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How Can They Tell A Fibroid Isn't Cancer From An Ultrasound?

mhc4165
Posts: 46
Joined: Dec 2008

Hi I'm new on here,

I was wondering how can they tell if you have a fibroid or a endometrial cancer tumor just from looking at it on a pelvic vaginal ultrasound?

I had been having spotting off and on in between my period for 3 years now, and I went to 2 gynecologists and nurse practioner two years ago who only gave me a regular pelvic exam. So I went to my internist and she gave me a prescription to have a pelvic vaginal ultrasound which I had never heard of, because she said there are certain things you can't see with a regular pelvic exam.

I was really worried because my mother died at age 49 just 4 months after being diagnosed with stage 4 endometrial cancer that was already in her lungs when it was found!

So I had it done in 2006 and it came back totally normal, and when the technician was doing it she looked at my uterus on her scren and I was so afraid and I asked her are there ant tumors there, and she said no nothing not even fibroids.

Well, I had posted on here a few months back about how in July My now former gynecologist called me after I had a Pap test a week before and she said that endometrial cells turned up on my Pap test.

I was understandably very scared after what happened to my mother but this gynecologist was an insensitive creep as she had been 5 years before when I had some atypical cervical cells show up, but with a repeat Pap test 3 months later it was normal, I had used tampons just a few days before and I found out from The American Cancer Society soon after this,that this can effect the test results.

Anyway I went to a new gynecologist on September 9, who uses a newer more accurate not too painful endometrial biopsy called,The Truetest which uses a brush and collects a lot more cells and is said to more accurate than the standard endometerial biopsy.

The biopsy came back as benign but said that I had a secretory pattern and it said that altered secretory patterns may be seen with advancing age,in luteeal phase defects,or secondary to polyps ,leiomyemas or progestins.

So in September I asked my same internist if she could please prescribe another pelvic vaginal ultrasound because it has been 2 years and 2 months since the last one and she agreed that it was a good idea to do it again since I haven't had it done in 2 years. But she wanted me to do it in December 3 months after my biopsy in case there was something disrupted from it.

So last week I had it done, and I did to hopefully get some piece of mind if there was nothing in there like there wasn't 2 years ago, and since my new gynecologist said that a hysteroscopy is 100% accurate which he orginally said I needed but I was afraid and I asked if he could do the Truetest biopsy instead, and he now refuses to do a hysteroscopy because he said there is risks with surgery. He had told me that the biopsy is only 99% accurate.

So I was hoping that if there was no growths in my uterous like the last time I could relax and be reassured that the biopsy was right. But instead when the same exact tech as the last time was looking at my utrous on the screen,this time she tells me I have a very small fibroid. I said how do you know it's a fibroid just from looking at it and not a cancer tumor. She said because she sees millions of fibroids all of the time,they are very common and she said she knows what a fibroid looks like.

In my mother's medical records from 1985 which I got a few months ago, it says they thought that she just had fibroids until they did a D & C about a month later. So they couldn't tell that one of her tumors wasn't a fibroid but a stage 4 cancer that had as they described,extensively replaced her uterous lining and was in her lungs!

My gynecologist called me yesterday and he wasn't that nice he acted annoyed he said I ws asking him a lot of good questions he doesn't have answers for. I asked him how can they tell that I have a fibroid and not a cancer tumor and do fibroids look different from cqncer.

He said that sometimes they can't tell but it's 99% that it's a fibroid. I told him that they thought my mother just had fibroids too.He said the only way to know 100% is to have a hysterectomy and he wouldn't recommend it and he said he doesn't think many other Dr.'s would either.

And I said that a D & C and a hysteroscopy can diagnose it, and he said thats surgery and that any surgery has a risk of death. I said I know it's scary but I don't know anyone who died from surgery I have a few relatives older than me who had surgery and they didn't die.

He said if you look on the consent forms you'll see it says there is a risk of death.

I asked him what kinds of tests can I have in the future to make sure this really is a fibroid, and all he said was a Pap test and pelvic exam.

I also asked him if he thinks there is a conection to this growth if it is a fibroid, and the endometrial cells that turned up in my Pap test, and he said that fibroids don't usually shed, but I know cancer tumors do and so do pollyps which have to removed because they can sometimes turn into cancer.

He said he thinks that because my period ended 2 days before the Pap, that even if I wasn't bleeding cells could still have been shedding.
I told him that The American Cancer Society, The National Cancer Institute and The Gynecologic Cancer Foundation all say that endometrial cancer is not usually found in Pap tests and that it's designed to find Cervical cancer.

And I know that a pelvic exam can't usually see it either, I'm sure my mother had plenty of Paps and pelvic exams but she still had stage 4 when it was found only from a D & C! He actually claimed that about 80 some % of endometral cancer is found from Pap tests!

If you could let me know if you know anything about this, I really would appreciate it.

Thank You.

mhc4165
Posts: 46
Joined: Dec 2008

I also had asked 4 gyn's and my internist since my mother died and my recent gyn if endometrial cancer is genetic and if I have to worrry about it. And they all said that it usually isn't and that breast cancer more often is.

