Oncology (General Cancer)/Pap test / symptoms

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QUESTION: Hello,  I'm 41  years old and for the last 5 years have had many abdominal/pelvic symptoms.  I've always been thin but gained about 20 pounds in 4 years time.   My stomach seems bloated all the time.   I have sharp pains, clothes feel tight.   My periods have never been completely normal but i started to record the dates for the last 2.5 years.   They've generally been 23-30 days, with an average amt of blood.   This last year, i've had tremendous daily discharge and my periods are extremely heavy.  They are more watery and now I gush blood.  I noticed that i skipped periods from March - June of this year.  Then, a few of my periods were too close together (14-17 days after the last periods).    

These last 2  periods were extremely heavy, prompting me to get a pap test. I've had a few other heavy periods about 2 years ago. I have no insurance so I had to go to a clinic. I tested negative for HPV and cervical cancer cells but it was noted  "ENDOMETRIAL CELLS IDENTIFIED IN A WOMAN 40 YEARS OF AGE OR OVER"  also  ""NEGATIVE FOR LESIONS"  but "PARTIALLY OBSCURING INFLAMMATION".      

I assumed I had a fibroid, but the nurse ruled it out during a pelvic exam.    After lots of internet reearch,  the only symptoms that match up to mine are endometrial /uterine cancer. (I also recently had a kidney stone).  The nurse referred me to a obgyn (i have an appt next month), and she seemed very concerned.  I guess what i would like to know is if my symptoms could be anything else.   I thought for years i had endometriosis but never had any tests.   How common is uterine/endometrial cancer in someone  my age? Can a fibroid be ruled out without a scan?  The nurse said it could be endometriosis, but I have a feeling she was trying to ease my mind.   I can't help but think the worst.

ANSWER: With the information you've given me, I can't make a diagnosis.  Endometriosis is a possibility, as is endometrial cancer.  But there are other things that could be contributing.  The fact that you have heavy and frequent bleeding may be a "perimenopausal" issue.  Unless something else is noted, you are probably a candidate for a "D and C" which removes endometrial tissue for examination.  sometimes that solves the problem as well.  Keep me posted.  

---------- FOLLOW-UP ----------

QUESTION: thanks for the reply.   do you know what would cause the periods so close together?  how likely is cancer?   I'm in a lot of pain on my left lower abdomen especially after my period.  I can't tell if it's an issue with my kidney,  constipation (from iron pills)  or from my ovary area.    Because i'm in frequent pain,  i need to act quickly but would like to know if cancer is high on the radar.

Also, does the pap test sound concerning? or just the symptoms?

ANSWER: I can't rule out cancer, but at this time there is nothing to strongly suggest cancer.  Finding endometrial cells in a woman over 40 is only an issue if you have stopped having periods, and even then it doesn't mean much, just something for the gynecologist to file away.  The pain could very well be due to endometriosis, or to an infection that flares up.  You might have a polycystic ovary.  The bleeding could be associated with fibroids, with abnormal hormonal levels, or something else.  Cancer isn't very high on my radar.  hope this helps.

---------- FOLLOW-UP ----------

QUESTION: I finally went to urgent care and they found a kidney stone lodged in my ureter (5 mm).  They sent me for a pelvic and transvaginal US.  It  showed:

Uterus: Measures 8.5 x 5.7 x 4.8 cm.   A 2.4 0.5 cm solid nodule is demonstrated in the uterus consistent with small fibroids.     Endometrial stripe measures 7 mm. The uterus is heterogeneous diffusely.     

Right Ovary: Measures 2.3 x 1.6 x 1.3 cm.  Appears within normal limits without focal mass.  
.         
MPRESSION:      
2 small intramural fibroids measuring up to 2.4 cm in greatest dimension. No significant thickening of the endometrial stripe. Left ovary not visualized but no left adnexal masses are     
demonstrated.     

Could this be the source of my bleeding? Thank you!

Answer
You could be having abnormal bleeding because of the masses which are consistent with fibroids, however, most of the time fibroids like these are asymptomatic.  I would still be suspicious of hormonal changes consistent with your age and with weight gain.  Again, I would recommend a D and C since the uterine lining can't be very well evaluated just with an ultrasound.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

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.

Experience

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.

Organizations
American Society of Clinical Oncology

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

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

Awards and Honors
America's Best Physicians, last 14 years

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