A 70-year-old woman diagnosed with cervical adenocarcinoma in situ underwent total hysterectomy and bilateral oophorectomy one year ago. Follow-up Pap smears confirmed adenocarcinoma in situ, and two vaginal biopsies were negative. What next steps do you recommend?—KATHY DENEUVE, PA-C, Orlando, Fla.

This patient requires close monitoring and follow-up with a gynecologic oncologist. It is important that the biopsies are directed at the areas discovered via the Pap smears. Repeated Pap smears and biopsies should be validated by more than one source. Postoperative therapy (e.g., radiation) may be necessary to assure clearance of dysplastic tissue. A balance of risks and benefits can be facilitated by a person with more experience in this area.—Claire Babcock O’Connell, MPH, PA-C (140-8)