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Getting A Correct Diagnosis

Program: In what way does being female increase your cancer risk? A look at gynecologic cancers
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Gina:

Well, a year went by and I pretty much had the same symptoms after the doctor told me not to worry, it was just menopause. He had done an ultrasound, and he also did an estrogen test, and the estrogen test showed that I certainly didn't have any dip in the estrogen so it wasn't menopause yet. But there was a build-up of the endometrial lining, which he didn't tell me about. So about a year later and I was still having the symptoms, I went back and he did another ultrasound and another estrogen test. And it was actually the lab and the people who were reading my ultrasound who told me that the size of my endometrial lining was, as he put it, alarming. It hadn't changed in about a year.

Andrew Schorr:

So you went on about a year with this spotting.

Gina:

Right.

Andrew Schorr:

But the estrogen test didn't seem to indicate it was menopause.

Gina:

Right.

Andrew Schorr:

So but you just sort of said well--

Gina:

It must be menopause. I believed the doctor. So after the "alarming" word came back, they sent me over to have a biopsy of my uterus, which is not a terribly painful procedure. It's done right there in the doctor's office. And it came back atypia cells, which are not necessarily cancerous but are a warning cell. The doctors who are here today could probably tell you more about those. And I did some research on the internet because all this was new to me. The internet can be a wonderful resource. It can also be kind of scary. Not all the information you get is correct, but one of the things that I read said even though the chance of it being cancer are small with atypia cells to take it seriously and assume that it's cancer unless it's proved otherwise. And that to me was a real turning point. Because my doctor told me to go get an orthoscopic hysterectomy, which goes through the vaginal walls, and they kind of remove everything that way, and that is very attractive because it only has a two-week recovery and you're back to work.

Andrew Schorr:

And that would get rid of the spotting.

Gina:

Well, it would get rid of the uterus and everything. But it wouldn't give the doctor the opportunity to look further and take the lymph nodes and things like that. So when I told my GP that I was considering going to Seattle Cancer Care Alliance he actually told me I was overreacting.

Andrew Schorr:

Right. And ladies, let's face it, there are instances, it could be headaches you're having, it could be fatigue, it could be spotting where sometimes you're just told, well, it's probably this, don't worry, when it could be something more serious. You need to know your own body and sometimes do your own research to push to what will allay your fears and get an accurate diagnosis if there is one to be had.

Gina:

Or ask your doctor to prove to you that it's not something.

Andrew Schorr:

Right. And of course in this case a worry would be about a scary cancer, and so you definitely want to rule that out. So what happened, Gina, was, eventually it wasn't ruled out, was it?

Gina:

After the surgery or in the surgery room they did another biopsy, and it still came up atypia cells. So I thought I was home free. I was quite happy. And then about a week or two later all the biopsy reports came back, and indeed in one of the lymph nodes there was cancer cells and in a wash that they did of my pelvic area there were cancer cells. So I was very grateful that I had gone the full route of a complete hysterectomy.

Andrew Schorr:

Right, and I just want to make that clear. The initial doctor said, well, you can have a hysterectomy, we can do it vaginally, no big deal, quick recovery. Sounds good. But it wouldn't have given the surgeon the opportunity to really look around for cancer.

Gina:

Correct.

Andrew Schorr:

You chose to go that extra way. Any woman who has had an abdominal hysterectomy knows that it's a bigger deal. It's abdominal surgery. You made that choice, and then it ended up that in fact your doctor did and the pathologist did find cancer. Now, the woman sitting next to you is your doctor, the one you chose, and that is Dr. Heidi Gray. She's a gynecologic oncologist. She did the surgery at the Seattle Cancer Care Alliance.

So, Dr. Gray, this extra detective work that Gina pushed for paid off in identifying a cancer earlier than maybe would have been known otherwise, correct?

Dr. Gray:

Yeah. I first of all just want to thank Gina for being on this show.

Andrew Schorr:

Absolutely.

Dr. Gray:

I think it's really excellent to have a patient advocate.

So in Gina's case, as she was describing, there was a couple of red flags when she came to see me. Certainly someone at the age of 59--the average age of menopause is usually around 50, early 50s, and so for someone to continue having bleeding of course always kind of raises a little bit of a red flag that symptoms have been going on for a while. And, yes, she did have a biopsy that only showed this hyperplasia with atypia, which we think of as kind of a precancerous condition, but again the length of the symptoms she was having was a little bit alarming to me.

So we did discuss about different routes of hysterectomy, but in patients with a diagnosis of this precancerous or atypia, about 25 to 30 percent will actually have cancer in her hysterectomy specimen. So it isn't, as Gina said, it's not necessarily a get out of jail free card. There is a high percentage of patients that will have cancer. And in Gina's case, again, although initially it didn't--it looked like the cancer was confined I did do a could complete surgical staging, and in her case she did have spread.

Andrew Schorr:

Okay. We're going to take a break. You're going to meet another expert, somebody who has been at the University of Washington in gynecologic oncology for a long time, actually helped train Dr. Gray too. And you're going to have an opportunity to ask questions about gynecologic cancers, endometrial, uterine cancers in general and ovarian. I know we're in Breast Cancer Awareness Month now, ladies, but this is important to be on your radar too. We'll be back with more Patient Power right after this.

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