Ask Dr Faz Pakarian from BMI about cancer

29 March 2012

Consultant Gynaecologist Mr Faz Pakarian was our expert for the third session of last week's online live chat on cancer. Here are the questions and answers in full:

AXAPPPhealthcare: Morning Dr Faz Pakarian - would you mind telling us little about yourself?

Faz Pakarian: Hi. I have been a consultant gynaecologist at Worthing hospital for the last 11 years, I also practice at Goring Hall hospital. My interests include colposcopy and pelvic floor repair.

AXAPPPhealthcare: Great thanks, we have a question from one of our blog readers that we hope you can help with. Linda Warden - My sister had uterine cancer, had a hysterectomy and has undergone chemo and radiation. They have told her the cancer has spread but she said the chemo was so awful she can not have anymore. She is now doing gerson therapy and went to Mexico to learn what to do. She believes this will cure her. Do you have a point of view on this?

Faz Pakarian: I understand the side effects of chemo and radiotherapy following surgery form gynaecological cancers but have little knowledge on the type of treatment that your sister is having in Mexico,

AXAPPPhealthcare: Thanks for coming back on that question, we have another question - Carol -A year or two ago my doctor told me I did not need any further tests for cervical cancer. I haven't been able to establish why and should like to know if you agree. I am 73 years of age and assume I could still get cervical cancer Is it possible to book myself in for a test as I do for the breast cancer screens and if so where do I go to do that.

Faz Pakarian: Hi, It is extremely unlikely to get cervical cancer in the 70s.  We recommend 3 yearly smears up to the age of 50 years and then 5 yearly till the age of 65 years.  If you have had normal smears, as I have indicated unlikely to develop at this age. If however, there are symptoms, i.e. per vaginal bleeding, then a cervical assessment will be part of the routine examination

Joshua77: My partner is currently undergoing LLETZ treatment for cervical cancer and we are worried that it will reduce her chances of getting pregnant. Is this true?

Faz Pakarian: HI, having a LLETZ does not reduce the chances of pregnancy,  having recurrent LLETZ can be associated with mid trimester miscarriages. To reduce the incidence of cervical abnormalities, we recommend that women should stop smoking (if they do in the first place).

Joshua77: Fortunately she has never smoked! Is there anything else she should do to not reduce the risk of pregnancy??

Faz Pakarian: Once a LLETZ has been carried out, it is likely that up to 95% of the abnormality is removed so the odds are that less likely to have abnormal smears for follow up.  Having said that, we would still recommend cervical surveillance six months and then yearly thereafter.

Joshua77: Thanks Dr Pakarian

Faz Pakarian: Pleasure

Kate22: Hi Mr Pakarian, I know I keep bringing up ovarian cancer but is there anything I can do to prevent this along with cervical cancer - are the 2 connected in any way?

Faz Pakarian: With regards to cervical cancer, having regular smears is beneficial. With regards to ovarian cancer, symptoms such as bloating, weight loss, indigestion, feeling full, pelvic or abdominal pain in over 50s may warrant further investigations.  There is not such a good screening programme for ovarian cancer as there is for cervical.

Kate22: Ok thank you, and do other gynaelogical issues lead to cancer?

Faz Pakarian: Can you be more specific please?

Kate 22: Sorry, for example if you had abnormal cells at a young age but they didn't lead to anything, should you get checked out more often and continue to do so as you age?

Faz Pakarian: If you have had abnormal cervical cells, if these were high grade, they would have been treated.  However if the initial abnormality was  low grade which  has reverted back to normal with subsequent smears , then you do not need more assessment,

Kate22: Thank You

Jo: Hi Mr Pakarian could you please answer my question. My mum was diagnosed with cervical cancer, does it run in families and am I more likely to get it?

Faz Pakarian: Hi, as long as you have regular smears, it is very unlikely that you will have the same problem. Certain cancers such as breast and ovarian runs in families.

Jo: Ok thanks for your help

Faz Pakarian: Pleasure

799621: I am 73 years old and my doctor told me some years ago I do not need cervical smears any longer.  Could you please tell me the reason for this.  I do not have any concerns at the moment but wonder if I should be having tests periodically.

