Endometrial Biopsy

For patients with abnormal uterine bleeding, we conduct the biopsy to obtain tissue from the lining of the uterus (endometrium) for further examination.

Can I resume normal activities following an endometrial biopsy?

Yes, this is a very common procedure done in the office where we obtain tissue samples from the lining of the uterus. Patients might feel cramping during the procedure and some mild cramping and spotting afterwards, but normal activities can be resumed the same day.

Ectopic Pregnancy

In a normal pregnancy, a fertilized egg travels through a fallopian tube to the uterus. The egg attaches in the uterus and starts to grow. But in an ectopic pregnancy, the fertilized egg attaches (or implants) someplace other than the uterus, most often in the fallopian tube. (This is why it is sometimes called a tubal pregnancy.) In rare cases, the egg implants in an ovary, the cervix, or the belly.

There is no way to save an ectopic pregnancy. It cannot turn into a normal pregnancy. If the egg keeps growing in the fallopian tube, it can damage or burst the tube and cause heavy bleeding that could be deadly. If you have an ectopic pregnancy, you will need quick treatment to end it before it causes dangerous problems.

An ectopic pregnancy is often caused by damage to the fallopian tubes. A fertilized egg may have trouble passing through a damaged tube, causing the egg to implant and grow in the tube.

Things that make you more likely to have fallopian tube damage and an ectopic pregnancy include:
Smoking. The more you smoke, the higher your risk of an ectopic pregnancy.

  • Pelvic inflammatory disease (PID). This is often the result of an infection such as chlamydia or gonorrhea.
  • Endometriosis, which can cause scar tissue in or around the fallopian tubes.
  • Being exposed to the chemical DES before you were born.

Some medical treatments can increase your risk of ectopic pregnancy. These include:

  • Surgery on the fallopian tubes or in the pelvic area.
  • Fertility treatments such as in vitro fertilization.

In the first few weeks, an ectopic pregnancy usually causes the same symptoms as a normal pregnancy, such as a missed menstrual period, fatigue, nausea, and sore breasts.

The key signs of an ectopic pregnancy are:

  • Pelvic or belly pain. It may be sharp on one side at first and then spread through your belly. It may be worse when you move or strain.
  • Vaginal bleeding.

If you think you are pregnant and you have these symptoms, see your doctor right away.

A urine test can show if you are pregnant. To find out if you have an ectopic pregnancy, your doctor will likely do:

  • A pelvic exam to check the size of your uterus and feel for growths or tenderness in your belly.
  • A blood test that checks the level of the pregnancy hormone (hCG). This test is repeated 2 days later. During early pregnancy, the level of this hormone doubles every 2 days. Low levels suggest a problem, such as ectopic pregnancy.
  • An ultrasound. This test can show pictures of what is inside your belly. With ultrasound, a doctor can usually see a pregnancy in the uterus 6 weeks after your last menstrual period

Dysmenorrhea

What is dysmenorrhea?

Pain associated with menstruation is called dysmenorrhea.

How common is dysmenorrhea?

Dysmenorrhea is the most commonly reported menstrual disorder. More than one half of women who menstruate have some pain for 1–2 days each month.

What are the types of dysmenorrhea?

There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

What is primary dysmenorrhea?

Primary dysmenorrhea is pain that comes from having a menstrual period, or “menstrual cramps.”

What causes primary dysmenorrhea?

Primary dysmenorrhea usually is caused by natural chemicals called prostaglandins. Prostaglandins are made in the lining of the uterus.

When does the pain associated with primary dysmenorrhea occur during the menstrual period?

Pain usually occurs right before menstruation starts, as the level of prostaglandins increases in the lining of the uterus. On the first day of the menstrual period, the levels are high. As menstruation continues and the lining of the uterus is shed, the levels decrease. Pain usually decreases as the levels of prostaglandins decrease.

At what age does primary dysmenorrhea start?

Often, primary dysmenorrhea begins soon after a girl starts having menstrual periods. In many women with primary dysmenorrhea, menstruation becomes less painful as they get older. This kind of dysmenorrhea also may improve after giving birth.

What is secondary dysmenorrhea?

