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Thread: Question regarding best biospy option

  1. #1
    Newbie New User
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    Aug 2017
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    Question regarding best biospy option

    This is my first post to this forum. I have a question regarding the best course of action to take in my particular situation in terms of endometrial biopsy.

    My doctors want to rule out either primary endometrial cancer or metastatic breast cancer to the uterus. My background is below, but first, my main question is--what is the best biopsy method available? What will yield the best results and the most complete information without being more invasive than the situation warrants?

    1) In-office endometrial biopsy

    2) Hysteroscopy

    3) Hysteroscopy plus D & C

    The radiologist recommends #2, my gyn has offered #1 and #3 as options. I am waiting to talk to the gyn in person, so I want to be informed prior to that conversation.

    My background is as follows:

    I was diagnosed with invasive pleomorphic lobular breast cancer in 2007, and had a local recurrence in 2015. My sub-type of breast cancer (pleomorphic lobular) has a propensity for spreading to the ovaries and uterus. I was on Tamoxifen from 2007-2015, when my breast cancer recurred while still taking it. Tamoxifen use increases the risk of primary endometrial cancer. I had an endometrial biopsy while on Tamoxifen in 2014 due to abnormal bleeding. It was negative.

    My current breast cancer oncologist checks tumor markers, and my CEA is currently abnormal. From 2007-2015, my CEA was always between 2.7-2.9. When I had my local recurrence in 2015, it was 3.3. I went for two years without the CEA being checked, and as of the past four weeks, it has been 6.5, 7.2 and 5.9. Anything over 3.0 is considered elevated.

    As a result of the abnormal CEA, I recently have had a colonoscopy (which yielded a benign 3 mm tubular adenoma), a bone scan (stable, with uptake assumed to be arthritis) and a CT of the chest/abdomen/pelvis. The CT, and subsequent pelvic/TV ultrasound, show a thickened endometrium of 10mm.

    I am 49 and still menstruating, albeit irregularly. I know that 10 mm is not thick for a premenopausal woman. For several years, my periods have been heavy, with large clots and flooding. I occasionally have some spotting between periods. My gyn has written all the bleeding off to perimenopause.

    So clearly, since I am at risk for both primary endometrial cancer and breast cancer mets to the uterus, and I have an abnormal tumor marker for the first time in my ten year cancer history, I want to be thorough. I also don't want to have invasive procedures which are not completely necessary. Thanks in advance for input.

  2. #2
    Moderator Top User jorola's Avatar
    Join Date
    May 2014
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    1,760
    Hi there,

    I am sorry you are having to possibly deal with further concerns.

    Unfortunately we are not qualified to answer your question as we are patients, survivors and caregivers and not medical professionals. Your question is best answered by a medical professional as they are properly educated to know what would be the best.

    I am sorry I do not have more to offer. Normally someone with an unconfirmed diagnosis would have their post go in the Worried forum but as you already do have a confirmed diagnosis of breast cancer and this is a concern of a met or a new primary I am going to leave this for now.

    I do wish you all the best and nothing but good news in your results.

    Jodie
    Wife to husband with squamous lung cancer stage 3 b
    dx - April 20/14
    tx started May 20/14 - radiation and chemo
    June 23 - chemo finished
    July 4 - radiation finished
    July 8 - PET scan shows tumor almost gone, lymph nodes back to normal
    Married July 19/14
    Sept 9/14 - repeat can shows tumor continues to shrink more, no new spots. New coughing and pain due to chest infection or side effect of radiation.
    Sept 19/14 - not infection but pneumonitis, place on dex for 4 weeks
    Oct 22/14 - now off of dex and facing even more symptoms of withdrawal
    Dec 16/14 - pretty much nothing left but a scar
    April 7/15 - ditto scan and screw you stats
    Oct 6/15 - more scarring but still cancer still gone
    Feb 2016 -scan the same
    Aug 2016 - more of the same
    Aug 2017 - and ditto
    Aug 2018 - 4 yrs NED - no evidence of disease
    Aug 2019 - 5 yrs NED and discharged from cancer clinic!!!!!

  3. #3
    Newbie New User
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    Aug 2017
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    Thank you. I've always learned more from other patients and caregivers than from my doctors, which is why I reached out to this forum. My gyn essentially left the biopsy decision up to me via email. I am trying to gather more information before talking to him in person.

    I will rephrase my question more broadly then. What is widely considered to be the gold standard in endometrial biopsies?

 

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