Is adenomyosis a cancerous tumor?

Patient's Query

Hi doctor,

I have irregular periods with very heavy bleeding, clots, cramps, stabbing pains in my pelvic area with no pattern connecting to bleeding. Some days, I am so fatigue and cannot function. This started five years ago. I had constant bleeding following coil insertion. Then it was removed and had a miscarriage at six weeks. When I was pregnant, there was no bleeding but had spotting throughout. Since delivery I am suffering again with irregular and heavy bleeds. It became worse for the past eight months. I have IBS which is stress related. I am taking Adalat for high blood pressure, which is under control. I was prescribed Mefenamic acid and Tranexamic acid as I refused coil due to previous bleeding with one and refused Esmya due to side effects. My transvaginal ultrasound found two polycystic ovaries and bulky adenomyotic looking anteverted uterus vascular ++ on anterior wall. The size was 2 x 3 x 0.9 cm. There are no fibroids or polyps or other pelvic masses or free fluid. Then what is it?

Answered by Dr. Garima Sawhney

Hi,

Welcome to icliniq.com.

The problem which you are facing is most likely due to the adenomyosis and polycystic ovaries.

As you have not mentioned your age and the number of kids, it is really difficult to tell you the exact management. Because, management is totally age related and number of kids you have.

We can suggest you some hormonal treatment or surgical treatment based on your age and parity.

Revert back with the personal details to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Patient's Query

Thank you doctor,

I have three children and all were emergency cesareans. I am 34 years old now and had pre-eclampsia twice. My husband had vasectomy. Should I undergo hysterectomy as the symptoms are so bad?

Answered by Dr. Garima Sawhney

Hi,

Welcome back to icliniq.com.

As you are just 34 years old opting directly for hysterectomy is not a good option.

According to me, you should first undergo endometrial biopsy, which is an opd procedure (outpatient department).

Also, simultaneously you can get Levonorgestrel intrauterine device inserted which helps in reducing this kind of bleeding due to adenomyosis (uterus inner layer thickening).

In case this device does not suits you, which you will come to know within three months after insertion, then you can think of undergoing hysterectomy.

For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Patient's Query

Thank you doctor,

Are the vascular ++ area and the size made you to think of adenomyosis? Is it indicative of a cancerous tumor? The scanning gynecologist seemed very concerned about it. She also did a Doppler which is in the scans here too and it showed a large vascular area. I understand a biopsy needs to be done and nothing is known until then. I do not like to have an IUD as I had terrible bleeding from one before. I have already refused this option when they told me.

Answered by Dr. Garima Sawhney

Hi,

Welcome back to icliniq.com.

Regarding vascular area, this could be due to adenomyosis. Adenomyosis has only 1% chance of turning out to be cancerous and 99% are non cancerous.

There is no specific thing by which we can take the biopsy from that area particularly. So, I had advised you endometrial biopsy which will give us some hint if it is cancerous.

There are blood tests which you can do like CEA (carcinoembryonic antigen), CA 19-9, CA125, AFP (alpha-fetoprotein) or beta hCG (human chorionic gonadotropin) which can give us idea whether it is cancer or not.

Get MRI pelvis to rule out cancer.

If these tests come negative then definitely this is not cancer and you can first go for medical therapy. If it fails then you can go for hysterectomy.

If this comes positive for cancer then only hysterectomy directly is the first line of management. Take care.

For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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