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Forum Name: Endometrial Cancer

Question: Please add direction


 Anonymous - Thu May 08, 2003 11:36 am

I began w/ family Dr. many months ago for a pain in the LUQ, proximinal to adrenal gland. Severe fatigue and at that time abnormal menstration. Abnormal being every 10 days, terrible cramping and about the 7th day severe diarrhea lasting 3 days, then the cycle beginning again. I was told it was reflux and dreaded the next 3 visits with the same complaint. The 4th visit was with the NP, told it was gastrointestinal something and I requested a Pap, may as well while I was there. The Pap was abnormal and I followed up with a GYN and colposcopy. On 3/6/3 I had a cone biopsy and vaginal complete hysterectomy. Dianosis Stage1A1 adenocarcinoma of the cervix. No lymphs were biopsied that I know of. I have more detail on the tissue diags if it would help. I've spoken with the surgeon numerous times via phone since with the same LUQ pain, bladder contractions, low back pain (similiar to labor pain), and cramping. I was told this is normal. Two weeks ago I went to urgent care, with the same pains, terrible fatigue and ill feeling. UA was done and clear. I was told of anemia I had after the surgery and still in recovery period. The cramping is on both sides and I know I have the right ovary and apparently some of my left ovary that was suppose to be taken in 1986, I was told cancer, but Dr. notes apparently say cyst. Darn glad I'm a nursing student, but still confused and frustrated. All of the above, and back to the cramping every 7 days, bloating, loss of appetite, no weight loss, unsymetrical thighs and seems pitting behavior. I'm questioning whether a CA-125 assay, pelvic ultrasound, or whatever test maybe valuable. UC physician suggested follow up with family doctor and I feel I've hit a dead end there. Would follow-up with GYN be more appropriate now or wait until middle of June for surgery follow-up appointment. I really like to have a nurse in the room, not because I feel uncomfortable with the Dr. doing the procedure, but I can get a non-medical answer to my questions. But I feel uncomfortable making this request, because I don't want to offend a male Dr.
 Dr. Jeffrey Gordon - Fri May 09, 2003 10:32 am

Eskimopup,

Thanks for your posting. It seems very appropraite that you seek the medical evaluation of a GYN specialist given the continued problems that you are experiencing. I am not implying to overstep the role of a GYN docotor, but you should seek the evaluation as well of a GYN Oncologist for a thorough work-up of your problems. Your problems may not be related to any cancer issues, but your symptoms are not specific enough to be diagnostic of any particular problem, thus the need for a thorough re-evaluation of what is going on. A CA-125 level can be helpful if it is significantly elevated, but other non-malignant processes can mildly or moderatley elevate its level. Nevertheless, I would obtain such a test.

Have you had a pelvic ultrasound or CAT scan imaging of the abdomen and pelvis regions?

Do you have more detailed information about the pathology report outlining "adenocarcinoma of the cervix"? What information is present to declare the cancer a Stage IA1?

You should not feel embarassed or shy in asking for a female health care worker (such as a nurse) to be present when a male doctor performs a GYN exam. In my practice, whenever I perform such an exam or even a digital rectal exam on a female patient, I have one of my female nurses present. This is not just for legal reasons, but I believe it provides a level of comfort for my female patients.

Likewise, you should not feel that you are disturbing or disappointing a doctor in asking a non-physician to explain what is goin on. Sometimes doctors don't have a lot of time to explain everyhting or tend to explain it in technical terms that are not always easy to understand. You should know what is goin on with your medical evaluation and should be an active part of it. Asking questions is part of the process. That is how I view it.
 Eskimopups - Sun May 11, 2003 11:25 am

This is right off my hospital summary and mostly means absolutely nothing to me, so if there's incomplete or too much info I apologize.

Tissue Description
Uterus (85grams; endometruim curettings 2x1.2x1cm; endocervix curettins 8mm) and conization of the cervix (3.3x3x1.7cm). CR03-1907 A1, A2, A3, A4, A5, A6, A7, A8, B1, B1, C1, C2, C3, C4, C5, C6

Diagnosis
Multifocal areas of endocervical adenocarcinoma in situ are identified. Focally the endocervical margin is positive in the 9-10 o'clock position.
Residual endocervical adenocarcinoma in situ is identified with a focal area of superficial invasion (less than 2mm invasion).
The endometrium is proliferative phase.
The myometruim is unremarkable.
Proliferative phase endometruim.
Endocervical mucosa and stroma.

I did have a pelvic ultrasound done prior to the surgery, but not after and no CAT scan ever.

The surgeon also mentioned removal of some lymph node prior to surgery and when I asked why the sagittal incision, rather than the transverse pelvic, it was explained in the event of the removal of this lymph node. I had a vaginal hysterectomy, so I know that the para aorta lymph node wasn't removed. I'm wondering where this lymph is located in relationship to the pain I have in the LUQ. I know that when there are swollen lymphs in the groin or neck they are tender and are generally worse in the morning when there is little activity. I'm wondering if this LUQ pain is possibly this lymph, I don't know where this lymph is located. This pain is worst in the morning before I get out of bed and when I'm up and moving it lessens and sometimes goes away. I feel my pain tolerance is great and upon wakening it is probably an 8. I've learned that if I'm up it lessens, so it's a great effort to "drag myself out of bed".

Dr.s have cooralated this pain with constipation, maybe from their exams and respiratory. I'm confident that my bowel routine is normal with the exception of the diarrhea at the 7th day of my cycle. I have asthma and WBC was high for histamines. Chest x-rays were clear and I haven't noticed any allergy or asthma problems.

My personal feeling with the exams with a physician is that a nurse should be present, not for the legalities, but because generally they are female and can relate...their job is to educate as well. If I'm able to describe in detail, the nurse is not only able to relate to the experience but has medical and personal knowledge as to the description. I know how time is a factor, I don't think the legalities is what a Dr. should consider as a factor of whether a nurse is present, but the quality of care. I don't ask for a nurse's presence not because of being uncomfortable, but because of the Dr.s time restraints and the implication that I may feel uncomfortable. My personal opinion is anytime a physician is with a patient a nurse should be present, for educational and follow-up purposes. Working in healthcare I see the nurse isn't present many times and that interferes with the quality of care. Not only does it require extra time of reading Drs. notes, but often there are questions that aren't in take home pamphlets and nursing education that a patient thinks of that are significant.

Besides even though I work in healthcare and I'm a nursing student, I don't know everything my Dr. may be explaining to me either. I am my ownly advocate, but I'm not likely to seek further care because there may be a connotation of some sort. Many being a hyprochondriac, after being told "its a normal healing process". The forum is great as far as pointing me in a direction in that although each Dr. at my facility has the same access to my records, I'm getting direction from them in that they don't want to step on one another's toes in their specialty. Urgent care treats the complaints and refers to family Dr., Surgeon refers it's "normal healing" see family Dr.; family Dr. refers surgeon says complaints "normal healing" and he sees 100's of patients and doesn't remember my original complaints. I'm referring that although I'm in this healthcare circle, I need direction that I refer to the specialty that most meets my needs and stop the pass the buck. Which I feel from your response it would be my GYN and suggest the CA-125 assay, pelvic ultrasound and CAT scan.

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