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Abnormal uterine bleeding
and family history of uterine cancer
I have had abnormal bleeding on/off for the past 3 yrs. I've
mentioned it to my G.P., who brushed it off as stress ("If you were
40, I'd be concerned about uterine cancer"). I told her that my mom
had uterine cancer when she was 25.. she just shook her head. Recently,
it has been worse, mostly just spotting during the month. Besides my
mom, her 2 sisters have also had uterine cancer, and just recently, my
grandmother has been diagnosed (she is 65, hasn't had a pap in 25 yrs).
I'm somewhat nervous (okay, scared), at facing the possibility that I
could also be afflicted with this disease. I guess I just need a friend!
:)
Three years is a long time to have abnormal uterine bleeding and not
have a diagnosis or treatment. You are right to be concerned just on
that basis. How abnormal is the bleeding? What is its pattern?
Uterine cancer can be endometrial (the lining of the uterus),
cervical (abnormal paps etc.) or rarely the muscle of the uterus. Did
everyone in the family have endometrial cancer (not cervical cancer)
that you know of? There are some genetic tendencies toward early
endometrial cancer.
While usually endometrial biopsies or D&Cs are not done to rule
out cancer at ages less than 35 or 40, that only applies to initial
presentations of abnormal bleeding. If bleeding persists after
attempts at hormonal therapy it still needs to be evaluated, including
possibly an endometrial biopsy even at age 25. There are very few
drugs or medications known to prevent any cancer but birth control
pills have definitely been shown to prevent endometrial cancer if
taken over a long period of time.
Use of Clomid and risk
of ovarian cancer
I'm 39, mother of 2 adopted children (ie: never been pregnant) and
took 9 months of Clomid in 1988. I'm scared. My Dr. recommends an annual
screening for ovarian cancer by vaginal probe ultrasound and blood
work... is that enough? He says I'm too young to arbitrarily remove my
ovaries. Any advice?
There does appear to be an increase in the lifetime risk of ovarian
cancer in women who had long term use of Clomid for ovulation
induction. That risk is a doubling of a 1 in 70 lifetime risk. I
enclosed an abstract below that studied many infertility patients.
Those authors feel that using Clomid less than 12 cycles does not
increase your risk.
Ovarian tumors in a cohort of infertile women.
Rossing MA, Daling JR, Weiss NS, Moore DE, Self SG
N Engl J Med 1994 Sep 22;331(12):771-776
BACKGROUND. Case reports and the results of a recent
case-control study have raised questions about the potential
neoplastic effects of medications used as treatment for infertility.
METHODS. We examined the risk of ovarian tumors in a cohort
of 3837 women evaluated for infertility between 1974 and 1985 in
Seattle. Computer linkage with a population-based tumor registry was
used to identify women in whom tumors were diagnosed before January 1,
1992. Data on infertility testing and treatment were abstracted from
the medical records of women who had ovarian cancer and those of a
randomly selected comparison group. The risk of ovarian tumors
associated with exposure to ovulation- inducing medications was
assessed through an age-standardized comparison with the rate of
ovarian tumors in the general population, and Cox regression analysis
was used to compare the risk of cancer among women who received these
medications with the risk among infertile women who did not receive
them.
RESULTS. There were 11 invasive or borderline malignant
ovarian tumors, as compared with an expected number of 4.4
(standardized incidence ratio, 2.5; 95 percent confidence interval,
1.3 to 4.5). Nine of the women in whom ovarian tumors developed had
taken clomiphene; the adjusted relative risk among these women, as
compared with that among infertile women who had not taken this drug,
was 2.3 (95 percent confidence interval, 0.5 to 11.4). Five of the
nine women had taken the drug during 12 or more monthly cycles. This
period of treatment was associated with an increased risk of ovarian
tumors among both women with ovarian abnormalities and those without
apparent abnormalities (relative risk, 11.1; 95 percent confidence
interval, 1.5 to 82.3), whereas treatment with the drug for less than
one year was not associated with an increased risk.
CONCLUSIONS. Prolonged use of clomiphene may increase the
risk of a borderline or invasive ovarian tumor.
What are symptoms of ovarian cancer?
Can you tell me what the symptoms are for ovarian cancer?
There are no symptoms at all for early ovarian cancer (Stage I and
II), because it is a slow growing process and doesn't cause pain.