Secondary dysmenorrhea is caused by a disorder in the reproductive system. It may begin later in life than primary dysmenorrhea. The pain tends to get worse, rather than better, over time.

When does the pain associated with secondary dysmenorrhea occur during the menstrual period?

The pain of secondary dysmenorrhea often lasts longer than normal menstrual cramps. For instance, it may begin a few days before a menstrual period starts. The pain may get worse as the menstrual period continues and may not go away after it ends.

What disorders can cause secondary dysmenorrhea?

Some of the conditions that can cause secondary dysmenorrhea include the following:

  • Endometriosis—In this condition, tissue from the lining of the uterus is found outside the uterus, such as in the ovaries and fallopian tubes, behind the uterus, and on the bladder . Like the lining of the uterus, endometriosis tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially right around menstruation. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, resulting in pain.
  • Adenomyosis—Tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.
  • Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus. Fibroids located in the wall of the uterus can cause pain.

What tests are done to find the cause of dysmenorrhea?

If you have dysmenorrhea, your health care provider will review your medical history, including your symptoms and menstrual cycles. He or she also will do a pelvic exam.

An ultrasound exam may be done. In some cases, your health care provider will do a laparoscopy. This is a type of surgery that lets your health care provider look inside the pelvic region.

How is dysmenorrhea treated?

Your health care provider may recommend medications to see if the pain can be relieved. Pain relievers or hormonal medications, such as birth control pills, often are prescribed. Some lifestyle changes also may help, such as exercise, getting enough sleep, and relaxation techniques.

If medications do not relieve pain, treatment will focus on finding and removing the cause of your dysmenorrhea. You may need surgery. In some cases, a mix of treatments works best.

What medications are used to treat dysmenorrhea?

Certain pain relievers, called nonsteroidal anti-inflammatory drugs (NSAIDs), target prostaglandins. They reduce the amount of prostaglandins made by the body and lessen their effects. These actions make menstrual cramps less severe.
NSAIDs work best if taken at the first sign of your menstrual period or pain. You usually take them for only 1 or 2 days. Women with bleeding disorders, asthma, aspirin allergy, liver damage, stomach disorders, or ulcers should not take NSAIDs.

What types of birth control methods help control dysmenorrhea?

Birth control methods that contain estrogen and progestin, such as the pill, the patch, and the vaginal ring, can be used to treat dysmenorrhea. Birth control methods that contain progestin only, such as the birth control implant and the injection, also may be effective in reducing dysmenorrhea. The hormonal intrauterine device can be used to treat dysmenorrhea as well.

What types of medication can be used to treat dysmenorrhea caused by endometriosis?

If your symptoms or a laparoscopy point to endometriosis as the cause of your dysmenorrhea, birth control pills, the birth control implant, the injection, or the hormonal intrauterine device can be tried. Gonadotropin-releasing hormone agonists are another type of medication that may relieve endometriosis pain. These drugs may cause side effects, including bone loss, hot flashes, and vaginal dryness. They usually are given for a limited amount of time. They are not recommended for teenagers except in severe cases when other treatments have not worked.

What alternative treatments help ease dysmenorrhea?

Certain alternative treatments may help ease dysmenorrhea. Vitamin B1 or magnesium supplements may be helpful, but not enough research has been done to recommend them as effective treatments for dysmenorrhea. Acupuncture has been shown to be somewhat helpful in relieving dysmenorrhea.

When is uterine artery embolization (UAE) done to treat dysmenorrhea?

If fibroids are causing your dysmenorrhea, a treatment called uterine artery embolization (UAE) may help.

What is done during UAE?

In this procedure, the blood vessels to the uterus are blocked with small particles, stopping the blood flow that allows fibroids to grow. Some women can have UAE as an outpatient procedure.

What complications are associated with UAE?

Complications include infection, pain, and bleeding.

When is surgery done to treat dysmenorrhea?

If other treatments do not work in relieving dysmenorrhea, surgery may be needed. The type of surgery depends on the cause of your pain.

