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Endometrial cancer

Alternative Names:- Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma -endometrium; Adenocarcinoma – uterus; Cancer – uterine; Cancer – endometrial; Uterine corpus cancer

Definition:
The endometrium is the tissue lining the uterus (or womb). The uterus, a hollow organ about the size and shape of a pear, is found in a woman’s pelvic region and is the organ where the fetus grows until birth. The upper part of the uterus is called the corpus; the lower, narrower part of the uterus is called the cervix. The cervix is the opening between the uterus and the vagina. The outer layer of the uterus is called the myometrium. The myometrium is thick and composed of strong muscles. These muscles contract during labor to push out the baby.

The endometrium is soft and spongy. Each month, the endometrium changes as part of the menstrual cycle. Early in the cycle, the ovaries secrete a hormone called estrogen that causes the endometrium to thicken. In the middle of the cycle, the ovaries start secreting another hormone called progesterone. Progesterone prepares the innermost layer of the endometrium to support an embryo should conception (pregnancy) occur. If conception does not occur, the hormone levels decrease dramatically. The innermost layer of the endometrium is then shed as menstrual fluid. This leads to the cyclical nature of the menstrual cycle.

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Endometrial cancer occurs when cells of the endometrium undergo a transformation and begin to grow and multiply without the control mechanisms that normally limit their growth. As the cells grow and multiply, they form a mass called a tumor. Cancer is dangerous because it overwhelms healthy cells by taking their space and the oxygen and nutrients they need to survive and function.


Not all tumors are cancerous; however, cancerous tumors are called malignant, meaning they can spread to other tissues and organs. Cancerous tumors may encroach on and invade neighboring organs or lymph nodes, or they may enter the bloodstream and spread to the bones or distant organs, such as the lungs. This process is called metastasis. Metastatic tumors are the most aggressive and serious of all tumors.

Two main types of endometrial cancers exist. Nearly all endometrial cancers are endometrial adenocarcinomas, meaning they originate from glandular (secreting) tissue. The other type of endometrial cancer, uterine sarcomas, originates in the connective tissue or muscle of the uterus. A subtype of endometrial adenocarcinomas, adenosquamous carcinoma, includes squamous cells (that is, the type of cells found on the surface of the skin and cervix). Other subtypes of endometrial adenocarcinomas are papillary serous adenocarcinomas and clear cell carcinomas.

Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often eliminates all of the cancer.

In developed countries, uterine cancer is the most common cancer of the female genital tract. In the United States, uterine cancer is the fourth most common cancer in women. Uterine cancer was diagnosed in about 42,160 women in the United States in 2009, and about 7,800 women died of the disease. Uterine cancer occurs in women of reproductive age and older. About one-quarter of cases occur before menopause, but the disease is most often diagnosed in women in their 50s or 60s.

Symptoms:
Signs and symptoms of endometrial cancer may include:

*Prolonged periods or bleeding between periods
*An abnormal, watery or blood-tinged discharge from your vagina
*Pain during intercourse
*Abnormal uterine bleeding, abnormal menstrual periods
*Bleeding between normal periods before menopause
*Vaginal bleeding or spotting after menopause
*Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
*Lower abdominal pain or pelvic cramping
*Thin white or clear vaginal discharge after menopause

Causes & Risk Factors:
Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to play a role. Estrogen helps stimulate the buildup of the lining of the uterus. Studies have shown that high levels of estrogen in animals result in excessive endometrial growth and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.

The following increase your risk of endometrial cancer:

•Diabetes
•Estrogen replacement therapy without the use of progesterone
•History of endometrial polyps or other benign growths of the uterine lining
•Infertility (inability to become pregnant)
•Infrequent periods
•Tamoxifen, a drug for breast cancer treatment
•Never being pregnant
•Obesity
•Polycystic ovarian syndrome (PCOS)
•Starting menstruation at an early age (before age 12)
•Starting menopause after age 50

Associated conditions include the following:
•Colon or breast cancer
•Gallbladder disease
•High blood pressure
•Polycystic ovarian disease

Complecations:
Endometrial cancer can spread to other parts of your body, making it more difficult to treat successfully. Endometrial cancer that spreads (metastasizes) most often travels to the lungs.

Diagnosis:
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.

Tests that may be done include:

•Endometrial aspiration or biopsy
•Dilation and curettage (D and C)
•Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)….

If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.

Stages of endometrial cancer:

1.The cancer is only in the uterus...….

2.The cancer is in the uterus and cervix.
3.The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
4.The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.
Cancer is also described as Grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive.

Treatment:
Treatment options involve surgery, radiation therapy, and chemotherapy.

A hysterectomy may be performed in women with the early stage 1 disease. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.

