Perfect Predictor of Uterine Cancer: Not Possible

The other day on my radio show I had a caller that wanted me to tell her which physician's advice to follow, or at least suggest a solution for resolving the clearly divergent pieces of advice. Although I didn't take careful notes, so I am paraphrasing here (in case you are reading!) apparently one  physician recommended only a small suction biopsy to determine why the lining was abnormal, and the other physician advocated a large battery of tests combined with a visual inspection with a hysteroscope, a full D and C, as well as apparently an MRI test. It wasn't clear to me whether those tests were to be done regardless of the findings of each step along the way or not. and it is tough in medicine when your second opinion is so widely divergent, you almost feel you are forced to get that third tiebreaker opinion. So lets look at a few facts. Endometrial biopsies are accurate, D and Cs are more accurate still, but in fact, almost 1/5 women may still have cancers growing into the wall of the uterus that cannot be detected is in fact an actual hysterectomy is performed on women who have lining changes that stop short of cancer on the D and C test! Using a hysteroscope to visualize the interior of the uterus and make sure sampling is accurate helps detection, but some worry that the fluid medium pushed through the uterus into the fallopian tubes can be potentially spreading cancerous cells if they happen to be abundant in the uterus. This theory has mostly been disproved. Just to throw a bit of a wrench into the discussion. pathologists cannot always agree on what is going on with the lining of the uterus. Some changes that are cancerous look just precancerous and visa versa.


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