Advanced cancers have symptoms, however, usually including abdominal
fullness and feeling full and not hungry all of the time. Increasing
abdominal girth can also be a late sign because of fluid in the
abdominal cavity.
What is the likelihood of its occurrence in someone in their early
thirties with no history of reproductive cancers in their family?
I can't give you an exact number on that in the 30's, it would
probably be in the order of less than 1 in a thousand. It goes up in
later ages but the cumulative lifetime incidence is 1 in 70 women.
Abdominal bloating, could it be ovarian cancer?
I am 33 years, old have 2 kids and have been having menstrual-like
cramps, pain in my left lower abdomen, sometimes sharp and have
abdominal bloating that comes and goes during the day. I also
have urination urgency. This has been going on for about 2 months
on and off, sometimes even when I have my period. I am so scared
because all the symptoms seem to be the same as ovarian cancer.
Are there other things other than cancer that can cause these
symptoms? Please help! I have a gyn exam for next week.
Abdominal bloating can be a sign of ovarian cancer but it is
always very slow in onset (over many months) and rarely causes
pain and cramps until very late in the disease. Ovarian cancer is
usually a disease of the 50s and 60s. I doubt you have ovarian
cancer and would bet against it.
Ovarian cysts, endometriosis, fibroids, adenomyosis and infection
would be possible. How frequently are you having to pass urine?
Does it burn? Do you get up at night to void? Does pain get worse
or better with bowel movement or voiding. Are you on anything for
birth control. When was your last pelvic exam? Was it normal?
Thanks for your response. I feel more relaxed already. On the
days that I feel the pain and bloating I urinate 8-10 times a day
and have to get up at night because I feel pressure and feel
better after I urinate. When I don't have the pain and I have a
bowel movement, the pains seem to start. I can only describe the
pain by comparing it to when you get a piece of glass in your
finger and your rub your nail over it. And it seems to be in the
area of my left ovary. And the pain comes and goes, it's not
constant.
About 5 years ago I had a vaginal sonogram and they told me I
had 3 fibroids and one cyst on my ovary that was the kind that
comes and goes. I was never told anything about it except that if
I wanted to have any more children I should do so right away
because sometimes fibroids get real large and prevent pregnancy.
I don't plan on more children so I never really thought about it
again. At my last exam 7 mos. ago my Dr. said he didn't feel any
fibroids and that everything felt normal. I went because I was
having spotting between my periods. He said sometimes that
happens to women.
The symptoms you describe can be consistent with large fibroids
or ovarian cysts. Your doctor will check out the urine for
infection just to be sure. Probably an ultrasound will be done.
If the ultrasound is normal, that is against ovarian cancer.
The fact that this pain is aggravated by bowel movements goes
along with a diagnosis of irritable bowel syndrome. If all your
other studies are normal, you may ask you doctor to refer you to
a medical gastrointestinal specialist. Irritable bowel is usually
treated with dietary change and occasionally medications.
Birth control pills and
ovarian cancer prevention
I have 1 child and earlier in my life was on the pill for 5 years.
I've heard this has a preventative type effect on ovarian cancer.
Longtime pill use (over 10 years) is associated with a decreased
incidence of ovarian cancer just as having 5 children is also
associated with a decrease. See:
Risk of ovarian
cancer
This is probably because the less the ovary is allowed to ovulate,
the less it is exposed to cancer causing agents. If that's true (we
are not certain it is), then Depoprovera use, nursing your children
for long periods of time and any diseases or stress that makes a woman
anovulatory would also decrease the lifetime incidence of ovarian
cancer.
I don't have any complaints, just a paranoia about cancer.
What in your experience makes you worry more about this than say
colon cancer?
Gosh, I don't know. I guess I've never looked at it that way.
Thanks for the information.
Vaginal bleeding 5 years after cervical cancer therapy
A friend of mine (really) just called upset because she has been
bleeding upon wiping and has had small amounts of spotting. She
had a complete hysterectomy and radiation for cervical cancer
almost five years ago. By the way, she has been giving HRT
supplements, but takes them only sporadically, and in different
dosages. She thinks she feels something in her vagina that feels
like a skin flap. She also has had some vaginal discharge. She is
going to her oncologist in five days, but I am hoping that there
is something encouraging I can tell her until she gets there. She
is very sexually active with her husband, and I am hoping that
there could be a vaginal tear or perhaps an infection, instead of
a recurrence. Can you help, please?
