How did a third biopsy reveal endometrial cancer?

Question

Hello doctor,

My grandma is 69 and had postmenopausal bleeding, but the first two biopsies were normal. Symptoms continued, though.

How does a 69-year-old get two clear biopsies before a third reveals endometrial cancer?
Do biopsies miss cancer often in older women?
Should hysteroscopy have been done earlier?

Ultrasound later showed focal thickening despite earlier normal reports. Final hysteroscopy-guided biopsy confirmed grade 2 endometrioid carcinoma. We feel angry and confused about the delayed diagnosis. We worry if the delay worsens the prognosis.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I’m really sorry your family is going through this; it’s upsetting and confusing to see reassuring tests followed by a cancer diagnosis. What happened can occur because the common office biopsy, often called an endometrial biopsy, samples only a small, blind portion of the uterine lining, so if the cancer is focal or sitting in a polyp or a limited thickened area, it can be missed on one or even more than one attempt.

This is especially true when imaging later shows focal rather than diffuse thickening, because the abnormal tissue may not be in the path of the sampling device. In contrast, a hysteroscopy allows direct visualization of the uterine cavity and targeted biopsy of suspicious areas, which is why it often detects disease that blind sampling can miss.

Most guidelines suggest that persistent postmenopausal bleeding, even after a normal biopsy, should prompt further evaluation, such as repeat imaging and often hysteroscopy, so your question about whether it should have been done earlier is a fair one to discuss with her care team.

While delays are understandably distressing, many grade 2 endometrioid cancers are still very treatable when found at an early stage, and prognosis depends more on the final stage, depth of invasion, and spread rather than the number of weeks or a few months to diagnosis.

It would be reasonable to ask her doctors about the stage, imaging, and planned treatment so you have a clearer sense of outlook, and to share your concerns about the diagnostic pathway so they can explain what happened in her specific case.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.