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Online Chat - Endometrial (Uterine) Cancer

Online Chat - Endometrial (Uterine) Cancer

Friday November 11, 2011

Dr. Seamon:
Welcome to our online chat on endometrial cancer. I am Dr. Leigh Seamon. I am a gynecologic oncologist with Spectrum Health Medical Group. I’m here to answer any questions or concerns you may have about endometrial (uterine) cancer.

Comment From Dawn:
My mother has just had a recent scare. She recently had been sent to get a pelvic and vaginal ultra sound because she had been having blood in her urine. When the ultrasound results were sent, her PCP said she needed to get in and have a biopsy done asap as she had thickening of the uterine wall? She is 70, and a breast cancer survivor. She has not had a hysterectomy, or any real issues in this area previously? Just wondering what this could be?

Dr. Seamon:
The concern here is for endometrial (uterine cancer) or it could be a benign (not cancer) process. Maybe, your doctor thinks the blood in the "urine" is really coming from the uterus. Has she been having spotting?

Spectrum Health:
FAST FACT: Uterine cancer usually occurs around the time of menopause, but younger women are also at risk. The most common warning sign is bleeding after menopause. Younger women may develop endometrial cancer and may notice irregular or heavy vaginal bleeding.

Comment From Deb:
A biopsy revealed that I have simple endometrial hyperplasia. I am not going to do the normal 6 month hormonal therapy as I have had breast cancer twice. I am BRCA 1 and 2 negative. My doc wants to do a robotic hysterectomy. My main question is to take the ovaries or not. I am 47 years old. She warned me that I would be jumped into instant menopause. Would there be a pro to removing the ovaries; thus outweighing the negative of menopause? Risk of ovarian cancer? Another surgery? Please help!

Dr. Seamon:
Hi Deb. How old are you? Does anyone else in the family have ovarian cancer? Removing the ovaries in a pre-menopausal patient who has had an ER/PR positive tumor, will help decrease the risk of recurrent breast cancer. Do you have an ER/PR positive cancer?

Comment From Dawn:
Yes, spotting, and her urine had high red/white blood cell counts. Initially he treated her for a UTI. She is post menopausal almost 20 years. Her breast cancer was post menopausal as well

Comment From Dawn:
In addition, in my research, I've seen that her being overweight is a potential factor in the thickening of the uterine wall, as she's at least 100 lbs overweight and has been for almost 20 years?

Dr. Seamon:
Yes, being overweight is a risk factor for endometrial cancer. She should have the biopsy performed. In addition, a catheterized urine specimen would be helpful. If is shows blood, she should have a cystoscopy performed.

Comment From Katy:
Hi Doctor, is endometrial cancer one of the ones that runs in a woman's family? can genetic testing help identify if my daughter will be at risk as well?

Dr. Seamon:
Endometrial cancer is not usually hereditary; however, it can be. Families with "Lynch syndrome" or HNPCC have a 40-60% lifetime chance of endometrial cancer. These families usually have a history of multiple other cancers- mainly colorectal. There is also a condition that is hereditary known as Cowden syndrome in which patients are more prone to uterine cancer.

Spectrum Health:
FAST FACT: There is no screening test for endometrial cancer. The Pap test only screens for cervical cancer—it does not screen for endometrial cancer.

Comment From Deb:
I am 47 with no family history of ovarian cancer. What do you mean by ER/PR? Oncologist says no hormones.

Dr. Seamon:
ER/PR is estrogen/progesterone ("hormone") positive cancer. If you were my family member with this history and this age, I would definitely strong recommend removal of the ovaries. Benefits here outweigh risks; however, it is a very personal decision.

Spectrum Health:
FAST FACT: Risk factors for endometrial cancer include taking estrogen alone without progesterone, obesity, diabetes, hypertension, use of tamoxifen, late menopause (after age 52), never becoming pregnant and a family history of endometrial or colon cancer.

Comment From Lisa:
My 82 year old mother was just diagnosed with endometrial cancer but cannot have the Davinci surgery done. What other ways can a hysterectomy be done and how much recovery times is needed for someone this age.

