How long should I wait to get Hysterectomy?
I am a 51 year old obese woman. I have a concern about how long I'm going to have to wait to get a hysterectomy. I was referred to Gyn because of heavy bleeding and clotting and my ultrasound showed multiple fibroids. I went to the Gyn today and she said she was going to do a biopsy and then we'd discuss possible treatments. She said my uterus was very enlarged about the size of 3 month pregnancy. After excruciating pain, She ended up not being able to get the biopsy due to the size of my cervix and the location of the fibroids and recomended a hysterectomy. I'm concerned if there is cancer having to wait 6 to 8 weeks to have the hysterectomy and get a biopsy then. How quickly does this type of cancer grow? Should I be pushing to get in there sooner? Or am I overly concerned?
Sorry to hear about the problems with getting a biopsy done. I'm no expert on this, but a couple of thoughts:
1. Does the ultrasound show that your endometrium is more than 4 or 5 mm thick? A thin endometrial stripe would be good news--very unlikely that it is cancer. A thick endometrial stripe may indicate cancer but it can also be caused by other things.
2. I have heard that they sometimes do a D&C if they can't do the endometrial biopsy. That would be another way of getting a sample so that they could examine it to see if you have cancer or not. But maybe with an enlarged uterus, you should have the hysterectomy anyway.
3. I would get a second opinion, both because second opinions give you more info and because you might not have to wait for 6 to 8 weeks at another hospital. For your second opinion, you might want to consider going to a major cancer center and to someone who is experienced in the da vinci robotic system. You don't know that you have cancer (hopefully you don't), but if you do, being in the hands of a gyn oncologist would be a good thing. I don't know if you would qualify for the da vinci hysterectomy, but if you do it is a really great way to go. Being obese is not a problem, but having an enlarged uterus might be a problem (they need to be able to pull the uterus out through the vagina). Anyway, the da vinci is worth asking about--it is much less painful and much easier recovery. The da vinci web site has a list of doctors that have been trained in this.
4. With regard to how quickly this cancer grows, I think it depends on what grade cancer you have and you can't know that until they can get a uterine sample. I first noticed bleeding in December 2010, had an ultrasound in January, an endometrial biopsy in mid-Feb and a da vinci hysterectomy in mid-March. My hysterectomy was scheduled about 2 1/2 weeks after my meeting with my second opinion doctor (the one I went with), and that seemed like a long wait at the time. The endometrial biopsy sample was diagnosed as endometrial cancer grade 1 (the least aggressive of 3 grades), but that was increased to grade 2 after surgery. Surgery confirmed that my cancer was caught early (stage 1b with only 10% pentration of the myometrium) and I have a very good prognosis. So that gives you some sense of my timing, but of couse each case may be different.
Hope all goes well for you.
Thanks for your answers. It was very helpful.
My Dr. did mention the D&C with anesthesia but recommended going straight to the hysterectomy since with the fibroids and enlarged uterus I would need it anyway.
And she also said I am not a candidate for the DaVinci method because of the enlarged uterus. I only mention that I'm obese because I had read that it can be a risk factor for this type of cancer. I keep telling myself that women get fibroids all the time and I'm sure it's not anything more than that but the not being able to get the biopsy is freaking me out.
I think I will get a second opinion and take your recomendation on finding a Gyn Oncologist just to be well prepared. I hadn't even thought about that.
Women do get fibroids all of the time, and that may very well be all that you are dealing with. I have read that only 10-15% of post menopausal bleeding (if yours is post-menopausal) is due to cancer. While obesity is certainly a risk factor, that just means that your probability might be a little higher. There are plenty of other risk factors too, and even if you have all of them, that doesn’t mean that you have cancer. And even if you do have cancer, endometrial cancer is one of the most curable cancers and it is often fully cured with surgery alone. So your situation is certainly very hopeful.
Not being able to get a biopsy, and on top of that having to wait 6 to 8 weeks for a hysterectomy just seems too stressful. Definitely worth looking around for another doctor/hospital that can move the process ahead a little quicker.
Also the second opinion is helpful because doctors simply do not always agree on things. I actually spoke to 3 doctors--my gyn who wanted to do the hysterectomy herself and two cancer doctors. All 3 had different perspectives and recommendations that differed in some ways.
Interestingly, I found this at the davincihysterectomy web site (the site of the manufacturer of the davinci system): "Unlike conventional laparoscopy, da Vinci allows gynecologists to treat patients with more advanced benign pathology, such as an enlarged uterus (e.g., due to fibroids) and pelvic adhesive disease (e.g., due to endometriosis or prior pelvic surgeries). This, in turn, will allow gynecologists to extend the benefits of minimally invasive surgery to more patient types." Of course, you don't know if you are dealing with a benign condition or not so this may not be the best option for you. But I do think that a second opinion from a gyn-onc who is very well experienced in da vinci would be a good idea. Not that I am disagreeing with your doctor--what she said does seem to make sense. But the da vinci is a really great way to go if you could possibly be a candidate. So it doesn’t hurt to ask.
I think I am probably being overly concerned cause I know that lots of women have fibroids.
I think I will get a second opinion though just to have options. If it is possible to do the Davinci I'd rather go that way.
Thanks Again I feel much less stressed about it after this.
Consider getting a second opinion as suggested in the other threads. It will give you piece of mind and may give you additional information to make an informed decision. Each doctor is different. It also helps to have your questions written down and/or take someone with you. Good luck. I will keep you in my thoughts.