Abdominal hysterectomy is recommended over vaginal hysterectomy. This type of hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for a biopsy.

Surgery combined with radiation therapy is often used to treat women with stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. It is also used to treat women with stage 2 disease.

Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.

Coping & Support:
After you receive a diagnosis of endometrial cancer, you may have many questions, fears and concerns. How will the diagnosis affect you, your family, your work and your future? You may worry about tests, treatments, hospital stays and medical bills. Even if a full recovery is likely, you may worry about possible recurrence of your cancer.

Fortunately, many resources are available to help answer questions and provide support. The key is to remember that you don’t have to face your questions or fears alone.  Some strategies and resources are given below that may make dealing with endometrial cancer easier:

*Know what to expect. Find out enough about your cancer so that you feel comfortable making decisions about your care. Ask your doctor for information about the stage, your treatment options and their side effects. In addition to talking with your doctor, look for information in your local library and on the Internet. Staff of the National Cancer Institute (NCI) will answer questions from the public. You can reach the NCI at 800-4-CANCER (800-422-6237). Or contact the American Cancer Society at 800-227-2345.

*Be proactive. Although you may feel tired and discouraged, try to take an active role in your treatment. Before starting treatment, you might want a second opinion from a qualified specialist. Many insurance companies will pay for such consultations.

*Maintain a strong support system. Strong relationships may help you cope with treatment. Talk with your close friends and family members about how you’re feeling. Connect with other cancer survivors through support groups in your community or online. Ask your doctor about support groups in your area

Prognosis:
Endometrial cancer is usually diagnosed at an early stage. The 1-year survival rate is about 92%.

The 5-year survival rate for endometrial cancer that has not spread is 95%. If the cancer has spread to distant organs, the 5-year survival rate drops to 23%.

Prevention:
To reduce your risk of endometrial cancer, you may wish to:

*Talk to your doctor about the risks of hormone therapy after menopause. If you’re considering hormone replacement therapy to help control menopause symptoms, talk to your doctor about the risks and benefits. Unless you’ve undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking a combination of estrogen and progestin can reduce this risk. Hormone therapy carries other risks, such as a possible increase in the risk of breast cancer, so weigh the benefits and risks with your doctor.

*Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after you stop taking oral contraceptives. Oral contraceptives have side effects, though, so discuss the benefits and risks with your doctor.

*Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight. If you need to lose weight, increase your physical activity and reduce the number of calories you eat each day.

*Exercise most days of the week. Work physical activity into your daily routine. Try to exercise 30 minutes most days of the week. If you can exercise more, that’s even better.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000910.htm
http://www.mayoclinic.com/health/endometrial-cancer/DS00306
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/womb_cancer.shtml
http://www.emedicinehealth.com/endometrial_cancer/article_em.htm
http://health.allrefer.com/health/endometrial-cancer-endometrial-cancer.html

http://mesotheliomaz.info/endometrial-cancer.html

http://www.medicalook.com/Cancer/Endometrial_carcinoma.html

http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html

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Soy Formula Linked To Fibroid Tumors

A study has linked soy formula given to babies with uterine fibroids in adults. Uterine fibroids are tumors of the uterus that can cause pelvic pain, vaginal bleeding, and fertility problems. Uterine fibroids are the leading cause of hysterectomy.

Twenty thousand women participated in the study. They were asked whether they had ever been diagnosed with uterine fibroids, and were also asked about a variety or early childhood exposures including whether they had been fed soy formula.

According to Baby Gooroo:
“Women who were fed soy formula as babies were 25 percent more likely to develop uterine fibroids … The link between uterine fibroids and soy formula is thought to be a response to the isoflavones (naturally occurring estrogen-like substances) in soy, and in particular, the high exposure at an early age in women given soy formula during infancy.”

Sources: Baby Gooroo February 4, 2010

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Pelvic Ultrasound and Transvaginal Ultrasound

Alternative  Names:Endovaginal ultrasound; Ultrasound – transvaginal; Sonohysterography; Hysterosonography; Saline infusion sonography; SIS
.
Definition:
Ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures inside the body. This imaging technique works in a manner similar to radar and sonar, developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible. After coating your skin with a lubricant to reduce friction, a radiologist or ultrasound technician places an ultrasound transducer, which looks like a microphone, on your skin and may rub it back and forth to get the right view. The transducer sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor.

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Pelvic organ ultrasound is used to monitor pregnancy, find cysts on your ovaries, examine the lining of your uterus, look for causes of infertility, and find cancers or benign tumors in the pelvic region. Depending on the view needed, the ultrasound sensor is placed either on your abdomen (pelvic ultrasound) or in your vagina (transvaginal ultrasound).