Dr. Seamon:
Why can't she have a da Vinci?

Comment From Guest:
Why are women who have never been pregnant have a higher risk of endometrial cancer than do women who have been pregnant?

Dr. Seamon:
Women who have never been pregnant are definitely at higher risk for ovarian cancer. The theory here is that the ovary continues un-interrupted ovulation (releasing of the egg each month), so there is more trauma monthly to the ovary and thus more need for repair. Some women who are infertile, have chronic anovulation ( do not ovulate) and thus their uterine lining does not shed monthly and they have increased estrogen unopposed by progesterone (2 hormones that regulate the uterine lining). This increases their risk for endometrial cancer.

Spectrum Health:
FAST FACT: The endometrium is the lining layer of the uterine cavity, and most uterine cancers begin because of cancerous changes in the lining. With endometrial cancer, cells in the endometrium lining grow out of control, may invade the muscle of the uterus and sometimes spread outside of the uterus (ovaries, lymph nodes, abdominal cavity).

Dr. Seamon:
Hi Lisa. Many patients that are obese can have a robotic surgery; however, there is a limit to what we can do. It also depends on the surgeon's comfort level with this procedure. Other options include a vaginal hysterectomy, but this is difficult in obese women as well and the vaginal approach does not allow assessment of potential abdominal or lymph node spread.

Comment From Deb:
Cancer was not estrogen receptor positive

Comment From Deb:
Was on tamoxifen for 5 years

Dr. Seamon:
In this case, I think that there is no "cancer benefit" regarding your breast cancer to removing the ovaries. Regardless, at 47 it is reasonable to remove the ovaries and one that I would consider.

Comment From Guest:
Are there any recent new studies out there about the tamoxifen link to endometrial cancer?

Dr. Seamon:
Tamoxifen does increase the risk of uterine epithelial cancer as well as sarcoma. The benefits of taking tamoxifen for those at risk for breast cancer outweigh this potential risk.

Comment From Guest:
A co-worker mentioned to me a concern of endometrial cancer leading to lung cancer if not caught early? Is that a primary risk/concern to be aware of?

Dr. Seamon:
Yes, endometrial cancer can spread to other areas including the lung if not detected early. It is important that you see your doctor for any abnormal bleeding if you are pre-menopausal and ANY bleeding if you are post-menopausal.

Comment From Lisa:
If vaginal hysterectomy is performed and they cannot determine if there is any potential abdominal or lymph node spread, how else can they determine this or identify ?

Dr. Seamon:
Usually, if vaginal hysterectomy is planned, a CT scan is done of the abdomen and pelvis to make sure there are no enlarged lymph nodes; however, this is not a guarantee that they are not involved. It also depends on the grade of the tumor (only tumors that are grade 1 should be considered for vaginal hysterectomy). A vaginal hysterectomy is usually reserved for women at high risk for an an abdominal or minimally invasive (daVinci or laparoscopy). An option for women who cannot have surgery is radiation.

Comment From Connie:
For the past three years I've been religious about getting my yearly exam and every year the pap test is negative and I have to have it redone. And every time the test results from the second test are fine. I'm concerned, but I'm not sure if I should be really concerned and get a second opinion?

Dr. Seamon:
Connie, I think that this might be redone because there are insufficient cells on you pap test. Sometimes that happens particularly in post-menopausal women. I would find out why your test needs to be repeated. If it is for insufficient cells, I would not worry about that too much as long as the repeats are normal.

Comment From DeAnn:
If I'm a breast cancer survivor, do I have a higher risk of uterine cancer?

Dr. Seamon:
No, you do not have a higher risk, unless you have taken tamoxifen and assuming other cancers (uterine, colon, ovary, prostate) do not run in your family.

Comment From Deb:
Is there an ovarian cancer benefit to removing them? Any other benefits? Why would you consider removing the ovaries? I am in the process of making the decision right now.

