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Re: Gyn: complex hyperplasia with atypia--follow upFrom: Garry Siegel (garrys@mindspring.com)Tue Jan 30 19:52:36 2001
At Mon, 29 Jan 2001, Richard Chudacoff, MD wrote: > >No need, as the lesion was confined to the endometrium. Non-invasive. > Nodes: agree, not needed. Had the intraop uterine evaluation/frozen by the pathologist indicated invasive disease needing nodes, then I would have done them somehow, or gotten the gyn onc on the phone. I took a reasonable chance that she would either not have invasive disease, or have superficially invasive disease not requiring nodes. Paps after hyst: great discussion, guys. I don't do them at all unless the patient has had a hyst for malignancy or CIN, or if the patient requests after discussion. I educate all of the women who don't get paps that they still need annual exams for the health screenings outlined above nicely. Hormones after surgery: no reason not to use estrogen, and, Robert, I don't think that there is any data to suggest adding a progestin. OTOH, there probably isn't any data other than retrospective stuff/wisdom of the experts to use estrogen after a hyst for endometrial Ca. I would offer Raloxifene as I would any other patient; this woman had chosen estrogen long ago, and happened to get a cancer likely aggravated/caused by her own decision to drop the progestin. How to do the hyst: had this been a preop dx. of cancer, depending on grade/nuclear grade, likely a TAH BSO with the oncologist, with intraop assessment of the uterus. Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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