If fibroids are causing the pain, sometimes they can be removed with surgery. Endometriosis tissue can be removed during surgery. Endometriosis tissue may return after the surgery, but removing it can reduce the pain in the short term. Taking hormonal birth control or other medications after surgery may delay or prevent the return of pain.
Hysterectomy may be done if other treatments have not worked and if the disease causing the dysmenorrhea is severe. This procedure normally is the last resort.

Reference: The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Dysmenorrhea-Painful-Periods

Disorders of the Vulva

Disorders of the Vulva: Common Causes of Vulvar Pain, Burning, and Itching

What is the vulva?

The external female genital area is called the vulva. The outer folds of skin are called the labia majora and the inner folds are called the labia minora.

When should I contact my health care provider about vulvar symptoms?

If you see changes on the skin of the vulva, or if you have itching, burning, or pain, contact your health care provider.

What will my health care provider check?

Your health care provider may examine you, ask you questions about the pain and your daily routine, and take samples of vaginal discharge for testing. In some cases, a biopsy is needed to confirm diagnosis of a disease.

What are some skin disorders that can affect the vulva?

Some of the skin disorders that affect the vulva include folliculitis, contact dermatitis, Bartholin gland cysts, lichen simplex chronicus, lichen sclerosus, and lichen planus.

What is folliculitis?

Folliculitis appears as small, red, and sometimes painful bumps caused by bacteria that infect a hair follicle. It can occur on the labia majora. This can happen because of shaving, waxing, or even friction. Folliculitis often goes away by itself. Attention to hygiene, wearing loose clothing, and warm compresses applied to the area can help speed up the healing process. If the bumps do not go away or they get bigger, see your health care provider. You may need additional treatment.

What is contact dermatitis?

Contact dermatitis is caused by irritation of the skin by things such as soaps, fabrics, or perfumes. Signs and symptoms can include extreme itching, rawness, stinging, burning, and pain. Treatment involves avoidance of the source of irritation and stopping the itching so that the skin can heal. Ice packs or cold compresses can reduce irritation. A thin layer of plain petroleum jelly can be applied to protect the skin. Medication may be needed for severe cases.

What is a Bartholin gland cyst?

The Bartholin glands are located under the skin on either side of the opening of the vagina. They release a fluid that helps with lubrication during sexual intercourse. If the Bartholin glands become blocked, a cyst can form, causing a swollen bump near the opening of the vagina. Bartholin gland cysts usually are not painful unless they become infected. If this occurs, anabscess can form.

If your cyst is not causing pain, it can be treated at home by sitting in a warm, shallow bath or by applying a warm compress. If an abscess has formed, treatment involves draining the cyst using a needle or other instrument in a health care provider’s office.

What is lichen simplex chronicus?

Lichen simplex chronicus may be a result of contact dermatitis or other skin disorder that has been present for a long time. Thickened, scaly areas called “plaques” appear on the vulvar skin. These plaques cause intense itching that may interfere with sleep. Treatment involves stopping the “itch-scratch” cycle so that the skin can heal. Steroid creams often are used for this purpose. The underlying condition should be treated as well.

What is lichen sclerosus?

Lichen sclerosus is a skin disorder that can cause itching, burning, pain during sex, and tears in the skin. The vulvar skin may appear thin, white, and crinkled. White bumps may be present with dark purple coloring. A steroid cream is used to treat lichen sclerosus.

What is lichen planus?

Lichen planus is a skin disorder that most commonly occurs on the mucous membranes of the mouth. Occasionally, it also affects the skin of the genitals. Itching, soreness, burning, and abnormal discharge may occur. The appearance of lichen planus is varied. There may be white streaks on the vulvar skin, or the entire surface may be white. There may be bumps that are dark pink in color.

Treatment of lichen planus may include medicated creams or ointments, vaginal tablets, prescription pills, or injections. This condition is difficult to treat and usually involves long-term treatment and follow-up.

What is vulvodynia?

Vulvodynia means “vulvar pain.” The pain can occur when the area is touched or it can occur without touch. There are two types of vulvodynia: generalized and localized. With generalized vulvodynia, the pain occurs over a large area of the vulva. With localized vulvodynia, the pain is felt on a smaller area, such as the vestibule.

What are the signs and symptoms of vulvodynia?

