelines

The medical terminology you're asking about refers to a Pap smear (Papanicolaou test) that came back as NILM (Negative for Intraepithelial Lesion or Malignancy) with a negative HPV (Human Papillomavirus) test, which is good news as it means your cervical screening showed no abnormal or precancerous cells, and you don't have high-risk HPV infection. However, the mention of "abnormal cervix" suggests there may be other concerns with your cervix despite the normal Pap result. The plan appears to include a procedure to evaluate and possibly treat the cervical abnormality. Additionally, there's consideration of a BSO (Bilateral Salpingo-Oophorectomy), which is the surgical removal of both fallopian tubes and ovaries, but this decision will be made during surgery after your ovaries are examined, as suggested by recent guidelines 1. This suggests your doctor has found something concerning about your ovaries on imaging or during examination that requires further evaluation during surgery. The final decision about removing the ovaries will be made based on what the surgeon sees during the operation. This approach allows for the most appropriate treatment while avoiding unnecessary removal of organs if they appear healthy during surgery.

Some key points to consider:

• The decision to perform a BSO should be individualized, taking into account factors such as childbearing status, menopause status, comorbidities, family history, and the specific genetic mutation involved, if any 1.
• The timing of BSO should also be individualized, with some guidelines suggesting it may be considered starting at age 40-45 years for certain genetic mutations, such as BRCA1 or BRCA2 1.
• It's essential to weigh the potential benefits of BSO against the potential risks, including premature menopause and its associated health consequences 1.
• Other options, such as salpingectomy with delayed oophorectomy, may also be considered for women who are not yet ready for oophorectomy 1.

Overall, the plan for your care will depend on various factors, including your individual circumstances, medical history, and the results of further evaluation and testing. It's essential to discuss your options and concerns with your healthcare provider to determine the best course of action for your specific situation.

From the Research

Understanding the Medical Terms

• PapNILM refers to a Pap test result that shows no intraepithelial lesion or malignancy, indicating a normal result.
• Negative HPV means that the human papillomavirus (HPV) test is negative, which reduces the risk of cervical cancer.
• "Plan for RT LH for abnormal cervix" likely refers to a plan for a radical hysterectomy (RT LH) due to an abnormal cervix, which may be related to cervical cancer or precancerous lesions.
• "Possible BSO pending evaluation of the ovaries at time of surgery" refers to a possible bilateral salpingo-oophorectomy (BSO), which is the removal of both ovaries and fallopian tubes, pending evaluation of the ovaries during surgery.

Surgical Approaches for Cervical Cancer

• Radical hysterectomy is a surgical procedure that involves the removal of the uterus, cervix, and part of the vagina, as well as surrounding tissues and lymph nodes 2, 3.
• The approach to radical hysterectomy can be either open (abdominal) or minimally invasive (laparoscopic) 3, 4.
• The choice of approach depends on various factors, including the stage and type of cervical cancer, as well as the patient's overall health and preferences.

Complications of Hysterectomy

• Hysterectomy, including radical hysterectomy, can be associated with various complications, such as infection, bleeding, and injury to surrounding organs 5, 4.
• The risk of complications can vary depending on the approach used (open vs minimally invasive) and the patient's individual factors 5, 4.
• It is essential to discuss the potential risks and benefits of each approach with a healthcare provider to make an informed decision.

Relevance of the Provided Studies

• The provided studies primarily focus on the surgical approaches for cervical cancer, complications of hysterectomy, and the impact of the Laparoscopic Approach to Cervical Cancer trial on surgical practices 2, 3, 5, 4.
• While these studies provide valuable information on the topic, they do not directly address the specific question about the meaning of the medical terms and plan. However, they do offer context and insights into the surgical management of cervical cancer and the potential complications associated with hysterectomy.