Undergoing second hysteroscopy w D&C

Stephnew

Hi all, I am curious if anyone has had this happen and whether there is anything more I should know or advocate for myself. I am undergoing my second Hysteroscopy w d/c for suspected polyp removal. I am 53 peri menopausal w recent irregular bleeding (spotting for 2 weeks right after period x2, and one or more bleeding (light) after sex. Saline Sonohysterogram showed probably polyp 1.3cm. Biopsy taken was benign. I had my first hysteroscopy w d/c in 2018 for endometrial cells showing in 3 paps and heavy bleeding during period. It was fine and I had one year wo any endo cells in my pap. However every year since they have been there.

So I am curious if anyone has had a similar situation arise (need for 2 hystereoscopies/endo cells on pap, recurrent polyps) and any recommendations or if anyone was diagnosed with similar situations was diagnosed subsequently with cancer. Thank you in advance for reading and any input.

misstaylor84

In my case, I started bleeding after a normal period in October 2020. At times it was super light, other times I thought I was hemorrhaging. In June 2021 I finally got an appointment with an OBGYN and she said she could either do an ultrasound or do a hysteroscopy with D&C. I had had issues for years and had an ultrasound done about 5 years earlier and it hadn't shown anything so I went with D&C. It is how I was diagnosed with endometrial adenocarcinoma on August 3. Prior to all that I had been told that I had an abnormal Pap smear 2 times in a row but nobody ever said how it was abnormal or even thought it should be checked on. My first D&C, I had 2 polyps removed and then later, after diagnosis, I had many small polyps all over the lining that were removed.

I would say the D&C with hysteroscopy will show more than an ultrasound. An endometrial biopsy may not be enough for a proper diagnosis either.

Stephnew

Thanks misstaylor84. I feel like this route (hysteroscopy d/c) is probably the best course of action. But I wasn’t sure if there were other things that could be done minus hysterectomy. The continuation of issues (Endo cells and polyps) is stressful and my mind tends to wander too much🙂. Thanks again and I wish you well.

Forherself

https://csn.cancer.org/discussion/324856/undergoing-second-hysteroscopy-w-d-c

Welcome to the board. It sounds like your doctor is being very proactive. Only 1 in 10 polyps biopsied is cancerous. And there are risk factors for endometrial cancer. Do you have those? No children, obesity, diabetes, early menarche, late menopause. There may be more I'm just trying to remember them. Do you have those? And when you say endometrial cells in the pap, are they irregular cells? Have you had a pelvic u/s? And the other thing you can do is seek a second opinion. All options for you at this point. And remember the women like you don't usually stay on the board. They drift away. Hopefully that is your story too 😀

Stephnew

https://csn.cancer.org/discussion/comment/1694356#Comment_1694356

Thanks. None of those risk factors other than latish menopause. I’m 53 and still in peri menopause. I’ve had several us. Most due to endometrial cells being consistently found in my paps And not related to my lmp. This time around she saw what she believes are polyps. She did a biopsy with the us and it was benign. Doing the hystereroscopy and d/c to remove polyps and make sure no cancer. I’ve had some irregular bleeding which is why she’s going to remove them. Thanks again for your input. I assume it will be fine but wondered if anyone had similar situations that came out to be cancer.

cmb

My situation was not exactly the same as yours but I had my first D&C/hysteroscopy because of vaginal bleeding that started about a year after menopause. Only a benign polyp was found and the bleeding stopped after the polyp was removed during the D&C.

Interim pap smears were all normal. However, nine years later I had vaginal bleeding again. Had a second D&C/hysteroscopy. This time I wasn't as lucky, as it was cancer.

But as Forherself said, most polyps are not cancer and removing them during a D&C can resolve the bleeding problem as it did in my first case.  You should have time enough to decide about a hysterectomy after the D&C if the D&C doesn't show cancer, but does identify other issues.

Stephnew

Thanks for your response cmb. Having done the polyp removal not too long ago it is nerve racking to go through again. I freely admit most of all my concerns are from an overworking brain. I know the odds of a polyp being cancer are small. I don’t like that it’s come around again and that I’ve had endo cells in my paps consistently for years wo any explanation. It makes me feel like I am just waiting for it to happen. Which is all in my head. I do thank you for taking the time to answer and wish everyone on their individual journeys well.

SpringerSpanielMom

My "benign fibroid" "100% not cancer" per hysteroscopy was in fact a very bad cancer. She "chopped it up" with a "neat little machine she had". If I had to do over again, I would go straight to a gynecological oncologist. I have come to view many regular gynecologists as barbershop surgeon hacks. Treat things like cancer until confirmed otherwise. How big is your endometrial stripe, which number you get from an ultrasound.

SpringerSpanielMom

Stephnew

Thanks for responding. My lining was 4.4 and suspected polyp was 1.3 cm. I’m not through menopause yet and get my Period about every 3 weeks except for past month where it was 2 weeks late. I was having a light period when my sonohysterogram was performed.

SpringerSpanielMom

I had a "polyp" too, but it was really my cancer coming through my cervix. 4.4 would be a bit too much post-menopause with the conservative limit being 5, but I don't know the numbers for peri-menopause. Peri-menopause is such a confusing unpredictable time that it's a wonder anything ever gets diagnosed correctly. I remember before peri-menopause, I vaguely that it would be about a year long. Hahaha--several years! I'll be thinking of you. Just tell them not to morcellate anything (chop it up), even with just a hysteroscopic morcellator or by hand. Biopsy it sure, or if they must cut it off cleanly to go to pathology. If it's your gyn, if in doubt, tell her to bring in a gyn onc to take a look or do mid-surgery pathology on the specimens. They must not use a morcellator on anything growing in the uterine wall.

Stephnew

Thank you for the advice. I also do not know the numbers. My Gyno mentioned it was getting thinner due to menopause but I’m not sure of her words exactly. I did think it should be at its thinnest as I was having a light period but I’m not that knowledgeable on it.

I haven’t had any conversations regarding the removal process. I can bring it up during my pre op. I’m 53 so I assume I’m nearing the end of the peri stage soon🙂. Thank you again.

SpringerSpanielMom

Just have a good, thorough talk. Best wishes.