Pelvic ultrasound, primarily performed on females is most frequently used for evaluation of pelvic pain, abnormal vaginal bleeding, inflammatory disease, or detection of a mass. Pelvic ultrasound may help explain findings from a manual examination and provide additional information. Pelvic ultrasound examination will generally result in good depiction of the bladder, uterus, and ovaries.

In some patients, transvaginal ultrasound, which involves the insertion of a small transducer (probe) into the vagina, may be necessary to provide a complete analysis of the ovaries and uterine endometrial lining. Early pregnancy or body habitus (obesity) can obscure adequate evaluation of some structures. The decision to use transvaginal ultrasound is determined by the radiologist following pelvic ultrasound.

Pelvic ultrasound generally requires a full bladder and is performed with the patient lying flat on a padded table. Transvaginal ultrasound testing requires the patient to empty their bladder in the restroom and return to the scanning room for a transvaginal examination. Patients are asked disrobe from the waist down with hips elevated by folded towels or a foam pad. Patients usually insert the probe themselves, but can be assisted.

How to prepare for the test.
You will be asked to undress, usually from the waist down.
Your doctor might ask you to drink a few glasses of water before the test because a full bladder lifts your intestines out of the way and provides a clearer view of your pelvic organs. If you’re having a transvaginal ultrasound and have a tampon in place, you’ll need to remove it before the test.

A full bladder is essential for adequate visualization of the pelvic region.

* Finish drinking 4 glasses (32 ounces total) of water one hour prior to your appointment. It is important to drink water only. Do not substitute other beverages.

* Do not empty your bladder prior to the exam.

* Eat as you normally would before and after the examination and return to your usual or recommended activities after the exam.

To avoid delay or rescheduling of your pelvic / transvaginal ultrasound examination, follow preparation instructions carefully.

* Arrive 15 minutes prior to your scheduled appointment time to register for your test.

* The length of time needed to complete this examination will vary depending on the information needed. Plan for up to 45 minutes to complete your exam.

How the Test is Performed
You will lie down on a table with your knees bent and feet in holders called stirrups. The health care provider will place a probe, called a transducer, into the vagina. The probe is covered with a condom and a gel. The probe sends out sound waves, which reflect off body structures. A computer receives these waves and uses them to create a picture. The doctor can immediately see the picture on a nearby TV monitor.

The health care provider will move the probe within the area to see the pelvic organs. This test can be used during pregnancy.

In some cases, a special transvaginal ultrasound method called saline infusion sonography (SIS), also called sonohysterography or hysterosonography, may be needed to more clearly view the uterus.

This test requires saline (sterile salt water) to be placed into the uterus before the ultrasound. The saline helps outline any abnormal masses, so the doctor can get a better idea of their size.

SIS is not done on pregnant women.

What happens when the test is performed.

You lie on your back on a table for the test. For a pelvic ultrasound, after squirting some clear jelly onto your lower abdomen to help the ultrasound sensor slide around easily, a doctor or technician places the sensor against your skin. For a transvaginal ultrasound, the doctor or technician covers a sensor with a condom and some jelly before inserting it into your vagina.When the sensor is in place, a picture will appear on a video screen. The technician or doctor moves the sensor on your abdomen or in your vagina to see the uterus and ovaries from many different views.

How the Test Will Feel
The test is usually painless, although some women may have mild discomfort from the pressure of the probe. Only a small part of the probe is placed into the vagina.

Risk Factors:
There are no known harmful effects of transvaginal ultrasound on humans.

Unlike traditional x-rays, there is no radiation exposure with this test.

How long is it before the result of the test is known.

If a doctor does the test, you might be able to get preliminary results immediately; this will not be possible if a technician performs the test.Whether a doctor or technician performs the test, he or she records it on a videotape so that it can be formally reviewed by a radiologist. Your doctor should receive the radiologist’s report in a day or two.

Results:
Normal Results

The pelvic structures or fetus are normal.

What Abnormal Results Mean

An abnormal result may be due to many conditions. Some problems that may be seen include:

* Cancers of the uterus, ovaries, vagina, and other pelvic structures
* Non-cancerous growths of the uterus and ovaries (such as cysts or fibroids)
* Twisting of the ovaries
* Infection, including pelvic inflammatory disease
* Birth defects

Some problems that may be found specifically in pregnant women include:

* Ectopic pregnancy
* More than one fetus (twins, triplets, etc.)
* Miscarriage
* Placenta previa
* Placental abruption
* Tumors of pregnancy including gestational trophoblastic disease

Resources:
https://www.health.harvard.edu/fhg/diagnostics/pelvic-ultrasound-and-transvaginal-ultrasound.shtml
http://www.tacomarad.com/exams/ultrasound/pelvic.html
http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm

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Hysteroscopy

Definition:
Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
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The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.

