Biopsies vs. D&C

oldbeauty · February 2020

Truenortherngirl said:
Biopsies Vs.D&C
Hi Forherself, you are absolutely right, I am learning quickly you do have to advocate for yourself. When returning to the physician for my second biopsy, the gyn didn't even ask me about my experience on the drug. It's a bit of a conveyor belt in his office. It's just another reason to get a second opinioun. Usually the nurse will come in and request I get undressed and in the chair for the procedure before the doc comes in. During the biopsy he is concentrating and I am a bit uncomfortable so I don't ask any questions. I will insist on having a chat before I even get undressed because otherwise he's out the door on to the next patient. I even asked my sister is I was being too demanding of a patient to seek some clarification about "the plan" as I'm now going on to my 3rd biopsy! She said it is absolutely understandable that I am frustrated and haven't had things explained. Thanks.

Provera as alternative to Megace

Since you are going for 2d opinion, you might ask about Provera. It is in the same class as Megace but a different formulation--medroxyprogesterone acetate. I was put on that after a recurrence while living overseas in a Commonwealth country. I took 200mg twice a day and it kept me in remission for 4 years before another recurrence here in USA which was treated with chemo. My USA endocrinologist told me to stick with Provera (even tho the largest dose available in USA was a 10mg tablet) because she said the weight gain issue with Megace was so likely. The high dose knocked my adrenal gland into permanent slumber but that is controlled by taking a small daily dose of hydrocortisone. I actually wish I was still on the Provera but they took me off it bc the recurrence suggested it was no longer effective, But now I am also taking Metformin (thanks to takingcontrol58), which seems to be working to counter a slow growing lung nodule. So, like the others, I say educate yourself and advocate strenuously. To the extent you can, if a doctor is distant or gets huffy over being questioned, find a new doctor. Best wishes, Oldbeauty.

MoeKay · February 2020

JillAndrea said:
Lisa Pizza, thanks for the
Lisa Pizza, thanks for the clarification. Perhaps I misunderstood - I had Davinci robotic surgery with everything removed (Uteris, Ovaries, FTs, and Cervix) , plus a lymph node disection, with a vaginal cuff created. I do know that my recovery has been much longer than what I am hearing others have described. I am nearing the 6 week post-op mark, and I still have a lot of pain, abdominal swelling, and difficulty going to the bathroom.

Operative Report should tell you what surgical procedure you had

Jill, I would suspect that your Operative Report should tell you what type of surgical procedure your gyn-onc performed. For example, mine states at the top of page 1, "Exploratory laparotomy, Type II radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral paraaortic and pelvic lymphadenectomy."

BluebirdOne · February 2020

Truenortherngirl said:
Biopsies Vs.D&C
Hi Armywife, I am going to get a second opinioun. I do have "extra" coverage in the Canadian Cleveland Clinic here in Toronto. I don't know that they will get me a referral to a gyn/onc but I'm sure I could get one to see a different gynecologist. I truly feel in the dark right now as I'm going on to my 3rd biopsy in 9 months (scheduled for April) and he hasn't discussed his plan of action with me. It's discouraging going through these biopsies and not knowing to what end? Never mind wondering whether the biopsies themselves are reliable. Thanks!

Experience is key

So many gynecologists have not seen many cases of cancer, especially if they do more OB than GYNE. My initial doctor told me that the likelihood of cancer was small, (not true), if it was it would be cured by hysterectomy (true for many but he conveyed it in such a way that my risk was small, but curable, this made me complacent), but luckily suggested a hysteroscopy rather than a simple D&C.

A D&C (dilatation and curettage) is a procedure where the opening of the uterus (called the cervix) is widened and the lining of the uterus is scraped away.

A dilatation and curettage of the uterus lets your health care provider:

find the cause of unusual bleeding (such as during menopause, after sexual intercourse or abnormal menstrual bleeding)

look for growths

end an incomplete miscarriage.

A hysteroscopy is a procedure that allows your doctor to see inside your uterus and make a diagnosis.

The D&C is performed during the hysteroscopy. I was dx with UPSC from this. I did not know anything about the type or grade of any uterine cancer so after the shocking news, which my doctor did not prepare me for, I had to educate myself about this terrible DX. The point being is that while proactive, he downplayed the fact I could have cancer and he admitted he had seen very few cases of USPC. A gynecological oncologist will have seen many cases and have the experience to guide you through your procedures, especially given your family history. They may even want to perform the D&C. Second opinions give peace of mind, confirming or not confirming your situation.

Good luck to you!

Denise

MAbound · February 2020

JillAndrea said:
Lisa Pizza, thanks for the
Lisa Pizza, thanks for the clarification. Perhaps I misunderstood - I had Davinci robotic surgery with everything removed (Uteris, Ovaries, FTs, and Cervix) , plus a lymph node disection, with a vaginal cuff created. I do know that my recovery has been much longer than what I am hearing others have described. I am nearing the 6 week post-op mark, and I still have a lot of pain, abdominal swelling, and difficulty going to the bathroom.

I had the radical procedure

I had the radical procedure along with an oopherectomy and removal of sentinal lymph nodes for testing. It's beyond a total hysterectomy because connective tissue and and the top part of the vagina are also removed to get clear margins. They also removed my omentum and did a pelvic wash. I came out of surgery with a catheter and a drainage tube, so my discomfort during recovery was longer than with a robotic procedure. No picnic, but necessary when this cancer doesn't get caught early. I had both a PET scan and an MRI as part of my pre-surgical testing to guide my surgeon for how far he needed to go. I must have lit up like a Christmas tree.

