Uterine Bleeding, Precancer, 
and Uterine Cancer

Edited excerpts from our book
A Gynecologist's Second Opinion
by William H. Parker, M.D.

WHAT ARE THE SYMPTOMS OF UTERINE CANCER?
Abnormal bleeding is an early sign of uterine cancer, but most women who have abnormal bleeding do not have uterine cancer. As discuss in chapter 3, there are lots of other, more likely, and non-worrisome causes of abnormal bleeding. But in the rare woman who has developed uterine cancer, the cancer cells often become fragile and are more prone to bleeding. 

The bleeding tends to occur irregularly and unpredictably, whenever the cells become fragile enough to break off. Luckily, the blood from these cancer cells can be easily seen as it passes through the cervix and into the vagina. As a result, abnormal cells are often detected at a very early stage, when they are treatable and long before cancer has a chance to spread. 

Uterine cancer in its early stages does not cause pain, nausea, vomiting or other obvious symptoms. Since they feel entirely well, many women are shocked to find that they have uterine cancer. Also, irregular bleeding may last for only a few days and then, as some of the abnormal tissue temporarily heals, may stop for days, weeks, or even months. Therefore, if you have abnormal bleeding, you should see your doctor, even if you otherwise feel fine, and even if the bleeding stops. This is true for women of any age, but is especially true for postmenopausal women, where the incidence of uterine precancer and cancer is higher.

JANET HAS ABNORMAL BLEEDING
Janet is a 69-year-old women who was referred to me by her family physician because she had begun having vaginal bleeding. When she had entered menopause twenty years ago, she had initially resisted taking estrogen replacement therapy. At the time, this was not uncommon since many women and doctors were skeptical and afraid of hormone replacement. However, severe hot flashes and lack of sleep finally wore her down, and within a year she asked to start estrogen. As was common at that time, estrogen was started alone, without any progesterone. And for the next twenty years, estrogen alone is what her doctor continued to prescribe, and that is what she took. 

The bleeding had started recently, but otherwise she felt fine. Her pelvic examination was entirely normal. Since she had not been taking any progesterone, I knew she was at risk for uterine cancer. Therefore, I recommended that she have a D&C and hysteroscopy to evaluate the cause of the bleeding. As usual, we performed the hysteroscopy first. The hysteroscope is a very small telescope that allows us to see inside the uterus in order to determine what may be the cause of abnormal bleeding. Instead of the normal pale pink, smooth lining of the uterus, a cauliflower shaped, grayish bleeding area was seen at the top of the uterus. It appeared that a cancer was present . 

The D&C removed a considerable amount of tissue for the pathologist to examine under the microscope. I told Janet what I suspected, and she was shocked because she had felt entirely well. It is sometimes especially difficult to come to grips with having a major illness when you feel completely well. I explained that this was often the case with uterine cancer. It does not cause pain until it is very far advanced. And, since this was Janet's first episode of bleeding and she had no symptoms and a normal pelvic examination, I was hopeful that the disease was early and curable. 

A week after the D&C, the pathology report confirmed that uterine cancer was present. But, the cells appeared to be slow growing, which suggested an excellent prognosis. For reasons that are not clear, uterine cancer that results from taking estrogen after menopause without any progesterone is usually a slow growing disease, and often is less agressive than uterine cancer unrelated to estrogen therapy. We scheduled Janet for surgery the next week. In order to remove all of the cancerous cells, removal of her uterus- a hysterectomy- would be neccesary. However, the surgery would provide an almost certain cure. 

At the time of surgery there was no evidence of any spread of the cancer, and on the morning of her discharge from the hospital, the pathology report from the hysterectomy confirmed that the cancer was the slow growing type and had not begun to spread. Janet's prognosis was excellent and she was relieved that she would be well. 

The following questions and answers can be found in our book

  • ABOUT UTERINE CANCER

  • WHAT IS UTERINE CANCER?

  • WHAT IS ATYPICAL HYPERPLASIA?

  • WHAT CAN BE DONE IF YOU HAVE PRECANCEROUS CELLS OF THE UTERUS?

  • IS UTERINE CANCER COMMON?

  • WHAT CAUSES UTERINE CANCER?

 

  • RISK OF UTERINE CANCER

  • DOES BEING OVERWEIGHT INCREASE YOUR RISK OF UTERINE CANCER?

  • DOES FREQUENTLY MISSING YOUR PERIOD INCREASE YOUR RISK OF UTERINE CANCER?

  • DO OTHER MEDICAL CONDITIONS INCREASE YOUR RISK OF UTERINE CANCER?

  • DOES TAKING ESTROGEN ALONE FOR MENOPAUSE INCREASE YOUR RISK OF UTERINE CANCER?

  • DOES TAKING TAMOXIFEN FOR BREAST CANCER INCREASE YOUR RISK OF UTERINE CANCER?

  • IS UTERINE CANCER AN INHERITABLE DISEASE?

  • DOES HAVING CHILDREN DECREASE YOUR RISK OF UTERINE CANCER?

  • WHAT CAN YOU DO TO DECREASE YOUR RISK OF UTERINE CANCER?

 

  • DIAGNOIS

  • WHAT ARE THE SYMPTOMS OF UTERINE CANCER?

  • DOES A PAP SMEAR DETECT UTERINE CANCER?

  • CAN A SONOGRAM DETECT UTERINE CANCER?

  • WHO SHOULD BE EVALUATED FOR UTERINE CANCER?

  • HOW IS THE DIAGNOSIS OF UTERINE CANCER MADE? 

  • WHAT DOES ENDOMETRIAL CANCER LOOK LIKE UNDER THE MICROSCOPE?

  • SHOULD YOU CONSIDER A SECOND OPINION FOR THE PATHOLOGY RESULTS OF AN ENDOMETRIAL BIOPSY OR D&C?

  • IS ALL UTERINE CANCER THE SAME?

 

  • TREATMENT

  • WHAT SHOULD BE DONE IF ATYPICAL HYPERPLASIA OF THE UTERUS IS FOUND?

  • WHAT HAPPENS IF UTERINE CANCER IS FOUND?

  • CAN YOUR OVARIES BE LEFT IF YOU NEED A HYSTERECTOMY FOR UTERINE CANCER?

  • IS RADIATION USED TO TREAT UTERINE CANCER?

  • IF YOU HAVE HAD UTERINE CANCER, CAN YOU TAKE ESTROGEN REPLACEMENT THERAPY?

  • WHY SHOULD YOU SEEK EARLY MEDICAL EVALUATION?

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