Re: Post-menopausal cyst
From: art fougner, md (evsono@pipeline.com)
Mon Jul 17 10:01:36 2000
Yup -
i call that the "God Theory"
art
At Mon, 17 Jul 2000, Richard Chudacoff, MD wrote:
>
>Sometimes patients make the right decisions for the wrong reasons.
>
>Rick
>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of art
>>fougner, md
>>Sent: Saturday, July 15, 2000 9:40 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Post-menopausal cyst
>>
>>Joanne -
>>
>>last year we had the flip side case. a 1 yr postmnopausal 52 y/o woman
>>was referred for an ultrasound with a bordeline levated ( ~ 50 ) CA 125
>>ordered reluctantly by her gyn because she insisted. the ultrasound
>>confirmed the pelvic exam - no abnormal masses. because a recent
>>publication on screening CA 125 's in The Lancet had suggested a 3 month
>>repeat f the CA 125 in those cases, that was suggested to the referring
>>gyn. The patient, however, chose not to wait and got the test done 2
>>mos later. The CA 125 was 1000! repeat sonogram again failed to
>>demonstrate abnrmal adnexal mass. However, this time a fair amount of
>>free pelvic fluid was noted. further w/u failed to explain the new
>>onset free pelvic fluid with CA125 elevation and the patient was
>>explored, at which time disseminated intraperitoneal carcinomatosis was
>>found - diffuse implants of papillary serous tumor without a discrete
>>primary mass. in fact, aside from surface studding, the ovaries were
>>quite nl in appearance. so perhaps the CA 125 should not be discarded
>>so quickly.
>>we still have so far to go in the diagnosis and treatment of ovarian
>>cancer. perhaps with the advances in genomics, better markers can be
>>found to help better stratify risks.
>>
>>art
>>
>>At Sat, 15 Jul 2000, Joanne Bulley, MD wrote:
>>>
>>>Well, I have had the experience of one patient 50-ish with a multicystic
>>>5 or so cm ovary and NORMAL CA-125 on the day of her laparotomy (this is
>>>about 10 years ago) - die of her ovarian cancer within 2 years of
>>>daignosis. I do not use CA-125 as part of my "flow chart"...
>>>
>>>Joanne
>>>
>>>a series begins with one case...
>>>
>>>At Sat, 15 Jul 2000, Steve & Eryl Raymond wrote:
>>>>
>>>>I concur with the suggestion about doing Ca-125. There was a
>>>>paper presented at the International Scientific Meeting of the
>>>>RCOG last year which came from the UK suggesting a flow chart
>>>>for screening, and suggested that with U/S first followed by Ca-125
>>>>if anything found, there would be aan almost 100% pickup rate.
>>>
>>>--
>>>Joanne Bulley, MD
>>>Keene, NH, USA
>>>
>>--
>>art fougner, md
>>
>>A series of 1000 cases begins with but a single anecdote.
>>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