MAbound · February 2020

JillAndrea said:
Lisa Pizza, thanks for the
Lisa Pizza, thanks for the clarification. Perhaps I misunderstood - I had Davinci robotic surgery with everything removed (Uteris, Ovaries, FTs, and Cervix) , plus a lymph node disection, with a vaginal cuff created. I do know that my recovery has been much longer than what I am hearing others have described. I am nearing the 6 week post-op mark, and I still have a lot of pain, abdominal swelling, and difficulty going to the bathroom.

PS

I don't know how your CKD impacts any of this, so I'd run it all by your doctor(s) first, but because chemo causes constipation like you wouldn't believe, most of us get advice like drinking 2-3 quarts of water a day along with taking Mirilax to deal with it. Drinking water is the really important thing along with getting up and walking around for part of every hour, but I don't know if you have any special considerations for pushing yourself to drink more than you are. Constipation is very possibly contributing to your pain and abdominal swelling, so you really need to get some guidance on how you can take care of it. Don't wait for it to get worse.

BluebirdOne · February 2020

JillAndrea said:
Lisa Pizza, thanks for the
Lisa Pizza, thanks for the clarification. Perhaps I misunderstood - I had Davinci robotic surgery with everything removed (Uteris, Ovaries, FTs, and Cervix) , plus a lymph node disection, with a vaginal cuff created. I do know that my recovery has been much longer than what I am hearing others have described. I am nearing the 6 week post-op mark, and I still have a lot of pain, abdominal swelling, and difficulty going to the bathroom.

I had difficulties after surgery, too

I healed well, but slowly, was almost incontinent and the bowels couldn’t make up their mind whether they were going to go fast or slow on any given day. So it was hard to figure out if I needed Senacote or Imodium. Weird, but it resolved to 95% normal for me. The urge to urinate came on so fast! By the time I got the “signal” I needed to go, it was too late, I had to run to the toilet. No grace period. So I got overly full with no warning. This was explained to me that some combination of things could be the problem. Nerve damage and/or the act of removal of the organs, swelling and slight moving around of what was left during surgery could cause urgency problems or lack of proper signaling, your internal organs and tissues surrounding the uterus, etc. had to adjust to an empty space. I had stress incontinence prior to the surgery so that was also a factor. The urgency and difficulty in realizing I have a full bladder have become better but not great, but a minor problem. We adjust. The bowel issues resolved in time, but my process never was the same as pre surgery. Different, but not problematic. For you, it sounds like you may have extra swelling or fluid retention. Also, for me having had two C-sections prior to the robotic surgery, the actual pain of incisions and general healing were much greater with the C-section, but the internal healing, swelling, and pain was not that much different for me. I was able to be up and about quicker, but had residual soreness, swelling, and lack of energy for about 6 weeks. Some people just recover more quickly than others. The important thing is that my docs were aware of the situation, asked me to monitor and report immediately any worsening or lack of progress. I also was older at 67, and probably don’t heal as quickly. I feel like my uncomplicated surgery and treatment has taken me MUCH a longer to recover from than I expected, 18 months out. I can only recently begin to walk an entire hour, three miles, without paying for it later with aches, pains. I have had osteo arthritis for 25 years in my spine, hands, wrists, shoulder, and now recently knees which is exacerbated by fatigue and becoming more sedentary during treatment. So it has been slow going for me, but I am still regainping more of my prior fitness. Hope this helps.

Denise

LisaPizza · February 2020

JillAndrea said:
Lisa Pizza, thanks for the
Lisa Pizza, thanks for the clarification. Perhaps I misunderstood - I had Davinci robotic surgery with everything removed (Uteris, Ovaries, FTs, and Cervix) , plus a lymph node disection, with a vaginal cuff created. I do know that my recovery has been much longer than what I am hearing others have described. I am nearing the 6 week post-op mark, and I still have a lot of pain, abdominal swelling, and difficulty going to the bathroom.

That would be at least a

That would be at least a total hysterectomy plus bilateral salpingo-oophorectomy. Could have been radical, you'd have to ask.

JillAndrea · February 2020

LisaPizza said:
Including the cervix just
Including the cervix just makes it a total hysterectomy. A radical hysterectomy is where they also remove more of the tissue around the uterus. That makes it a potentially longer recovery. Radical hysterectomy is not typical for endometrial cancer, but it is typical with cervical cancer, and they're more likely to need a urinary catheter for a while at home after surgery.

Whether or not the ovaries are removed is a separate issue. That surgery is called oophorectomy, and is not part of the hysterectomy, whether total or not.

Lisa Pizza, thanks for the

Lisa Pizza, thanks for the clarification. Perhaps I misunderstood - I had Davinci robotic surgery with everything removed (Uteris, Ovaries, FTs, and Cervix) , plus a lymph node disection, with a vaginal cuff created. I do know that my recovery has been much longer than what I am hearing others have described. I am nearing the 6 week post-op mark, and I still have a lot of pain, abdominal swelling, and difficulty going to the bathroom.

Biopsies vs. D&C

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