Dr. Seamon:
Yes, women who have their ovaries removed cannot get ovarian cancer; however, they are still at risk for primary peritoneal cancer that behaves like ovarian cancer. In BRCA patients who undergo risk-reducing ovarian removal, they have about a 1-2% chance of developing primary peritoneal cancer. Since you are BRCA negative, you likely do not have an increased risk of developing this. I am biased in that I see women like yourself daily who have had a hysterectomy for another reason around the time menopause would occur anyway and develop ovarian cancer. So, I admit it as complete bias. If you will be going through menopause in 3 or so years anyway, my view as a cancer doctor would be - why not remove them? Sorry to add to your confusion more. There is evidence that leaving the ovaries in place does help with other things (bone strength, potential memory issues- Alz disease, etc).

Comment From Nancy:
My mother died of endometrial clear cell carcinoma. She said she did not have symptoms, but due to her sister having ovarian cancer, her doctor ordered an abdominal ultrasound. It was discovered, and she had an immediate hysterectomy. She also had one episode of melanoma and her sister, squamous cell. What should I tell me doctor? Is there anything I should be doing at 64 years other than the usual pelvic?

Dr. Seamon:
You have a history of a mother and an aunt with gynecologic malignancy. Any other family members with any other cancers?

Spectrum Health:
FAST FACT: Cancer of the endometrium is the most common reproductive cancer. It is estimated that there will be about 40,000 new cases diagnosed this year.

Comment From Lisa:
What is the recovery time usually for abdominal hysterectomy at age 82 and can they determine if the cancer has spread with type of hysterectomy

Dr. Seamon:
This depends on her other medical problems. If relatively healthy, the recovery time is reasonable (sometimes requires rehabilitation after surgery). They can determine the risk of lymph node spread once the uterus is removed on final pathology. If the lymph nodes were not removed at the time of surgery (and this could be for a variety of reasons), then additional treatment, such as radiation may be recommended.

Comment From Nancy:
A half sister of theirs had breast cancer.

Dr. Seamon:
If any of these sisters are alive, they should be tested for a genetic mutation (hereditary cancer). If there is no one alive to be tested, you should consider asking your doctor to send you to a genetic counselor to determine if you should be tested for a hereditary condition. This will determine if additional risk reduction (surgery or screening) should be performed.

Spectrum Health:
FAST FACT: Like many tissues in the body, the endometrium can undergo cancerous changes, and when this happens, an endometrial cancer results. The cancerous cells may be found only on the surface, but also may grow into the underlying uterine muscle wall or, less commonly, spread outside of the uterus to the ovaries, fallopian tubes, vagina, lymph nodes or abdominal cavity.

Comment From Kate:
I have had an ablation and am now on immunosuppressants for an auto immune disease which raises the risk of cancer. I have often wondered after the ablation, if I were to ever get endometrial cancer, would there be any symptoms?

Dr. Seamon:
Kate, excellent question and one in which we don't really know the answer. An ablation does not cause cancer. The lifetime risk of endometrial cancer is 1 in 40 women and higher if you are overweight or have other risk factors. Ideally, if you had a cancer, you would start bleeding and this would be a symptom. To my knowledge, women who have had an ablation and a subsequent cancer are not any different in their Stage of presentation than other women. This is a great research question and maybe my next project. Thanks for your comments. I will look into any research done on this topic.

Spectrum Health:
FAST FACT: The majority of endometrial cancers are discovered in their early stages and are curable.

Comment From Lisa:
My mom has a short torso and could not have daVinci because of no room. Is there any other way to do the minimally invasive procedure

Dr. Seamon:
Laparoscopy is very difficult for obese women and has a high conversion rate to an open procedure. Sounds like your doctor is very skilled with daVinci, so I would go with their recommendation. However, you can always obtain a second opinion.

Comment From Lora:
Do you only practice at Spectrum?

Dr. Seamon:
Lora. Hi. Yes, currently my practice is limited to Spectrum.

Dr. Seamon:
Thank you for taking the time to participate in this online chat. I hope that I have been able to answer all of your questions. An office evaluation is the best way to determine the appropriate treatment plan. If you would like more information or to schedule an appointment, you can call my office, located at 145 Michigan Street NE, Suite 2220, in Grand Rapids, at 616.486.6000, or visit shmg.org to learn more.

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