Is it possible that cancer can be hidden in the uterus when a D&C shows no sign of cancer? The woman in question is 75 years old with a thick uterus and some pelvic pain. She also had some spotting for a few days. She had an ultrasound and a D&C. Her doctor wants her to have a hysterectomy as a precaution. Is this unnecessary surgery when there aren't any cancer cells?

--JB

I'm not exactly sure what you mean by a "thick uterus," but if you mean the uterine lining is thick, then yes, that could be worrisome in a 75-year-old. This condition warrants sampling of the uterine lining, such as with a D&C (dilation and curettage, which involves opening the cervix and scraping out the uterine lining). If by "thick uterus" you just mean her uterus is big, then that could be something benign like a fibroid.

To answer your first question, it is possible that a D&C can miss cancer cells. It is a blind procedure, meaning we can't see what we are scraping and small areas of the uterine lining may remain in place. Adding a viewing procedure called hysteroscopy allows us to actually look inside the uterine cavity and lowers the chance of missing an abnormal area. Even if these procedures don't produce evidence of cancerous cells, they can detect abnormal cells, which may be cause for concern. There is a condition called hyperplasia, which, while not cancer, may progress to cancer.

As for whether the recommended hysterectomy is unnecessary, it's impossible for me to say without examining your friend and reviewing the appropriate ultrasound and pathology reports. She should go back to her doctor and ask exactly what the pathology report showed (and ask for an explanation in simple, lay terms!). She should also ask and understand exactly why major surgery is being recommended.