Unexplained Pain: Gynecological Concerns and Early Detection

Unknown pain

Hello Dr.
Lin:
(1) How are vaginal cancer and endometrial cancer examined? Is it the same as doing an ultrasound?
(2) Do we have to wait until there are symptoms to discover these diseases? How can we prevent them early? What are the symptoms?
(3) For some gynecological diseases, aside from the cervix where Pap smears can be performed, do the others only get discovered when there is pain or abnormal phenomena?
(4) I heard from a nurse friend that women with polycystic ovary syndrome (PCOS) are more likely to develop endometrial cancer.
Is that true? Could PCOS be somewhat caused by obesity? Would weight loss help improve this condition? I previously asked you about a pain I feel on the right side of my abdomen near the navel, which has been frequent lately.
I consulted a gynecologist and asked if it could be pelvic inflammatory disease.
She pressed on my abdomen and asked if it hurt, to which I replied no.
The gynecologist then said it was not pelvic inflammatory disease and mentioned that the area of pain did not fall under gynecological issues, advising me to see a gastroenterologist.
Later, I visited a hepatobiliary and gastroenterology specialist who performed an ultrasound and said everything looked normal with no abnormalities found.
She also mentioned it could possibly be a gynecological issue, but I didn’t tell her I had already seen a gynecologist.

(5) I find it strange that both specialists said there was nothing wrong.
Which specialist should I see?
(6) The gastroenterologist suggested I could undergo a colonoscopy.
Is that related to the colon? Can ultrasound not visualize the colon? And could it be related to the kidneys as well? Thank you, Dr.
Lin.

An An, 20~29 year old female. Ask Date: 2007/01/30

Dr. Lin Zhaopei reply Obstetrics and Gynecology

1.
Vaginal cancer is extremely rare, while endometrial cancer typically presents with abnormal bleeding in its early stages.
The definitive diagnosis for both is made through biopsy rather than ultrasound.

2.
Vaginal cancer can be easily detected through Pap smears, while endometrial cancer can be screened regularly using ultrasound.

3.
Routine women's health examinations include Pap smears, pelvic exams, and ultrasounds.

4.
Women with polycystic ovary syndrome (PCOS) have a higher risk of developing endometrial cancer, and obesity is one contributing factor, as the ovaries cannot convert male hormones stored in fat into female hormones.
Weight loss is also one of the treatment options.

5.
Chronic pelvic inflammatory disease (PID) can potentially lead to pain in the right upper abdomen due to inflammation and adhesions of the falciform ligament of the liver.

6.
Consider consulting a third gynecologist for a second opinion.

7.
It may be related to the colon, but given your age, the likelihood is very low.
Ultrasound cannot visualize the colon due to its gas content, but a general abdominal ultrasound will typically show the right kidney.
Since an abdominal ultrasound has already been performed, there is no need to consult a nephrologist.

Reply Date: 2007/01/30

More Info

Understanding unexplained pain, particularly in the context of gynecological concerns, can be quite complex. Your questions touch on several important aspects of women's health, including cancer screening, symptom recognition, and the relationship between various conditions. Let's break down your inquiries systematically.

1. Screening for Vaginal and Endometrial Cancer:
To detect vaginal and endometrial cancers, healthcare providers typically use a combination of methods. While transvaginal ultrasound can be helpful in assessing the uterus and ovaries, it is not definitive for diagnosing cancer. For endometrial cancer, a more specific test is an endometrial biopsy, where a small sample of the uterine lining is taken for examination. For vaginal cancer, a visual examination and biopsy of any suspicious lesions are necessary. Regular gynecological exams and discussions about any unusual symptoms are crucial for early detection.

2. Symptom Awareness and Early Detection:
Many gynecological cancers can be asymptomatic in their early stages, which is why routine screenings and awareness of one's body are essential. Symptoms that may indicate a problem include abnormal bleeding, unusual discharge, pelvic pain, or changes in menstrual cycles. However, not all women will experience noticeable symptoms before a diagnosis, which is why regular check-ups are vital.

3. Screening Beyond Pap Smears:
While Pap smears are effective for cervical cancer screening, other gynecological issues may not present symptoms until they become more severe. Conditions like ovarian cysts or fibroids may be asymptomatic initially. Therefore, women should be proactive about their health, discussing any changes or concerns with their healthcare provider, even if they do not experience pain or discomfort.

4. Polycystic Ovary Syndrome (PCOS) and Cancer Risk:
It is true that women with PCOS may have an increased risk of developing endometrial cancer. This is often due to prolonged exposure to estrogen without the counterbalancing effect of progesterone, which can occur in women who do not ovulate regularly. Obesity is a common concern in PCOS and can exacerbate this risk. Weight management through diet and exercise may help regulate menstrual cycles and reduce the risk of endometrial hyperplasia and cancer.

5. Navigating Healthcare Providers:
If you are experiencing persistent pain and both gynecological and gastrointestinal specialists have not identified a cause, it may be beneficial to seek a multidisciplinary approach. Sometimes, unexplained pain can be related to conditions that overlap between specialties, such as endometriosis, which can cause gastrointestinal symptoms. A referral to a specialist in pelvic pain or a comprehensive women's health clinic may provide further insights.

6. Colonoscopy and Gastrointestinal Concerns:
A colonoscopy is a valuable tool for investigating gastrointestinal symptoms, particularly if there is a concern about the colon. While ultrasound can assess some abdominal organs, it may not provide detailed information about the colon. If your pain is localized and persistent, and if gastrointestinal symptoms are present, a colonoscopy may be warranted to rule out conditions like inflammatory bowel disease or polyps.

In conclusion, unexplained abdominal pain can stem from various sources, and it is essential to maintain open communication with your healthcare providers. Regular check-ups, awareness of symptoms, and a proactive approach to health can significantly aid in early detection and management of potential issues. If your symptoms persist, consider seeking a second opinion or consulting a specialist who can provide a comprehensive evaluation of your condition.

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