Vulvodynia usually is described as burning, stinging, irritation, or rawness. The skin of the vulva usually looks normal.

How is vulvodynia treated?

A variety of methods are used to treat vulvodynia, including self-care measures, medications, dietary changes, biofeedback training, physical therapy, sexual counseling, or surgery.

What is vulvar atrophy?

Vulvar atrophy is the thinning of the skin of the vulva. It usually occurs in response to the decreased estrogen levels that occur in perimenopause and menopause.

What are the signs and symptoms of vulvar atrophy?

Signs and symptoms include soreness, irritation, and dryness. Pain may occur during sexual intercourse. The vulva becomes more sensitive to irritants. Infections may occur more easily. In severe cases, vulvar skin may crack and bleed.

How is vulvar atrophy treated?

This condition is treated with medications containing estrogen that are applied to the skin or inserted into the vagina.

What is vulvar intraepithelial neoplasia (VIN)?

Vulvar intraepithelial neoplasia (VIN) is the presence of abnormal vulvar cells that are not yet cancer. VIN often is caused by human papillomavirus (HPV) infection.

What are the signs and symptoms of VIN?

Signs and symptoms include itching, burning, or abnormal skin that may be bumpy, smooth, or a different color like white, brown, or red. VIN should be treated to prevent the development of cancer.

How is VIN treated?

VIN can be treated with a cream that is applied to the skin, laser treatment, or surgery. The HPV vaccine that protects against HPV types 6, 11, 16, and 18 is approved to prevent VIN caused by these four types of HPV.

What is cancer?

Cancer is the growth of abnormal cells.

What causes vulvar cancer?

Vulvar cancer can be caused by infection with HPV. Other forms of cancer that can affect the vulva include melanoma (skin cancer) or Paget disease. Paget disease of the vulva may be a sign of cancer in another area of the body, such as the breast or colon.

What are the signs and symptoms of vulvar cancer?

Signs and symptoms may include itching, burning, inflammation, or pain. Other symptoms of cancer include a lump or sore on the vulva, changes in the skin color, or a bump in the groin.

How is cancer treated?

The type of treatment depends on the stage of cancer. Surgery often is needed to remove all cancerous tissue. Radiation therapy and chemotherapy also may be needed in addition to surgery.

What other disorders can affect the vulva?

There are a number of disorders that may affect the vulva. Infections (such as yeast infection) and sexually transmitted diseases, such as genital herpes, can cause vulvar signs and symptoms. Crohn disease is a long-term disease of the digestive system. It can cause inflammation, swelling, sores, or bumps on the vulva.

What self-care measures can help prevent or clear up vulvar problems?

The following self-care measures may help prevent or clear up certain vulvar problems:

  • Keep your vulva clean by rinsing with warm water and gently patting, not rubbing, it dry.
  • Do not wear tight-fitting pants or underwear. Wear only cotton underwear.
  • Do not wear pantyhose (unless they have a cotton crotch).
  • Do not use pads or tampons that contain a deodorant or a plastic coating.
  • Do not use perfumed soap or scented toilet paper.
  • Do not douche or use feminine sprays or talcum powders.

Reference: The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Disorders-of-the-Vulva-Common-Causes-of-Vulvar-Pain-Burning-and-Itching

Dilation and Curettage

Dilation and curettage (D&C) is a brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining. Knowing what to expect before, during, and after a D&C may help ease your worries and make the process go more smoothly. Here’s what you need to know.

Reasons for a D&C

You may need a D&C for one of several reasons. It’s done to:

  • Remove tissue in the uterus during or after a miscarriage or abortion or to remove small pieces of placenta after childbirth. This helps prevent infection or heavy bleeding.
  • Diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat growths such as fibroids, polyps, or endometriosis, hormonal imbalances, or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.

What to Expect When Having a D&CM

You can have a D&C in your doctor’s office, an outpatient clinic, or the hospital. It usually takes only 10 to 15 minutes, but you may stay in the office, clinic, or hospital for up to five hours.

