Gyn question: does biopsy always mean suspected cancer?

PurpleCat

I'm not really sure where to put this question, but it seemed like other women with whacked-out hormones might be most likely to have had similar experiences, so here goes:

I'm all hung up on the word "biopsy," which the gynecologist at my cancer center's multispecialty clinic used a couple of days ago upon seeing a small abnormality on my exterior parts when I went in to ask for an Estrace prescription. She didn't seem terribly concerned, suggested that it might well go away with the Estrace, but also said that we'll reassess in 3 months at my followup and biopsy if necessary, citing my history with breast cancer and and complex atypical endometrial hyperplasia. I was completely caught off guard and deflated. I've had a complete hysterectomy and not only am I STILL at risk for a gyno cancer in the diminished fraction of my decimated sexual/reproductive tract that remains, but it might already be developing? But I'm realizing I completely take the word "biopsy" to mean "we need to rule out cancer" when it may just mean they want to find out what it is and aren't particularly worried about cancer at all. Can anyone shed more light?

FWIW, as best as Dr. Google can inform me, it sounds like it might turn out to be the very earliest stages of lichen sclerosis, and if so, I'm lucky to be catching it so early. But all I can think about is that once again I have something that might be cancer. Is this just going to be my life from now on?

Beesie

I don't know about the diagnostic process for gyn lesions, but I know for breast lesions that anything with a 2% or higher risk of cancer is biopsied. Less that 2% is managed with short term follow-up screening.

So while a biopsy usually is done "to rule out cancer", it doesn't mean that cancer is suspected. More often, it's not. Since in your case a biopsy isn't being recommended now but was just mentioned as a future possibility, if it's similar to breast conditions, this would mean that your gyn assesses a less than 2% risk.

wallycat

What beesie said.

Having a concern and ruling it out is being a good doctor. I had two uterine biopsies "to rule out" cancer. Both were b-9. First time was a thickened endometrium from tamoxifen; second ended up being 3 polyps (no doubt from tamoxifen).

I am sorry you are going through this. Some people are hypervigilant and take it in stride; others get stressed over it. I'm in the stressed category. Each time something is found that "might be," I get anxious. The truth is that people without previous dx also need to be health-vigilant, it is just that once we've had cancer, we are at higher risk for new cancers.

moth

Would it help to think of it as "i need my friend the pathologist to look at it and she's really near sighted"

Looking at cells themselves is just such s helpful thing. Getting the cell on a slide under a microscope can help diagnose many things and most of them are not super dangerous...just weird conditions that arise from cells multiplying and interacting with their environment. There are a while bunch of weird things that cells do before going malignant..

Sounds like your doctor's being very thorough and proactive and you're in good hands!

PurpleCat

Thank you, all. Beesie, I had forgotten about the 2% rule with mammograms, so it helps to put this in perspective. Wallycat, it helps me to know I'm not the only one who thinks this way! Just want to be done with cancer, and it's so disheartening to think that every tiny thing for the rest of my life is going to warrant further investigation. Moth, I really like the phrase "My friend the pathologist." Yes, that does help!

Guess if there's anything I've learned in all of this, it's that there's no point in thinking about cancer outside of the moments when you really can't avoid it, and it would be so stupid to waste 3 months in worry if it turns out to be nothing ... or even if it doesn't, then I've wasted what could have been 3 carefree months. So, I'm just going to keep applying the Estrace and try not to think about it for 3 months.