Oncology (General Cancer)/endometrium lesion concern


Which course of treatment? In office biopsy then determine treatment after results or go ahead & do surgery such as hysteroscope and endometrial ablation? In addition to the lesion I also had a cervical polyp removed and tested benign as well as a vaginal cyst. Doctor said it is up to me. I am 48 years old and done having children.

Heavy periods have been my norm, but increasing. Had migraines increase during last pregnancy 19 years ago. Have been on low dose BC pills for 3 months. Spotting all 3rd week. Bleeding 4th week. This 3rd month less bleeding, but still 7 days of flow. Doctor suggested Mirena IUD as possible help to the heavy bleeding once polyp resolved. I dislike the idea of IUD, but consider it an option if it solves my excessive and prolonged bleeding.

Lab results are:

[HST]: endometrial polyp on US
[SAS]: menometrorrhagia


Prior study from 06/12/13 demonstrated a echogenic lesion within the endometrium, measuring 15 x 7 x 7

Transabdominal and transvaginal imaging was performed. Endometrial
stripe and ovaries are not well seen transabdominally. Therefore,
transvaginal scanning was performed, in order to better visualize
uterus and adnexa

Transabdominal: Uterus measures 9.5 x 4.7 x 6.3 cm. The endometrial stripe measures 7 mm. The myometrium is heterogeneous. There is fluid within the endometrial cavity. There is a 14 x 9 x 12 mm echogenic lesion with the endometrial cavity.

The right ovary measures 2.1 x 1.2 x 2.5 cm and the left ovary
measures 2.9 x 2.3 50.0 cm. No adnexal mass or free fluid

IMPRESSION: Endometrial stripe measures 7 mm. This is within normal limits for left patient, but would be prominent for a postmenopausal patient. There is a small amount of fluid within the endometrial cavity. There is a 14 x 9 x 12 mm echogenic lesion within the endometrial cavity, possibly representing a polyp, but cannot exclude other endometrial lesions. The lesion measured 15 x 7 x 7 mm on the prior study. This suggests possible interval increase in the size of the lesion. No adnexal mass or free fluid

I'd go ahead with a biopsy to determine the best course of treatment.  It may be that a better choice would be a hysterectomy, which now can be done by robotic surgery and "transvaginally" so there isn't a scar.  Endometrial ablation may help, but sometimes it's not permanent, and sometimes not entirely effective.  And I would want to know about the mass in the endometrial cavity which seems to be increasing.  Keep me posted.  

Oncology (General Cancer)

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Donald Higby, M.D.


I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.


I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

American Society of Clinical Oncology

New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

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