Before a D&C, you will have a complete history taken and sign a consent form. Ask your doctor any questions you have about the D&C. Be sure to tell the doctor if:

  • You suspect you are pregnant.
  • You are sensitive or allergic to any medications, iodine, or latex.
  • You have a history of bleeding disorders or are taking any blood-thinning drugs.

You will receive anesthesia, which your doctor will discuss with you. The type you have depends on the procedure you need.

  • If you have general anesthesia, you will not be awake during the procedure.
  • If you have spinal or epidural (regional) anesthesia, you will not have feeling from the waist down.
  • If you have local anesthesia, you will be awake and the area around you cervix will be numbed.

Before the D&C, you may need to remove clothing, put on a gown, and empty your bladder.

During a D&C, you lie on your back and place your legs in stirrups like during a pelvic exam. Then the doctor inserts a speculum into the vagina and holds the cervix in place with a clamp. Although the D&C involves no stitches or cuts, the doctor cleanses the cervix with an antiseptic solution.

A D&C involves two main steps:

  • Dilation involves widening the opening of the lower part of the uterus (the cervix) to allow insertion of an instrument. The doctor may insert a slender rod (laminaria) into the opening to gradually cause it to widen. Or medication may soften the cervix to help it widen.
  • Curettage involves scraping the lining and removing uterine contents with a long, spoon-shaped instrument (a curette). The doctor may also use a cannula to suction any remaining contents from the uterus. This can cause some cramping. In many cases, a tissue sample goes to a lab for examination.

Colposcopy

Colposcopy – this is a test we perform if a patient has an abnormal pap smear result. It further clarifies for us if a patient has abnormal cells on her cervix, known as dysplasia.

How is a colposcopy performed?

The colposcopy is performed in the office and takes about 15 minutes. We examine the patient’s cervix under magnification, rinse the cervix with several solutions and obtain very small biopsies after using local anesthesia. Patients might have some light bleeding afterwards with some mild cramping, but can resume normal activities immediately. Results take a little over a week.

Colorectal Cancer Screening

What is screening?

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum.

The colon and rectum are parts of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the mouth, throat,esophagus, stomach, and the small and large intestines. The colon (large bowel) is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6-8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).


Anatomy of the lower digestive system, showing the colon and other organs.

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer.Cancer that begins in either of these organs may also be called colorectal cancer.

Colorectal cancer is the second leading cause of death from cancer in the United States.

The number of new colorectal cancer cases and the number of deaths from colorectal cancer are decreasing a little bit each year. But in adults younger than 50 years, there has been a small increase in the number of new cases each year since 1998. Colorectal cancer is found more often in men than in women.

Age and health history can affect the risk of developing colon cancer.

Anything that increases a person’s chance of getting a disease is called a risk factor. Risk factors for colorectal cancer include the following:

  • Being older than 50 years of age.
  • Having a personal history of any of the following:
    • Colorectal cancer.
    • Polyps in the colon or rectum.
    • Cancer of the ovary, endometrium, or breast.
    • Ulcerative colitis or Crohn disease.

    Polyps in the colon. Some polyps have a stalk and others do not. Inset shows a photo of a polyp with a stalk.

  • Having a parent, brother, sister, or child with colorectal cancer.
  • Having certain hereditary conditions, such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).

Having certain hereditary conditions, such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

False-negative test results can occur.
Screening test results may appear to be normal even though colorectal cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

False-positive test results can occur.
Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn’t) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks.

The following colorectal cancer screening tests have risks:

Fecal occult blood testing
The results of fecal occult blood testing may appear to be abnormal even though no cancer is present. A false-positive test result can cause anxiety and lead to more testing, including colonoscopy or barium enema with sigmoidoscopy.

Sigmoidoscopy
There can be discomfort or pain during sigmoidoscopy. Women may have more pain during the procedure, which may lead them to avoid future screening. Tears in the lining of the colon and bleeding also may occur.

Colonoscopy
Serious complications from colonoscopy are rare, but can include tears in the lining of the colon, bleeding, and problems with the heart or blood vessels. These complications may occur more often in older patients.

Virtual colonoscopy
Virtual colonoscopy often finds problems with organs other than the colon, including the kidneys, chest,liver, ovaries, spleen, and pancreas. Some of these findings lead to more testing. The risks and benefits of this follow-up testing are being studied.

