Medically, I cannot answer your question about all uterine cancer beginning with a thickening of the uterine lining. However, I can share my experience with you and perhaps shed a little light on the subject. An ultrasound revealed my lining to be 5 1/2 times thicker than normal. My doctor said that the excessive thickness increased the likelihood that it was cancer, however, a thick lining can be caused by other things such as endometrial hyperplasia. An endometrial biopsy or D&C is usually performed to determine the cause of the thickening. In my case, the pathology report revealed it was cancer. A total hysterectomy with removal of ovaries and staging showed that the cancer was contained in the uterus and no further treatment is necessary. To sum it up, a thick uterine lining does not necessarily mean cancer, however it is wise to determine the cause as early as possible to ensure the best possible outcome. Hope this helps!
I found one reference which states that 96% of endometrial cancer is associated with a thickened endometrium. The article states that using a threshold of greater than 4 mm in post-menopausal women, there is a 50% error rate (meaning that the thickening is caused by things other than cancer). Here is the link to the article:
The report from my ultrasound before surgery stated that my endometrium measured 7.3 mm, however, I was not post-menopausal. Although I did have endometrial cancer, my ultrasound report stated that a hypoechoic myometrial mass found was compatable with a probable fibroid, which was ultimately determined at the time of surgery to be incorrect.
Thanks for your replies and the link. I'm just trying to figure things out here. I went to a new doc for the first time because I've been having spotting for several months. It didn't worry me at first because I never actually went a full year without at least a little spotting and I thought maybe I'm still going through menopause. Also, about 6 months
months prior to the start of the spotting, I had practically every test under the sun because of another gyn problem. I had a pap, ct scan, mri, ultrasound and endometrial biopsy. All were normal as far as the size of the lining and the problem turned out to be an infection in the fallopian tube resulting from an attack of diverticulitis.
Anyway, my new doc said my recent blood tests show that I am menopausal. She said the results of my ultrasound showed my lining was upper range of normal, but you still need the d & c, she said. So when she used the word "normal" I felt a great sense of relief since I had heard the first sign of cancer is thickening and spotting. Then when I kept asking her , "so its normal?" She said its normal for someone who is pre- menopausal so it is a little thick. So then why would she have told me its in the normal range and then say but thats for pre menopausal women. It doesn't make sense. Then she should have told me its not in the normal range when she called me. Is she pulling my leg or what? I also read that a d & c is not usually done without a hysteroscopy anymore and when I told her that, she said she didn't think it was necessary for me to have a hysteroscopy. My mind is going around in circles. I made an appt. with a gyn onco this week to run things by him but I'm not even sure I'm doing the right thing. I'm just so scared and confused. I'm sitting here thinking this is the end of my life.
Re your gyn explanation re the endometrial thickness; etc,, one can only venture some guesses:
If you have just been judged menopausal, perhaps she did not have that result in when you first spoke with her?
Or did she first give the results over the phone? If so, many doctors do not like to provide possible "bad" news unless face to face assuming the patient will ask for more info when they come in or if not they (the doc) will provide more as they gently break any suspicions re possible cancer to them?
My gyn stepped very gingerly with me as in my denial stage I kept telling her, "I really know/feel I don't have cancer;" she also could not definitively say I did but she kept saying the extreme thickness and what she "visualized" doing the D&C were not good and that the only way we would know for sure would be the surgery.
It is understandable that you are confused and perhaps it would be best to discuss this with the gyn herself. Endometrial cancer, which can be entirely "hidden" in the uterus, may be very difficult to definitively confirm before surgery. It even can hide from a biopsy as the cancer may be in the area not biopsied. I finally decided to have the TAH/BSO because both my gyn and the 2 gyn/oncs strongly recommended this but of course unlike you I had the very thick lining as well as the pre-cancer cell call of the D&C.
I hope you find you have good rapport with the gyn/onc you will soon see; this makes it lots easier to discuss concerns and fosters more confidence in their recommendations. If you still have doubts, you can always get a third opinion but be aware many insurance companies won't pay for this.
The C word is very scary. One thing "good," if anything can be good about a cancer, is that very often endometrial cancer is found early and then the surgery alone becomes the cure
My doc got both the blood test results and the sono results the same time. She gave me both results in the same phone call. If it is something bad, then it developed over the past year because as I said I had every test under the sun last year and all were normal. I'm not sure I should play games and wait for the d & c... I feel I should just go to the onc/gyn and just tell him to take everything out because I really can't deal with this stress anymore. I have even read that sometimes a d & c can miss cancer so whats the point? From what I've been reading on here most women with endo cancer had really thick linings and even then most seemed to have been caught in the early stages. So if mine is just a little thick, or the upper end of normal as the doc said, then I'm hoping that is an indication that its still in the early stages. But I don't know if the size of the lining indicates what stage its in.
I believe either a biospsy or D&C usually with hysteroscope seem to be the norm when trying to rule out endometrial cancer so the gyn/onc may order one or the other before recommending the surgery.
Usually this type cancer is quite slow growing so immediate surgery is not critical. I got my "precancerous cells" dx in mid-summer and my doctors told me to take a vacation if I had anything lined up already (cruise, etc.) assuring me the delay would be fine.
That's another thing I can't figure out.. what you said that usually a d & c is done with hysteroscopy. When I asked this doctor about this she said, "I don't think a hysteroscopy is necessary." I'm thinking that maybe she is not skilled in doing this test and that's why she's saying she doesn't think its necessary. Either that or maybe she's already convinced of what it is and knows that a hysteroscopy is just going to show what she already knows. I don't understand what you meant when you said your d & c showed "pre-cancerous" cells. If you definately had cancer then why would the biopsy say "pre-cancerous" as opposed to cancerous?
In my case the cancer was not found until they could get at the uterus in more depth. Usually when there are precancerous cells they will do a preliminary path report while you are still in surgery as it helps to decide if lymph nodes need checking, if abdominal wash is needed, etc.
My preliminary path report showed a stage 1A but 3 days later, when all tissue had been examined, the dx became a stage 1B.
Hope this helps.
You know you haven't even been diagnosed with cancer yet. I know it is hard to do but relax. If it should be cancer, I would think you are going to catch it very very early. (I spotted for 4 years before seeing my gyn and getting a D&C). He was very reasurring that this type of cancer is the best kind to get cause it is usually early. I was only stage 1c confined to uterus after 4 years. You might or might not need the hysterectomy and you'll be done with the cancer and the menstrual problems for good! Just think positive and take it one step at a time. Don't think bad thoughts, keep them positive it helps so much!!!