Faz Pakarian: Hi, It is extremely unlikely to get cervical cancer in the 70s. We recommend 3 yearly smears up to the age of 50 years and then 5 yearly till the age of 65 years. If you have had normal smears, as I have indicated unlikely to develop at this age. If however, there are symptoms, i.e. per vaginal bleeding, then a cervical assessment will be part of the routine examination

799621: Thank you. You have put my mind at rest

Jo: Hi Mr Pakarian I've just been asked to ask you is genetic testing or screening available for women with ovarian cancer in their families?

Faz Pakarian: Hi, yes there is.  If there is a family history, looking at BRCA1 and BRCA2 genes can indicate probabilities of developing this cancer

Jo: Can you ask your GP for this or do you have to see a specialist?

Faz Pakarian: You can ask your GP initially and they can refer you on

Jo: Ok thank you

Faz Pakarian: Pleasure

He45: I thought I would be cheeky and ask you a non-cancer question if that is ok? I've got friends who live in America who seem to have their own gynae that they know by name and have treatments done by them that we would see our GP/nurse for, why don't we see gynaes more often?

Faz Pakarian: Hi, We do! I have patients that see me annually for a check up rather than seeing their GP or nurse.

Hel45: So you can make an appointment for just a check-up or even just your routine smear test?

Faz Pakarian: Yes, but the smear or consultation will have to be privately funded.  As you know, a referral is needed to see a specialist in NHS

Hel45: That's good to know. Another non cancer question if that's ok, I've been told that someone I know has endometriosis but I don't really know a lot about it and read that it can be misdiagnosed as IBS, I suffer from IBS so should I get a second opinion

Faz Pakarian: No problems, if you have painful periods, heavy periods, pelvic pain which is cyclical, endometriosis will need to be excluded.  Endometriosis can also cause bowel symptoms which is worse at time of the periods.

Hel4I5: Is there a certain age when you get endometriosis?

Faz Pakarian: Usually in the reproductive years, unlikely after the menopause

Hel45: That's great thank you very much for all of your help.....and answering my non cancer questions!

Faz Pakarian: Pleasure

Roger99: Hi Dr Pakarian -What is this contraceptive coil that my I have heard about via my wife as a potential alternative to a hysterectomy?

Faz Pakarian: It is the mirena coil.  This has progesterone on it and stops women from having heavy periods and also acts as a contraceptive

Jay: Hi, is the mirena coil different to the contraceptive coil?

Faz Pakarian: Hi, the mirena has progesterone hormone on it and acts to reduce heavy periods.  The copper coil does not have any hormones and acts as contraceptive only

Jay: And is it true that some methods of contraception can cause cancer? How do you know what the safest option is?  

Faz Pakarian: The best method of contraception is dependent on the patient's age, contraceptive wishes, costs and side effects. There were suggestions of the pill being associated with cancer of the cervix but this is not been validated and there may be other factors

Martha529: Hi, I had an abnormal smear result a few years ago and tested positive for HPV.  Over the past couple of years I've had 3 colposcopies.  I have now had 3 normal smear results but have not been tested for HPV since my last colposcopy.  I don't want to return to 3-yearly smears until I know I'm HPV negative.  Do I have a right to be given the HPV test on the NHS?

Faz Pakarian: Thee good news is that the NHS will now be introducing HPV testing as part of cervical screening.  In the past, you would have known that you had  HPV based on a smear report.  However, we will now do an additional test to assess the type of HPV.  IF they are the ones not associated with abnormal cervical cells, then patients are put onto routine screening as for normal smears.

Martha 529: Thanks for your reply

Faz Pakarian: Pleasure

Jay: I'm in a long term relationship so don't need to worry about sexually transmitted diseases. I'm on the pill as I suffer with period pain but is either the coil or injection safer for long term use then the pill?

Faz Pakarian: The pill is also safe as long as your BMI is normal, that you do not smoke and have no history of thrombosis.  If you are happy with the pill, it should be ok to continue

Jay: Thanks for answering my questions

Faz Pakarian: Pleasure

Serena: I have had endometriosis maybe 10 years ago. Can it come back and how would I know, i.e. what are the signs as I have gone through menopause

Faz Pakarian: Yes it can come back, symptoms are pelvic pain which is cyclical, period pain heavy periods and pain during intercourse, if you have not had any periods for more than 12 months, and have had hot flushes, night sweats, then that is menopause

BMIHealthcare: Dr Mangar will be logging in shortly to answer your questions. Many thanks for answering the questions this afternoon Mr Pakarian, it has been very insightful

Faz Pakarian: Thank you, my website is

BMIHealthcare:Thank you