Your doctor can advise you about your risk for colorectal cancer and your need for screening tests.

Tests are used to screen for different types of cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person’s chance of dying from the disease. For some types of cancer, finding and treating the disease at an early stage may result in a better chance of recovery.

Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Studies show that screening for colorectal cancer helps decrease the number of deaths from the disease.

Four tests are used to screen for colorectal cancer:

Fecal occult blood test
A fecal occult blood test (FOBT) is a test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing. Blood in the stool may be a sign of polyps or cancer.


Fecal Occult Blood Test (FOBT) kit to check for blood in stool.

A new colorectal cancer screening test called immunochemical FOBT (iFOBT) is being studied to see if it is better at finding advanced polyps or cancer than the FOBT.

Sigmoidoscopy
Sigmoidoscopy is a procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer.

A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas.

Barium enema
A barium enema is a series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

Colonoscopy

Colonoscopy is a procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.


Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.

Studies have not shown that screening for colorectal cancer using digital rectal exam helps decrease the number of deaths from the disease.

A digital rectal exam (DRE) may be done as part of a routine physical exam. A digital rectal exam is an exam of the rectum. A doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. Study results have shown that there is no evidence to support DRE as a screening method for colorectal cancer.

New screening tests are being studied in clinical trials.

Virtual colonoscopy
Virtual colonoscopy is a procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography. Clinical trials are comparing virtual colonoscopy with commonly used colorectal cancer screening tests. Other clinical trials are testing whether drinking acontrast material that coats the stool, instead of using laxatives to clear the colon, shows polyps clearly.

DNA stool test
This test checks DNA in stool cells for genetic changes that may be a sign of colorectal cancer.
Screening clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Cervical Cancer Screening

What is cervical cancer screening?

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for human papillomavirus (HPV) .

How is cervical cancer screening done?

Cervical cancer screening is simple and fast. It takes less than a minute to do. With the woman lying on an exam table, a speculum is used to open the vagina. This device gives a clear view of the cervix and upper vagina.

For a Pap test, a small number of cells are removed from the cervix with a brush or other tool. The cells are put into a liquid and sent to a lab testing. For an HPV test, sometimes the same sample taken for the Pap test can be used.
Sometimes, two cell samples are taken.

Who should have cervical cancer screening and how often?

You should start having cervical cancer screening at age 21 years. How often you should have cervical cancer screening depends on your age and health history:

  • Women aged 21–29 years should have a Pap test every 3 years.
  • Women aged 30–65 years should have a Pap test and HPV test (co-testing) every 5 years (preferred). It is acceptable to have a Pap test alone every 3 years.

When can I stop having cervical cancer screening?

You can stop having cervical cancer screening after age 65 if you do not have a history of moderate or severe cervical dysplasia or cervical cancer and if you have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the last 5 years.

What happens if I have an abnormal screening test result?

You most likely will have additional testing after an abnormal test result. This testing can be simply a repeat Pap test, An HPV test, or a more detailed examination called a colposcopy (with or without a biopsy). If results of follow-up tests indicate precancerous changes, you may need treatment to remove the abnormal cells.

Are cervical cancer screening results always accurate?

As with any lab test, cervical cancer screening test results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a “false-positive” result. The tests also may not detect abnormal cells when they are present. This is called a “false-negative” result. Many factors can cause false results:

  • The sample may contain too few cells.
  • There may not be enough abnormal cells to study.
  • An infection or blood may hide abnormal cells.
  • Douching or vaginal medications may wash away or dilute abnormal cells.

To help prevent false-negative or false-positive results, you should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before your test. You also should not have cervical cancer screening if you have your menstrual period.

Cancer of the Uterus

What is cancer of the uterus?

Normally, healthy cells that make up the body’s tissues grow, divide, and replace themselves on a regular basis. This keeps the body healthy. Sometimes certain cells develop abnormally and begin to grow out of control. When this occurs, growths or tumors begin to form. Tumors can be benign (not cancer) or malignant (cancer).

