American Medical Association Family Medical Guide - American Medical Association [586]
D and C
In a D and C (dilation and curettage), the lining of the uterus is surgically removed to terminate a pregnancy, treat an incomplete abortion or miscarriage, or determine the cause of frequent or heavy periods. During the procedure, you will probably be sedated and receive some other form of anesthesia. The doctor will gradually widen your cervical opening so he or she can insert instruments to remove the tissue from the uterus with suction or with gentle scraping; the tissue is then examined under a microscope. A D and C is often combined with another procedure called hysteroscopy (see page 849), in which a viewing instrument is inserted through the cervix to enable the doctor to see the exact location of any abnormal tissue. Hysteroscopy can also be used to remove a lost IUD.
A D and C usually takes about 15 minutes. You should be able to go home the same day or the next morning. You will probably have vaginal bleeding for a few days and may have some pelvic and back pain. To reduce the risk of infection, avoid having intercourse or using tampons for 2 weeks (or for as long as your doctor recommends). You can resume most other activities after a few days.
D and C
During a D and C, a doctor inserts instruments called dilators to open up the cervix and inserts an instrument called a curette to gently scrape away the lining of the uterus.
Cancer of the Uterus
Most cancers of the uterus start in the endometrium (the lining of the uterus). After growing in the lining, the cancer can invade the wall of the uterus and, if not treated, spread to the fallopian tubes, ovaries, nearby lymph glands, and other organs. The precise cause of uterine cancer is not known, but it appears to be related to excessive exposure to the hormone estrogen, which can occur in women who have never been pregnant or who have taken the hormone estrogen in hormone therapy (see page 853) for many years without the counterbalancing hormone progesterone. Other risk factors include obesity (because obese women have higher levels of circulating estrogen), diabetes (see page 889), and high blood pressure (see page 574). In a small number of women, cancer of the uterus is caused by a mutation in a gene that also predisposes them to colon, breast, and ovarian cancer.
Cancer of the uterus occurs most often between ages 50 and 70 and is more common in whites than in blacks. Uterine cancer is less likely to be fatal than most other gynecologic cancers because it tends to grow very slowly and it is easier to diagnose at an early stage.
Symptoms
The most common symptom of uterine cancer is abnormal vaginal bleeding. The most obvious symptom of uterine cancer is vaginal bleeding in a woman who has gone through menopause and who has not had periods for some time. Women who are still menstruating may have unusually heavy periods or bleeding between periods. A woman may also have a vaginal discharge that ranges from a watery, pink fluid to a thick, brown, foul-smelling discharge. Uterine cancer may or may not cause intermittent pain similar to menstrual pain.
Diagnosis
If you have any irregular vaginal bleeding, your doctor will perform an endometrial biopsy (see page 849) to take a sample of endometrial tissue from the uterus for examination under a microscope. This procedure is done in the doctor’s office, takes only a few minutes, and produces only minor, temporary discomfort. A doctor may also perform a hysteroscopy (see page 849) or a D and C (see left) to diagnose cancer of the uterus.
Treatment
When cancer of the uterus is confirmed, the standard treatment is surgical removal of the uterus, along with the ovaries and fallopian tubes, in a hysterectomy (see below). Radiation therapy (see page 23) and sometimes chemotherapy (see page 23) may be used instead of—or in addition to—surgery. If the cancer is detected at an early stage, your chances