Uterine or ovarian cancer?

[nglili]

Uterine or ovarian cancer?
by nglili, May 25, 2010 09:53PM
Pipelle microscopic finding: section show blood clot, mucus and fragmented endometrial tissue exhibiting tubular glands within a cellular to mildly eodematous stroma.  In areas, some of the glands show subnuclear vacuolation.  In other areas, mitoses are seen.  A few of the glands appear tortuous and some are irregularly dilated.  No hyperplasia or malignancy noted.  Interpretation: Endometrium pipelle:late proliferative phase.  Comment: In vew of a few irregularly dilated glands, advise repeat sampling later to rule any possibilities of underlying disordered changes or hyperplasia. Transabdominal scan:  Uterus size 11x6cm, fibroid 5cm at fundal posterior, ET6mm, rt ovarian cyst 4x4cm unilocular thin wll, no solid area, no papillary projection. (This cyst was 3 months ago, now took 2 more scan, already burst with only egg shell visible, left a small follicle cyst). Papsmealr– negative for any malignancy, pipelle sampling- proliferative phase, CA125  7.3 U/ml, CEA 0.7ng/ml, AFP5.47 ng/ml. Had an adenoma poly 0.5cm removed from transverse colon in 2008, (noncancerous), repeated colon scope in 2009, no recurrence (doc advised repeat scope in 3 years). Maternal grandmother had colorectal cancer.  Had 1 mamogram in 2007, 2008 and in dec 2009 felt a small lump tissue in right breast, doc did ultrasound says thick tissue, normal. No need mammogram as I already had 2. Now still feel lump is there sometimes period bigger then after smaller. Sometimes a bit painful.  Am I safe from breast cancer? Please advise whether I need to do a dd&C and hysteroscopy now? Some docs says yes and some says no, some says repeat pipelle in 4 months time as it is 75% accurate compare to D&C 77%. What these result means or am I on the way to developing uterus cancer?

[nglili]

Thank you very much for your reply.  I am 48 years old Chinese lady with past history of dysfunctional uterus bleeding when I was 33 and again 44. Had a DD&C done at 44, normal. The fibroid which was in the report had been there since I was 33 but it has grown from 3cm to 5 cm over the years. Also there are another 2 fibroids detected measuring 2 or 3 cm. I have irregular bleeding recently which is twice a month and uses 8-9 pads on the 2nd and 3rd day. It has been 6 months. I am taking 1 cap of tranexamic acid 250mg on the 2nd day (heavy bleed) and the bleeding will immediately reduce and complete within 5 -6 days.  I had an ultrasound done in Dec last year cos the breast doc detected a small lump at right breast but that time, it was only thick breast tissue, no lump.  I had a mammogram last week,diagnosis: Two small specks of benign-type calcifications seen in right breast. – No suspicious lesion seen to suggest malignancy. BIRADS II. I went for the mammogram cos I still felt the small lump and felt uncomfortable. As I had an adenoma polyp 0.5cm (non-cancerous) removed from my transvers colon in 2008, 2009 repeated colon scope no recurrence though I have IBS and piles (which was removed).  My maternal grandmother die of colon cancer, paternal uncle and aunty had brain and intestinal cancer.  Are all my above problems genetic? Why am I having breast, uterus and colon problem together recently.  I  also have a long history of gerd and I take probiotic everyday. I am schedule for a DD&C and hysteroscope on 25 this month because of my pippelle result. I am very worried and cannot sleep.  Am I on the way to developing breast and uterine cancer? Should I just remove uterus and ovary now or do the DD&C first and wait for the outcome? The doc says if the report is not good he will do another operation to remove everything. I would have to go thro another session of anesiastic, is it save? I have been through 4 opertions in my life before. It is very scary to know and keep track of cancer developing.  What are my chances or surviving from uterus or breast cancer? I have been very careful but I still get these problems. Pls advise.    

[Annekathryn Goodman, M.D.]

Hi There,
wow, you have had a very comprehensive evalaution.
You have a normal endometrial biopsy, labs, pap smear, mammogram, and pap smear.
a pelvic ultrasound shows a fibroid and a stable simple ovarian cyst.

The decision to do further gyn evaluation will depend on context. Why are you having all this extra testing in the first place?
if you are post menopausal and are having unexplained uterine bleeding, then , yes, I would just do a formal dilation and curettage with hysteroscopy under anesthesia to be sure i am not missing something in the office biopsy.

On the other hand , if you are 25 years old and having irregular periods, I would not do anything more.

As for a breast mass, again this is age dependent. Breast cancer risk increases with age. An unexplained breast mass even in the setting of a normal mammogram should be biopsied.

if you are concerned , you should get a second opinion with a breast specialist.
I hope everything works out
take care