Malignant tumors can invade and destroy nearby healthy tissues and organs. Cancer cells also can spread (or metastasize)
to other parts of the body and form new tumors.

There are different types of cancer of the uterus. The most common type is endometrial cancer (adenocarcinoma).

Endometrial cancer affects the endometrium, the lining of the uterus. Sarcomas are another type of uterine cancer. They arise from muscle and other tissue. Although rare, this type of uterine cancer is more aggressive than adenocarcinoma and has different symptoms. Because endometrial cancer is more common and its symptoms differ from those of sarcoma, this FAQ focuses on endometrial cancer.

Who is at risk of endometrial cancer?

Endometrial cancer is the most common type of gynecologic cancer in the United States. About 2 or 3 women out of every 100 women will develop endometrial cancer during their lifetimes.

Endometrial cancer is rare in women younger than 40 years. It most often occurs in women around age 60 years.

What are the risks factors for endometrial cancer?

Certain factors can increase a woman’s risk of uterine cancer:

  • Obesity
  • Irregular menstrual periods
  • Never having a baby
  • Infertility
  • Starting menstrual periods at an early age (before age 12 years)
  • Late menopause
  • History of cancer of the ovary or colon
  • Use of tamoxifen to treat or prevent breast cancer
  • Family history of endometrial cancer
  • History of diabetes, hypertension, gallbladder disease, or thyroid disease
  • Long-term use of estrogen without progesterone to treat menopause
  • Long-term use of high–dose birth control pills
  • Cigarette smoking

Some of these risk factors are related to the use of estrogen. Estrogen is a hormone produced in a woman’s ovaries. It can be taken after menopause, when a woman’s ovaries stop producing estrogen (hormone therapy). Taken alone, estrogen increases the risk of endometrial cancer, if a woman still has her uterus. When estrogen is taken with another hormone, progesterone, a woman is protected against this increase.

What are the symptoms of endometrial cancer?

Abnormal bleeding, spotting, new discharge from your vagina, or bleeding or spotting after menopause all are symptoms of endometrial cancer. These symptoms may be constant or come and go. The cause of any abnormal bleeding or discharge, especially after menopause, should be checked by your health care provider.

How is endometrial cancer diagnosed?

There are no screening tests to detect endometrial cancer in women with no symptoms. But most women who have endometrial cancer have early symptoms. Several methods may be used to detect whether endometrial cancer is present:

  • Endometrial biopsy—A test in which a small amount of the tissue lining the uterus is removed and examined under a microscope. This test will likely be the first step in checking for abnormal cells.
  • Vaginal ultrasound—A test in which sound waves are used to check the thickness of the lining of the uterus and the size of the uterus.
  • Hysteroscopy—A surgical procedure in which a slender, light-transmitting scope is used to view the inside of the uterus or perform surgery.
  • Dilation and curettage (D&C)—A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.

For many women, a Pap test may be part of a regular checkup, but it may not always detect endometrial cancer. In fact, most women with endometrial cancer have normal Pap test results. Endometrial cancer can be diagnosed only by examining tissue from the uterus.

How is endometrial cancer treated?

Surgery usually is done to treat the disease and find out if further treatment is needed. Most patients have both hysterectomy and salpingo-oophorectomy. During surgery, the stage of disease is determined. Staging helps your doctor decide what treatment has the best chance for success. Stages of cancer range from I to IV. Stage IV is the most advanced.

The stage of cancer affects the treatment and outcome.

Radiation therapy may be done after surgery based on the stage of the disease. Although rare, some women are treated with radiation alone. Radiation stops cancer cells from growing by exposing them to high-energy rays.

Other forms of treatment include chemotherapy or hormone therapy. Some women may be treated with progestin, a synthetic version of the hormone progesterone.

What type of follow-up is required after treatment?

Women who did not receive radiation therapy should see their doctors every 3–4 months for 2–3 years to make sure the treatment is working. After that, they should see their doctors twice a year. Women who did receive radiation therapy may be able to see their doctors less frequently. With stage I disease, 85–90% of women will have no sign of cancer 5 or more years after treatment. The chance of a cure decreases with more advanced disease (higher stage).

