Re: Gyn: Fibroids/ovarian abnormality
From: art fougner, md (evsono@pipeline.com)
Tue Nov 6 13:23:53 2007
Garry
Can you not have a Gyn Onc on standby, just in case?
Art
At Tue, 6 Nov 2007, Garry E. Siegel, M.D. wrote:
>
>Well put and right on the mark.
>
>If she chooses for me to operate, I'll put a scope in, look around, and
>go from there. If ovarian cancer, I'll prove it by biopsy and get out.
>If negative, I'll proceed.
>
>Garry
>
>At Mon, 5 Nov 2007, Rafael Haciski wrote:
>>
>>The problem with ovarian masses as I see it is whether it will be
>>malignant.
>>
>>If it is benign, I have no problem taking out the ovary/mass, and/or
>>the uterus, usually through the laparoscope and the problem is
>>solved. However, if it is malignant on the frozen, then she needs
>>deep LN dissection and para-aortic LN dissection, neither of which i
>>feel comfortable doing on my own. Thus I would have to close and
>>send her to the onc who would need to do a second laparoscopy for the
>>node dissection for proper staging, thus putting her through two
>>surgeries, as opposed to the one surgery if the onc were doing it the
>>first time. However, going to oncologist involves extra effort on
>>her part, difficulties with switching doctors etc, and thus less
>>likable to the pt.
>>
>>The logistics for the oncologist to be on standby to assist in case
>>of positive malignancy are too impossible to arrange.
>>
>>So it boils down to a lot of guess work as to what are the chances of
>>malignancy, and how does the pt feel about the possibility of needing
>>a second laparoscopy.
>>
>>--
>>Rafael Haciski MD FACOG
>>Anchor Health Centers GYN
>>800 Goodlette Rd #360
>>239-643-8780 office
>>239-571-0292 cell
>>Naples, FL.
>>
>>On Nov 2, 2007, at 7:04 PM, Garry E. Siegel, M.D. wrote:
>>
>>> 48 YO P2002 referred by friendly radiologist.
>>>
>>> 15 years ago, had laparotomy and ovarian cystectomy (unsure which
>>> side)
>>> for a dermoid; no records available.
>>>
>>> A couple of years ago had menomet., but lately has been having regular
>>> but heavy periods until recently, when she has missed one or two here
>>> and there and had some hot flashes. She also is now having some
>>> bleeding in between the periods/spotting.
>>>
>>> She saw another gyn in the community, and was told to see the gyn
>>> oncologist ASAP due to a 7 cm. complex ovarian mass, and by the
>>> way you
>>> have fibroids and your uterus is tilted and the cervix couldn't be
>>> visualized (I have no records except ultrasound snapshots, and the
>>> history is from the patient).
>>>
>>> She somehow then saw the radiologist for embolization
>>> consideration, and
>>> he reviewed her history and recent ultrasound images. She had seen
>>> her
>>> in 2/07 and her MRI then showed a few fibroids, 4 cm. max. His
>>> review
>>> of the current ultrasound images said "no change" on the fibroids, but
>>> the ovary contained a 4 cm. complex cyst.
>>>
>>> In ROS, BTW she has increasing bloating and gas, and has always had
>>> hemorrhoid trouble (colonoscopy 2006 "ok") that is now worsened.
>>>
>>> On exam, she has a scaphoid abdomen that is non-tender and no masses.
>>>
>>> On speculum exam, when the posterior blade of the Pederson speculum
>>> hit
>>> the posterior fornix, she jumped, and I could only partially visualize
>>> the lower 1/2 of the very anterior cervix, and on bimanual exam, her
>>> uterus/pelvic mass is firm, directly retroverted and tender--she jumps
>>> away, and she says this degree of tenderness is not like her normal
>>> exams. A planned endo biopsy was ditched, obviously.
>>>
>>> CBC and Ca 125 are normal.
>>>
>>> I advised lapscope/H-scope at a minimum, with possible unilateral
>>> cystectomy and/or oophorectomy, as she was not at all interested in
>>> hysterectomy at the first meeting.
>>>
>>> Today, when I returned a follow up call, I reiterated same, and she
>>> asked if she needs to see a gyn onc, since gyn #1 suggested it.
>>>
>>> Thoughts?
>>>
>>> Garry
>>>
>>> --
>>> Garry E. Siegel, M.D.
>>> Private Practice
>>> Roswell, GA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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