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
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
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
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
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,
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
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
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
799621:Thank you. You have put my mind at
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
He45:lI 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
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
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
Hel4I5:Is there a certain age when you get
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!
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
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
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:he 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
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
Jay:Thanks for answering my questions
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
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
Faz Pakarian:Thank you, my website is