Reference: The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Cancer-of-the-Uterus-Endometrial-Cancer

Cancer of the Cervix

What is cancer of the cervix?

A woman’s cervix (the opening of the uterus at the top of the vagina) is covered by a thin layer of tissue made up of cells. Healthy cells grow, divide, and are replaced as needed. Cancer of the cervix occurs when these cells change. Cancer cells divide more rapidly. They may grow into deeper cell layers or spread to other organs. The cancer cells eventually form a mass of tissue called a tumor.

How long does it take for cervical cancer to develop?

It often takes several years for cervical cancer to develop. During this time, the cells on or around the cervix become abnormal. The cell changes that occur before cancer is present are called dysplasia or cervical intraepithelial neoplasia (CIN).

What is the main cause of cervical cancer?

The main cause of cervical cancer is human papillomavirus (HPV) . There are many types of HPV. Some types of HPV, called “high-risk types,” can cause cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. Other types have been linked to genital warts.

Who is at risk of cervical cancer?

The most important risk factor for cervical cancer is infection with the types of HPV linked to cancer. The following factors increase your risk of becoming infected with HPV:

  • Multiple sexual partners
  • Having a male sexual partner who has had multiple sexual partners
  • Early age at which you first had sex (younger than 18 years)

Other risk factors include the following:

  • A personal history of dysplasia of the cervix, vagina, or vulva
  • A family history of cervical cancer
  • Smoking
  • Certain sexually transmitted diseases, such as chlamydia
  • Problems with the immune system
  • Having a mother who took a drug called diethylstilbestrol (DES) during pregnancy

Is there a screening test for cervical cancer?

Yes. The Pap test checks for abnormal cell changes of the cervix. This allows early treatment of the abnormal cells so that they do not become cancer. An HPV test also is available. It is used along with the Pap test to screen for cervical cancer in some women and as a follow-up test when a woman has an abnormal Pap test result.

What are some of the symptoms of cervical cancer?

The first signs may be abnormal bleeding, spotting, or watery discharge from the vagina. Menstrual bleeding may be heavier than usual, and bleeding may occur after sex. Signs of advanced cancer can include pelvic pain, problems urinating, and swollen legs. If the cancer has spread to nearby organs or the lymph nodes, the tumors can affect how those organs work. For instance, a tumor might press on your bladder or block blood flow in a vein.

How is cervical cancer diagnosed?

If your health care provider suspects that you have cancer of the cervix, a biopsy may be done. For certain abnormal Pap test results that require treatment, the abnormal cervical tissue may be removed and sent to a lab to be studied.

If cervical cancer is diagnosed, your health care provider will assess the size of the cancer and the extent (if any) to
which the disease has spread. This process may include the following tests:

  • A pelvic exam (which may include a rectal exam)—An examination in which your health care provider checks the uterus, ovaries, and other organs near the cervix
  • Cystoscopy—A test in which the inside of the urethra and bladder are studied with a lighted device
  • Colonoscopy—A test in which the entire colon is examined with a slender, lighted instrument called a colonoscope

What is staging?

“Staging” is the process of finding out how much the cancer has spread. Most types of cancer have stages from I to IV. The lower the number, the less the cancer has spread.

Some types of cancer, including cervical cancer, have a Stage 0. Stage 0 also is called noninvasive cervical cancer or carcinoma in situ. In Stage 0, cancer cells are present on the top layer of the cervix only. They have not gone into deeper layers of the cervical tissue or other organs. The remaining stages are called invasive cancer. In these stages, the cancer has invaded into deeper layers of the cervix.

What are the types of treatment?

Invasive cancer of the cervix is treated with surgery (hysterectomy), radiation therapy, and chemotherapy (the use of cancer-killing drugs). The type of treatment chosen depends on the cancer stage. You may receive more than one type of treatment.

Is special follow-up required after treatment?

Your health care provider may suggest more frequent cervical cancer screening for the first few years after treatment to make sure that all the cancer cells were removed. Even if your cervix has been removed to treat your cancer, you still need cervical cancer screening. Cells are taken from the upper vagina instead of the cervix.

Reference: The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Cervical-Cancer

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