This is a follow-up to my December 13, 2019 post commemorating the six-year anniversary of my total robotic hysterectomy for endometrial adenocarcinoma—”the most common uterine malignancy in developed nations,” according to an article in the Mayo Clinic Proceedings. Because my tumor was type 1 (the endometrioid type), stage 1B (it had penetrated about 60% through the uterine lining, or endometrium), and grade 3 (the cells were almost entirely abnormal and misshapen), I also underwent vaginal radiation, or brachytherapy, following the surgery.
At my annual checkup with my regular gynecologist today, we discussed several things, including the fact that women need more information about uterine cancer because, as with ovarian cancer, no screening tests detect it, and a woman may or may not have any symptoms.
My only symptom was postmenopausal vaginal bleeding, and at the time I had no idea this indicated possible cancer. (See the one-minute video about common symptoms of gynecologic cancer from The Centers for Disease Control and Prevention.) Because of this, my doctor ordered an abdominal ultrasound, which showed a thickened uterine lining (endometrial hyperplasia). A biopsy is the only test that can confirm the presence of uterine cancer. A Pap test cannot detect uterine or ovarian cancer because the cells are taken only from the cervix, the opening to the uterus.
In addition, a Pap test is not recommended during uterine cancer follow-ups. The Society of Gynecologic Oncology (SGO), to which the surgeon who did my hysterectomy belongs, states:
Don’t perform Pap tests for surveillance of women with a history of
“Pap testing of the top of the vagina in women treated for endometrial cancer does not improve detection of local recurrence. False positive Pap smears in this group can lead to unnecessary procedures such as colposcopy and biopsy.” (See PDFs here and here.)
As it turned out, despite what my surgeon told me and what SGO states, I did have postsurgical Pap tests and also a colposcopy and biopsy because of an ongoing mild vaginal discharge—which turned out to be normal for me. You can read more about my 2013–2014 treatments in Uterine (Endometrial) Cancer – My Story & More. Because of the false-positive results of these repeats tests a few years ago, the deal I made with my gynecologist is NO Paps unless he sees something suspicious during my annual pelvic exam.
Today, I did not need a Pap, and I will return for a quick peek a year from now—and, I’m pretty sure, no Pap.
We also discussed some of the effects of vaginal radiation, which in my case include not only the discharge, but also vaginal tissue atrophy and dryness. Of course, because I am postmenopausal, the vaginal tissue would be a problem anyway. However, because I’ve had uterine cancer, it is not recommended that I use an estrogen cream, such as Premarin, for lubrication because estrogen is implicated in cancer of the womb. Also, my doctor said it could be used short-term only and would provide only mild relief from dryness—and would “make the tissue look better, and the only one who would see it is me!” I will be discussing more about the role of estrogen and other risk factors in the near future. You can read more about vaginal radiation in Radiation Therapy for Uterine Cancer – My Story & More.
The other residual problem I have since my treatment is a prolapsed (dropped) bladder, also called a cystocele, which is uncomfortable and adds to urinary frequency and related problems. Once again, just as when I was pregnant more than 35 years ago, my doctor told me to do Kegels—and to lose weight. (Overweight is another risk factor for uterine cancer, as well as many other problems.)
Check back soon for updated patient information on what the American Cancer Society says is most commonly diagnosed gynecologic cancer, fourth most common cancer, and sixth most common cause of cancer death in women in the United States. And remember, there is hope—as I am here to tell you.
Note on reclining images: The female figures are Chinese medicine or diagnostic dolls, which at one time were used to chastely assist a woman in pointing to problematic areas of her body to her doctor. See more here and here.