Method:-
The hysteroscope is an optical instrument connected to a video unit with a fiber optic light source, and to the channels for delivery and removal of a distention medium. The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus during hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure and the patient’s condition. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally depending on the quality of the high-resolution video images in front of surgeon’s eyes, CO2 gas is not commonly used as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they are conducting electricity, these fluids should not be used with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol and a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. Each of these distention fluids is associated with unique physiological changes that should be considered when selecting a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose in the liver and is contraindicated if patients has fructose intolerance. High-viscous Dextran also has potential complications which can be physiological and mechanical. It may crystallize on instruments and obstruct the valves and channels. Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and can cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% has a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) should be avoided in fructose intolerant patients.

A hysteroscope is in fact a modification of the traditional resectoscope, which is used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for less outflow through the smaller channel. This results in the distention of the uterine cavity. With modern optical technologies, hysteroscopes are getting smaller in diameter yet able to provide larger and brighter images for surgeons’ convenience.

After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy. Typically hysteroscopic intervention is done under general endotracheal anesthesia or Monitored Anesthesia Care (MAC), but a short diagnostic procedure can be performed in a gynecologist‘s office with just a paracervical block using the Lidocaine injection in the upper part of the cervix.

Why it is Done:
Hysteroscopy is useful in a number of uterine conditions:

Asherman’s syndrome (ie. intrauterine adhesions). Hysteroscopic adhesiolysis is the technique of lysing adhesions in the
*uterus using either microscissors (recommended) or thermal energy modalities. Hysteroscopy can be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure.
*Endometrial polyp. Polypectomy.
*Gynecologic bleeding
*Uterine fibroids. Myomectomy.
*Congenital Uterine malformations (also known as Mullerian malformations). Eg.septum,
*Evacuation of retained products of conception in selected cases.

Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman’s syndrome.
How do you prepare for the test
The time that you schedule this test can be important. Your gynecologist is able to get the best view of the uterine lining during the week that follows your period. If you have regular cycles, it is helpful for you to anticipate the timing of your next period and plan to have the hysteroscopy done in the following week.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Discuss different options for anesthesia with your doctor in advance.

If your doctor plans on giving you any anti-anxiety medicines before the procedure, or if you are going to have other tests done at the same time as hysteroscopy, you might be told not to eat or drink for eighthours or more before the test. Just before the test, you should empty your bladder.

Risk Factors:

After the procedure, you may have slight vaginal bleeding and cramps for one or two days. Sometimes a small amount of the gas used to expand the uterus can float up to the top of the abdomen and remain there for a day or two before it dissolves away. This can cause some shoulder pain. Some patients experience nausea from medicines used for anesthesia or anxiety.

Some of the procedures that are done along with hysteroscopy have risks of their own. You should ask your doctor about special risks that might come along with additional procedures planned for you.

A common problem is the uterine perforation when the instrument breaches the wall of the uterus. This can lead to bleeding and damage to other organs. A life-threatening condition is the bowel perforation by the instruments after the uterine perforation, resulting in acute peritonitis which can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media described above are also not uncommon. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less then 1% of cases.

How long is it before the result of the test is known
Your doctor can tell you what was seen through the hysteroscope right away. If a biopsy sample is removed, the analysis might take several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/hysteroscopy.shtml
http://en.wikipedia.org/wiki/Hysteroscopy

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Endometrial Biopsy

Introduction:An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body’s hormone levels that affect the endometrium are in balance.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

The lining of the uterus changes throughout a woman’s menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

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There are several ways to do an endometrial biopsy. Your doctor may use:

*A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.

*A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.

*An electronic suction device (Vabra aspiration). This method can be uncomfortable.

*A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done
An endometrial biopsy is done to:

*Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
*Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.

*See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare
Tell your doctor if you:

*Are or might be pregnant. An endometrial biopsy is not done during pregnancy.

*Are taking any medicines.

*Are allergic to any medicines.

*Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).

*Have been treated for a vaginal, cervical, or pelvic infection.

*Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done
An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor’s office.

Your cervix may be numbed with a spray or injection of local anesthetic.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.

If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.

You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels
If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks Factors:
You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.There is also a small risk of disturbing a very early pregnancy. To guard against this, your doctor might order a pregnancy test before performing the biopsy.

After the test:
You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

*Heavy vaginal bleeding (more than a normal menstrual period).

*A fever.

*Belly pain.

*Bad-smelling vaginal discharge.

Results:
Time to know the results:
An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.


Endometrial biopsy  Normal
: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Endometrial biopsy  Abnormal:

*A noncancerous (benign) growth, called a polyp, is present.

*Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

*Cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endometrial-biopsy.shtml
http://women.webmd.com/endometrial-biopsy

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