Cancer Concerns

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?

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.