Published: February 25, 2009 08:45 am      

Ask the doctor: Spotting could be a sign of cancer

Judy, not her real name, was a 39 year-old who did not know the other 60 year-old woman named Delores. They had almost everything in common, including a female cancer that eventually stole the life away from one of them.

Seventeen years ago, Judy came to my office for a second opinion regarding questions about her moods and hormone levels. But, what caught my attention during her initial encounter was that she was 80 lbs. over weight, had diabetes, high blood pressure, irregular menstrual cycles, and vaginal spotting in between her menstrual periods a couple of times within the past year. After addressing her main concerns, I then recommended she undergo a sampling of the lining of the uterus.

Even though she had symptoms suspicious for endometrial cancer such as irregular painless menses and spotting in between menstrual periods, and had three of the four high risk factors for endometrial cancer that included being close to the age of 40 or older, being significantly over weight, had high blood pressure and had diabetes, she called and canceled the scheduled office endometrial biopsy. At least Judy had the decency to call and cancel the endometrial biopsy appointment, as opposed to just not showing up.

I still vividly recall my thoughts yet today. My relationship with Judy, though short term at the time, was fairly well developed during our initial 60 minute office visit. Her show of respect toward other women in need of my services, my office staff, and me professionally by way of her call to cancel her biopsy appointment triggered me to make one of the most important phone calls in my career still today. You see, Judy’s medical problems truly made her a set up for endometrial cancer, just like Delores, the 60-year-old woman I’ll introduce to you a bit later. Something inside me, and I truly feel was the hand of God told me I had to call Judy back, even though it’s not what is usually done by most medical professionals this day and age.

Judy received my phone call very kindly. After I reiterated my reasons for her to undergo an endometrial biopsy, she was quiet for about five seconds. Knowing she didn’t know what to say, I said, “Judy, if you undergo this simple and fairly painless endometrial biopsy and it is negative, you have not lost anything and you may gain peace of mind.” She startled me when she said, “I called my regular gynecologist who I saw for my annual exam last month but obviously was not interested in addressing my moods and hormone imbalances. She told me that I didn’t need that endometrial biopsy and that you, Dr. Hetz, were trying to take me for a ride, just to make a lot of money.”

I was emotionally numbed by Judy’s words. I found the inner strength to say to Judy, “I am not that type of doctor or that type of person. My knowledge of endometrial cancer is possibly sharper because my aunt Delores, who I dearly loved and respected, died unnecessarily from endometrial cancer at age 62. You see, my aunt Delores told her doctor about her vaginal bleeding the second time she experienced spotting. By that time, one year later, the cancer had spread outside her uterus. My phone call to you today is to help you avoid making the same mistake that my aunt Delores made a few years ago.”

Endometrial cancer is fairly common. If caught early, it’s a very treatable and curable cancer. However, if vaginal spotting is not evaluated the first time it occurs, and a woman actually has endometrial cancer, then this potentially deadly cancer can grow and penetrate to the outside tissues of the uterus, making it very difficult to cure.

To make a long story short, Judy came in and had her 30 second endometrial biopsy. Nowadays, an endometrial biopsy is practically painless. I prescribe a powerful anti-inflammatory medication, like Cellbrex, the night before the biopsy. I then numb the surface of the cervix with Hurricaine spray before injecting the cervix with an injectable Lidocaine. Finally, I slowly infuse additional Lidocaine into the uterus before obtaining the sample using a state-of-the-art disposable, tiny, flexible, soft, plastic suction device.

Yes, Judy did have endometrial cancer. Yes, she required a vaginal hysterectomy, laparoscopic removal of her ovaries and tubes, and sampling of her pelvic lymph nodes. Luckily, her cancer was not an aggressive type and had not spread outside of her uterus. She did not require radiation treatments or chemotherapy because the cancer was caught in its earliest stages.

As you now realize, my Aunt Delores was the other 60 year-old woman. She lived most of her life in Davenport. Like Judy, Aunt Delores had diabetes, high blood pressure, and was significantly over weight. Aunt Delores died in 1983 after a very courageous battle with advanced endometrial cancer.

It was during my wedding reception in January 1982 that my Aunt Delores told me that her “spotting started again.” She apparently had one day of vaginal spotting one year previous. She did not inform her doctor because “it happened only once.” Even though I was only in medical school at the time, I knew immediately, as she danced with me, that her recurrent vaginal spotting was something more serious. Her three week delay in seeking a medical evaluation, until after my wedding reception, was not what caused her to lose her life. It was my Aunt Delores’ decision not to report her first episode of vaginal spotting that resulted in her unnecessary premature death.

Vaginal spotting at any time and at any age, whether it occurs after intercourse or in between a menstrual cycle, is never normal and should be evaluated. Thankfully, vaginal spotting is not always cancer, since it can be caused by an infection, a benign polyp inside the cervix or uterus, or precancer cells inside the cervix or uterus. There are a lot of Judys and Aunt Delores’ out there who have had a single episode of spotting and are waiting for their spotting to reoccur one more time before notifying their gynecologist. Don’t wait!



Dr. Nolan Hetz is a gynecologist and is a female bladder control specialist who practices at the Quality Care Clinic in Clinton. If you have a question for Dr. Hetz to answer in a future “Ask the Doctor” column, you may e-mail him at nolanhetz@yahoo.com or call 242-3208.