My mother didn't have any close relatives with it either. She didn't have a sister but her father's sisters didn't get it,her mother's oldest sister's 2 daughters are still living in their early 80's and my mother's mother, my maternal grandmother lived to be 91 and her mother lived to be 90.

My grandmother's youngest sister died of breast cancer in her 40's and her oldest sister died at 82 of bladder cancer.But on the web site of the hospital where my mother died it says that women with a close female relative ,a mother, daughter or sister with endometrial cancer are twice as likely to get it.

And The Women's Cancer Network and The American College Of Obstetricians and Gynecologists also say it's an increased risk. The National Cancer Institute doesn't have any information about a genetic link though.

I also have other risk factors for endometrial cancer too though. I had always been thin all of my life but when I was 34 my metabolism slowed down a lot and I gained weight and had to go on a diet for the first time in my life.I'm still about 10 pounds overweight and I could be 15 pounds thinner.

I don't even eat that much, I only eat 2 low fat low calorie meals a day and only drink diet drinks. I don't get enough exercise though. But I take long walks sometimes. I have also never have been pregnant and have never taken birth control pills.

deanna14
Posts: 734
Joined: Oct 2008

If I were you, I would get a second opinion. I am currently being treated for stage 3 endometrial cancer. After having an ultrasound and a vaginal ultrasound, the 3rd ultrasound found thickening of the endometrial lining. My doctor said it could be a fibroid or a polyp, but the only way to know for sure what was going on was hysteroscopy and d and c. The pathology from it showed Stage 1 and during the hysterectomy they found that it had spread to one pelvic lymph node making it stage 3. I just finished radiation treatments and will soon start chemo.
My mother also had endometrial cancer, due to her cell type and the fact that it had not spread out of the uterus, she only had to have a hysterectomy. No radiation or chemo. The key is catching it early. We were also told that it is not hereditary, but having a close relative who has it does put you at a higher risk of getting it.
I would get my medical records and go to another doctor for a second opinion. I don't know your age, but I found at 39 that I was often told "you are too young for that." Well evidently I'm not, because I am 39 and getting ready to start chemotherapy for endometrial cancer!
Get a second opinion!!!!

mhc4165
Posts: 46
Joined: Dec 2008

Thank you deanna14. I already made an appointment a few days ago for February 2 with an oncology gyn at The Fox Chase Cancer Center. I asked my other gyn's office to please fax over to her my recent transvaginal pelvic ultrasound report and biopsy results and she agreed to see me.

I'm 43 and a half. Good luck with your treatments and recovery!

deanna14
Posts: 734
Joined: Oct 2008

I am so glad to hear you will be seeing a gyn/onc. I worried for you when I read your post. I believe that it is better to know, you can battle the known! You too will may encounter that "you are to young" attitude. Thank you, I need all the luck I can get. I hope that you get answers soon and that you are cancer free. May God bless you.
Deanna

mhc4165
Posts: 46
Joined: Dec 2008

Same to you Deanna!

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

I had 'highly suspicious abnormal cells' found initially in a PAP test that my gynecologist pooh-poohed as probably nothing as I had absolutely NO symptoms. But "just to be sure", she did some biopsies (all negative) and an ultrasound that showed a small polyp in my uterous the size of a pencil point. She took the added precaution of doing a D&C (which is NOTHING to be scared of. I was on a plane 2 days later for a 9-day hiking trip at Zion National Park). While I was in recoverey from my D&C, the surgeon told husband that she was not at all worried, that everything looked good and that she had cut out the entire polyp, and would do pathology on it while we were on vacation. I came back to a recommendation that I should see a Gynecologic Oncologist. He looked at my pathology and diagnosed me with a rare aggressive cancer called Uterine Papillary Serous Carcinoma. My subsequent hysterectomy and staging showed I have Stage 3C cancer. NO SYMPTOMS at all! Had my gynecologist been as laid-back as yours, I would still be blissfully unaware of my cancer until it spread elsewhere and started giving me trouble,..too late. You are doing the right thing. You need to know, one way or the other, so that you can start the battle if it is warranted. Fox Chase is a GOOD place to go! Best wishes! Please let Deanna and I know how you make out. I have my 3rd round of chemo tomorrow.

mhc4165
Posts: 46
Joined: Dec 2008

Thank you also Linda, and good luck on your full recovery soon!