I know your friend is concerned about the possible recurrence of
cancer as the cause of the bleeding. Since that took place 5
years ago, it is much less likely to be a cancer recurrence than
it is a vaginal tear or abrasion. You are right to consider
mostly bleeding due to trauma with sexual relations because she
has risk factors for atrophic vaginitis. The radiation therapy
decreases vaginal and pelvic blood supply which in turn makes the
skin lining the vagina quite thin. Actually it can be more of a
problem farther away from the time of the actual radiation
therapy, i.e., it is a late occurrence complication.
Not taking the estrogen replacement therapy is also a risk
factor since she is probably menopausal from the radiation
therapy. Frequent sexual relations can thicken the vaginal skin
lining and make it resistant to bleeding but when you combine
that with a history of radiation therapy, the epithelium (skin)
may just be too thin to resist abrasion and then secondary
infection. Your friend's oncologist may have to do a biopsy and
other studies just to be sure there is no cancer recurrence, but
afterwards, have your friend discuss getting estrogen treatment
directly to the vagina with some of the new estrogen devices.
Are there similarities between colon and ovarian cancer?
I am scheduled for a hysterectomy soon. I have a decision to make
regarding keeping my ovaries. I have a 40 year old sister on
hospice with only a short time to live; she has colo-rectal
cancer metastatic to the liver and now stomach. Should this type of
cancer history in my family make a difference in my decision to
keep the ovaries at 43 years old (No ovarian cancer in family
history) I have heard ovarian and colon cancer are similar cancer
cells?
Ovarian cancer has been described in association with three
autosomal dominant syndromes: familial site-specific ovarian
cancer, familial breast and ovarian cancer, and the hereditary
nonpolyposis colon cancer syndrome. If your sister does not have
this type of colon cancer I am not aware of any connection.
Numbness 2 years after ovarian cancer surgery
I am a 24 year old female with a history of Stage 1-A ovarian
cancer, removed surgically after a mucinous cystadenocarcinoma
was found (football sized). Then I had another cyst on my left
ovary (the right was removed with the cyst), over 2cm and removed
with no sign of cancer recurrence. Then yet another cyst
discovered, supposedly "managed" by birth control (Ortho-Novum
1/35 with no break).
I have been on constant birth control for over a year now, so I
haven't had my period. No one ever explained to me that I might
have spotting after a year. I have been spotting for the past
four days. I have also had more pain (previous chronic pain
managed with amitriptyline), plus symptoms of what I now know is
meralgia parasthetica--numbness on the outside of my thigh
constantly, with some occasional tingling.
So my question is--could the cyst on my ovary (about 2cm again)
be pushing on the lateral femoral nerve causing the MP, or would
these two things be completely unconnected?
Assuming the meralgia paresthetica is on the left where the cyst
is, it is possible that the cyst is causing the pain. It may be
by direct pressure on the lateral femoral cutaneous nerve but it
more likely to be a referred pain because the ovary is innervated
by some of the same nerve roots as is the lateral femoral
cutaneous nerve.
So you are saying that nerves belonging to the cyst area are
connected to the lateral femoral nerve somehow?
In a way. Pain can go up one set of nerve fibers, e.g., from the
ovary) to the spinal cord (lumbar area) and then down another
nerve, e.g. lateral femoral cutaneous nerve. This is called
referred pain because you perceive it from one area when actually
it originates in another. Remember also that you can have direct
pressure on the nerve from anything in the pelvis.
The increased pain, corresponding with this new numbness
(about 2 months now) has me a bit worried.
Did the pain and numbness first start before or after any of your
surgeries?
I did have some numbness due to my staging operation (it was all
laparoscopic), but in different places. These surgeries all took
place in 1996. The numbness in my leg began about 2 months ago.
Is there any way to diagnose this or treat this without another
laparoscopy?
Ultrasound can diagnose cysts of the ovary but I thought you
already had that to diagnose the cyst in the first place. I know
you are concerned about possible recurrence of cancer. It's
unlikely that the new numbness is related to cancer. After an
ultrasound and possibly a CAT scan, the next step is to look
surgically. There can be adhesions that are causing this.
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