My Story – Uterine (Endometrial) Cancer: Second Colposcopy and Repeat Pap

Yesterday began another two-week waiting period for more Pap results.

In the July 22, 2014 post, I described the results of the uncomfortable colposcopy and biopsy I had earlier in the month (reported on July 10). I returned to the doctor’s office yesterday for what I thought would be a routine Pap test. However, after the doctor asked his assistant for a larger speculum and whipped out the Zeiss microscope, I realized I was in the midst of a second colposcopy. Although it was rather painful, at least this time I didn’t have to endure the hell-fire-like burning pain of iodine.

Visualization is now the preferred follow-up technique after a total hysterectomy. Although the Society of Gynecologic Oncology (SGO) no longer advises routine colposcopies and Paps, my ongoing vaginal discharge and previous abnormal Pap results require a higher level of vigilance. The doctor seems somewhat bemused by my abnormal symptom (vaginal discharge, which he doesn’t believe is a side effect of vaginal radiation, or brachytherapy) and Pap results (atypical glandular cells). Visualization shows no growths, and the previously biopsied skin tag (polyp) was benign. So we’re in watch-and-wait mode. Assuming that the next Pap results are either the same or—better yet—normal, I will return to see him in three months, which will be about a year since I learned I had uterine cancer.

I won’t know until we get the results, but in the meantime the doctor may put me on an estrogen blocker, probably anastrozole (Arimidex) or tamoxifen (Nolvadex), drugs that are often prescribed to treat breast cancer. This news, like the abnormal Pap itself, was unwelcome—not only because these drugs have side effects (more on this later), but because a prescription means ongoing treatment. Had my tumor been stage 1, grade 1, I probably wouldn’t be undergoing any of these postsurgical exams and treatments. But it was stage 1B, grade 3—the latter number being the more worrisome because it indicates an aggressive form of cancer, as described elsewhere on this blog.*

The doctor also prescribed a DEXA (dual X-ray absorptiometry) scan to check my bone density. The specific estrogen blocker may depend on these results as well. I already know I have osteopenia, which is typical for a post-menopausal woman.*

In the November 20, 2013 post on uterine cancer risk factors, I discussed how estrogen seems to be the big culprit in uterine cancer.** And, as the doctor bluntly put it to me yesterday, when you’re fat, the fat cells, especially in the abdominal area, grab and retain estrogen. Even after having all reproductive organs removed, women’s bodies still produce small amounts of estrogen, for example through the adrenal glands (more on this later).

Being overweight has always been on my list of top three life problems. I don’t know whether losing weight will help my cause, but, after dealing with the problem for most of the decades of my life, I think it’s time to try again. The SGO offers what they call an “obesity toolkit.” I recommend that any of you ladies out there who are overweight, even if you have already had a hysterectomy, seriously think about the effects of your weight on your health. I certainly am. You can start here: Obesity and Endometrial Cancer and continue here: A Patient’s Guide to Losing Weight to Reduce Your Risk of Endometrial Cancer. Or try any safe, healthful weight-management program.

I will be doing more research into the above matters and will report back soon. In the meantime, I will be attempting for the thousandth time to improve my diet and general habits so that what I lose from now on will be pounds, not more of my health.

Stay tuned for more information and updates, as well as posts about other topics.

*See the update on these topics in the September 17, 2014 post.

**Also see the companion piece Breast Cancer Risk Factors – Ladies (and Gents), Please Read.