allyHM
Posts: 1
Joined: Feb 2012

Deanna,

Your post jumped out at me, so I feel the need to ask you a couple of questions. On Monday of this week, I saw my gynecologist because I had a 14-day period after over a year of heavy bleeding and clotting periods with fairly intense pain especially in the area of my right ovary. Thankfully, my gyno really listens and didn't "poo poo" my concerns. At the appointment on Monday, he did a pelvic exam which caused some obvious discomfort in my right ovary as he palpated it. I have never had children (although I have been pregnant at least twice and miscarried at or before 8 weeks so that I didn't even know I was pregnant), and I'm 43. He suspected endometriosis with a possible "chocolate" cyst on my right ovary, but he scheduled a vaginal ultrasound the next day just to make sure there wasn't anything else going on. At the ultrasound on Tuesday, my ovaries appeared normal but I have what is assumed to be two small fibroids in my uterus, in the muscle wall, and the lining of my uterus is "very thick"...it was close to 2cm thick (but I don't know what's normal so, I can't really judge what that means). Based on those results, I am now scheduled for a biopsy on Monday, the earliest appointment that was available (he wanted it to be the next day). After seeing your post about the endometrial lining being thick, combined with my normally mellow but very positive attitude gyno becoming very serious as he talked with us (my husband was with me) about the biopsy, I am a little concerned. My gyno said I wasn't a high risk for cancer but he wanted to rule it out. Is this routine? Is it because my lining is so thick that he's doing the biopsy? I want to feel like there's nothing to worry about, but now my concern has gone up a notch. Greatly appreciate anything you may have to share, and I hope your treatments were successful.

longtermsurvivor's picture
longtermsurvivor
Posts: 1806
Joined: Mar 2010

Hi Deana,

These are old posts you responded to, and may not get responses from the original posters. The answer to your question is "yes", the biopsy is in response to thickened endometrial lining. The lining in a normal cycle is thin right after a period, obviously thicker right before a period. But 2 cm is thick no matter what. THIS DOES NOT MEAN YOU HAVE CANCER.

In fact, at age 43 the most common reason for this is loss of control over one or more cycles, which is a homone mediated problem. Not cancer or even precancer. However, that is why the biopsy is done. Others will show up and tell you "yes, but I know of an example to the contrary..." and that will be true. But don't let the exception to the general rule ruin your day. It is proper to biopsy this finding. It is a low risk situation.

I'm betting your gyno said essentially that. If he did, he was correct:)

Best to you

Teresa46
Posts: 1
Joined: Feb 2012

Hi,
I'm new to this site. I was doing some research and stumbled up on it. I'm almost 47 yrs old. I have a 26yr history of fibroids, very heavy periods, ovarian cyst and pelvic pain. Here is what I am dealing with now.
I'm scheduled for a hysterectomy and trying to find alternatives and was wondering if I should get a second opinion but after reading this page of comments I'm thinking maybe the hysterectomy is the best choice but it's major surgery and I am scared to death! I hate being put to sleep! I have secondary amenorrhea (absence of a period). I went 3yrs with only 2-3 a yr then I went 13mo then I had one then went 6mo before having another. I have had my hormones checked and my OB said I am no where near menopause. I had a pelvic ultra sound and it showed I have a fibroid the size of a tennis ball. She called it large but the stories I have read on line it's small in comparison!
Also, my OB said that my uterine lining is too thick. I had my ultra sound 2wks after my period and it was still too thick so she said I am not shedding it all. Not shedding it she said can cause cancer to grow. She said if I were younger she would do a endometrial ablation and just watch the fibroid for now but since I am almost 47 and average age for menopause is 50-52, I'm done having kids,I've been in constant pain for 12 days straight before it went away, and her concern for endometrial cancer, she wants to do a complete hysterectomy and put me on hormones until I am 50. Immediate menopause I do not like the thought of!
I even called and asked if I could have provera to make me start but she refuses to give it to me. I thought if I had another period that maybe it would shed enough and we could watch the fibroid. I read on line about herbs that shrink them.
After reading comments here and other sites about the lining being too thick causing cancer, maybe the hysterectomy is the best choice. What do you think?
Please give me some advice. I need some opinions!
Thanks!
Teresa

longtermsurvivor's picture
longtermsurvivor
Posts: 1806
Joined: Mar 2010

If you have a period disorder, and thickened endometrium on ultrasound,and are 47 years old, you should have a biopsy of the endometrium BEFORE any hysterectomy is performed.

Best regards

ccfighter
Posts: 384
Joined: Jan 2012

I don't have endometrial cancer, I have cervical. I will say though, that if you are worried and feel that something is not right than insist that the appropriate tests are done to ensure your peice of mind. Doctors are quick to find the easiest, most likely explination for symptoms but they are not always right. My diagnosis came late despite every screening test designed to catch cervical cancer early...each and every pap was normal, even the pap done a week before my D&C which finally diagnosed me. I had 2 transvaginal ultrasounds that did not detect a tumor, CA125 tests which were normal, several (4 or 5 over the course of a year) pelvic exams which did not detect a mass or anything else to indicate cancer. By the time they found it and performed a hysterectomy the tumor was 5cm and spread to the pelvic lymph nodes. Needless to say I am very frustrated with a cancer that had every opportunity to be found early and wasn't. As such, please advocate for yourself and don't let doctors blow off your concerns or your symptoms. Chances are everything will turn out fine for you, but I sit here as an example of one of those rare cases that wasn't. I wish a D&C had been done a lot sooner for me. I'm only 33 years old.

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