Dr. Keith Roach
DEAR DR. ROACH: I have had numerous endometrial biopsies and two D and C’s. A while ago, I had a little bit of spotting. I had an endometrial biopsy done, and the doctor said I have simple hyperplasia. Can I get cancer from this? And will the hyperplasia go away when my periods stop? I am 52 years young. Is a hysterectomy needed? — A.V.R.
ANSWER: Endometrial hyperplasia (literally, “too much growth in the lining of the uterus”) is caused by excessive amounts of estrogen acting on the glands of the uterus with not enough progesterone to counteract it. The growth of the cells lining the uterus is described as “simple” or “complex,” and there usually is a comment made about whether there are abnormal cells present, called cellular atypia.
For women who have endometrial hyperplasia with atypia, the risk of developing endometrial cancer is as high as 30 percent. Hysterectomy is recommended for women with cellular atypia if they do not plan on having more children. In women with no atypia, the risk for developing uterine cancer is very low — between 1 percent and 3 percent. Periodic sampling of the lining of the uterus (that’s the endometrial biopsy) is done to make sure there is no cancer. Progesterone medications often are recommended, and up to 80 percent of women will have their biopsies return to normal with treatment.
Since estrogen production reduces by about 50 percent at menopause, the endometrial hyperplasia usually goes away then.
Any spotting after menopause is completed needs to be taken very seriously indeed, since the risk of cancer then is high.
DEAR DR. ROACH: I am a 61-year-old man in good general health. Several weeks ago I started bleeding through the rectum. I went to the emergency room, and the bleeding stopped on its own, but the doctor estimated that I lost two units of blood. He said he “couldn’t rule out colitis,” while the GI doctor suspected diverticulitis, and my family doctor thought I had E. coli food poisoning from bad beef. I had no pain, no fever and only slight cramping. I had a malignant polyp removed four months previously.
Have you ever heard of this type of bleeding, and is there a likelihood it will recur? — Anon.
ANSWER: There are several possibilities. Your gastroenterologist has my vote as most likely. Diverticula are little outpouchings in the lining of the bowel, especially in the sigmoid colon — the final section of the large intestine. Diverticulosis is the condition of having these diverticula, and it becomes “diverticulitis” when they become infected, often causing pain and fever. However, bleeding is more common in diverticulosis without diverticulitis. If it is coming from the diverticula, the risk of recurrence is high.
Colitis is a good thought as well, but there are several kinds. Inflammatory bowel disease is a type of colitis; ischemic colitis also is possible. Colonoscopy, sigmoidoscopy or proctoscopy — visual inspections of the colon or rectum — can make these diagnoses. Infectious colitis, e.g. E. coli, cause bleeding when they are invasive — and that means fever and at least 48 hours after the infected meal, so I think that diagnosis is unlikely.
Given your history of a cancerous polyp, it’s possible but unlikely that a second polyp or cancer was missed during your previous colonoscopy. Twice in my career I have seen a hemorrhoid bleed out more than a unit of blood. One other unusual cause is an A-V malformation — abnormal connections between arteries and veins — present in less than 1 percent of the population.
The follow-up colonoscopy you are already scheduled for is likely to help sort out these possibilities.
TO READERS: The booklet on colon cancer provides useful information on the causes and cures of this common malady. Readers can obtain a copy by writing: Dr. Roach — No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.