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Re: How do you approach this one?From: Atkinson, Samuel M (ATKINSONS@mail.ecu.edu)Fri Jan 13 15:28:06 2006
You could solve the problem by running genetic testing for BrCa. The cost is about $2500. Taking out ovaries does does not protect genetically predisposed pts from "primary peritoneal carcinoma". which is indistinguishable from ovarian and colon ca. If she has the gene, she needs? careful following of breast and colon as well. simply removing the ovaries does nothing to protect the predisposed. It may help the pt with sporadic cancer, i.e., non genetic risk which is, I believe roughly equivalent to the risk of prophylactically performed oophoroectomy. For the average pt it would be important to know if she had the gene..which she could have passed on to her offspring. Taking out ovaries does nothing to let her children know about their genetic predisposition. In that this pt has no offspring it is a mute point. But for most pts it would be more more important to know about their future than mothers. While BSO may or may not protect mother, it will not forecast the risk to her offspring. PS..The fallacy of doing CA125's and untrasound has been recently reaffirmed in the NIH study on BR,OV,Colon,Prostte. REPORT. TtHEY ONLY FIND THE DISEASE IN AN INCURABLE STATE. WE HAVE NO EARLY SCREENING TECHNIQUE FOR OVARIAN CARCINOMA.. tob-gyn-l@obgyn.net <mailto:tob-gyn-l@obgyn.net> on behalf of Garry E. Siegel, M.D. Sent: Thu 1/12/2006 9:22 PM To: Multiple recipients of list OB-GYN-L Subject: Gyn: How do you approach this one? 45 YO P0001 (one adopted 7 year old) presented a couple of weeks ago for a second opinion. Her mother has had ovarian cancer, and the patient was undergoing twice yearly surveillance with Ca-125s and ultrasounds. The first ultrasound showed a 7 cm. unusual adnexal mass which was likely a pedunculated fibroid by MRI. This was barely palpable (more "sensed") on bimanual examination. Long story short, she came back and wanted a hysterectomy-BSO, and asked/preferred an LAVH-BSO so she could recover more quickly and go back to work. At her preop exam this week, I went to assess her pelvic arch (for vaginal surgery) and she was quite uncomfortable during the exam--like a virgin, frankly--and it made me think that even if I controlled the vessels from up top, that getting uterosacral and cardinal bites might be problematic at best. She was told that up front, and agreed to proceed. At exam under anesthesia today, her arch was a bit narrow, and her introitus was tight--again, almost virginal. I am starting to think that she may be virginal or perhaps not heterosexual, although we never explicitly discussed sexual function other than me discussing the influence of hysterectomy on sexual function. I believe she said "it has been years" or something similar. So. . .I want to ask her if she is indeed virginal, or homosexual, and am wondering how to do so. I am thinking: "Mary (not her real name), your vaginal opening was constricted and made me think that you've not had heterosexual (penis in vaginal) intercouse. Did I miss asking you something? Any thoughts welcome. Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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