Are Pap tests necessary after a hysterectomy?

June 6th, 2010

DEAR DR. GOTT: I had ovarian cancer and had a complete hysterectomy two years ago. My cancer was in the first stage, and, thankfully, I did not need chemo or radiation.

My surgeon continues to schedule me for Pap smears/internal exams yearly and says I will need to have this done for the rest of my life, but I don’t understand why. When I ask him, he gets short with me and says to “look it up on the Internet.” This does not make sense to me. Even my family doctor was surprised that I must continue to have Pap smears after having a complete hysterectomy.

Can you shed some light on this? Thank you.

DEAR READER: First things first. Find another surgeon/gynecologist. A huffy attitude and saying “Look it up on the Internet” is never an appropriate response to a concerned patient’s question, especially one who has a diagnosis of cancer. All patients deserve respect and simple politeness. Physicians dealing with cancer patients should realize this above all others because of the justified high emotions often associated with the diagnosis.

Now, onto your question. There are two types of hysterectomy: total and partial (also known as supracervical). A partial hysterectomy removes the uterus and leaves the cervix intact. A total hysterectomy removes both the uterus and the cervix. In each procedure, the ovaries and fallopian tubes may be removed as well, depending on the reason for the hysterectomy.

I assume your “complete” hysterectomy is a total one. Also, because of your ovarian cancer, it is a given that your ovaries and fallopian tubes would have been removed as well, since they were the source of the cancer and the reason for undergoing the procedure.

Treatment for ovarian cancer often begins with surgery to remove the ovaries, fallopian tubes, uterus, nearby lymph nodes and a fold of fatty abdominal tissue. Tissue and abdominal fluid samples are also taken to determine the stage of cancer and if additional treatments may be required. Depending on the results, chemotherapy and/or radiation are typically ordered. This is especially true for more advanced cases.

Unless you had a partial hysterectomy, a Pap smear, which tests for cervical cancer, doesn’t make any sense because you don’t have a cervix. However, because I am neither a gynecologist nor a surgeon, I must defer a final answer to the specialists.

Find a gynecologist with whom you feel comfortable. You can even make a “get acquainted” visit to determine whether he or she is someone you truly wish to see. Once you have found the specialist of your choice, provide him or her with your medical records. Then sit down to discuss what type of hysterectomy you had, the type of testing you should undergo to monitor your ovarian cancer until you enter remission, and whether Pap smears are necessary in your case.

Also, remember to eat well, exercise, get plenty of rest, and keep stress to a minimum to increase and/or maintain your quality of life. This may also help with any symptoms of menopause, such as hot flashes, mood swings, weight gain, and more, that you may be experiencing following your hysterectomy.

To provide related information, I am sending you copies of my Health Reports “Menopause” and “An Informed Approach to Surgery.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each copy to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.