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Re: gynecologic oncologists From: Braun, R. Daniel (rbraun@iupui.edu) Wed Mar 31 08:03:26 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: (no name): "Re: Trial of Labor?" Previous message: Braun, R. Daniel: "Re: Trial of Labor?" Maybe in reply to: Robin: "gynecologic oncologists" Next in thread: Betty Rommel, MD, PhD: "Re: gynecologic oncologists" We were just discussing this issue with our residents in our morning report this past week. The real problem comes when an OBGYN is practicing in a small hospital 140 miles away from the nearest GYN ONC Doc. Does this mean that he/she should never do an adnexal mass case in the local hospital? We felt that no it did not. It did mean that he/she would need to have arrangements made for help with debulking/staging (Gen. Surgeon or Urologist), because no preoperative evaluation is accurate in diagnosing Ovarian CA. Those of us who are "eminences grises" have all had the experience of opening what was obviously a benign tumor only to get a frozen back telling us that it was malignant. We also felt that the OBGYN should explain all this to the patient and offer that the patient be transferred to another surgeon or Gyn Onc at a hospital where there was a Gyn Onc. Several years ago, I was involved in 2 cases about 3 weeks apart. The first was a 23 Y/O G1 P1 who had a large mass arising from the pelvis to a level 5 cm above the umbilicus. US and CT scan were compatible with leiomyomata uteri. Ca-125 was <25. The patient was operated on in the local hospital. Stage 3 serous cystadenocarcinoma of the ovary was found. Staging and debulking were carried out. The second patient was a 42 Y/O G3 P3 who presented complaining of early satiety, and increasing abdominal girth. She had a mass arising from the pelvis to 8 cm above the umbilicus. US and CT scan were compatible with Ovarian carcinoma metastatic to liver. Ca-125 250. We sent her to M. D. Anderson. The fellow there called us a week later to thank us for sending him a case of uterine leiomyomata. He really enjoyed doing a benign case every now and then. These 2 cases demonstrate that the only way you will ever know for sure what a pelvic mass is, is to give it to the pathologist. Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN -----Original Message----- From: Jay Kulkin [SMTP:jkulkin@mindspring.com] Sent: Wednesday, March 31, 1999 6:38 AM To: Multiple recipients of list OB-GYN-L Subject: Re: gynecologic oncologists The concept sounds good but clinically this case would suggest that gyn-oncologists would remove a lot of 10cm endometriomas. Obviously, they don't have the time or inclination to do this but in my experience they make themselves available even on an emergency basis when unexpected findings arise. I think the entire clinical picture is significant and many would ask for gyn-onc assist in the majority of suspicious cases. One must also consider other variables as LFT's etc. A sensitive and important issue which should be on the minds of all clinicians. Jay At 01:28 AM 3/31/99 -0600, you wrote: >I realize that I am not "supposed" to be posting here. I would >apologize except that this is too important an issue to worry about >rules. Women's lives are at stake. > >I was merely quoting an excerpt from the NIH's Consensus Statement on >ovarian cancer. We are not discussing a skin condition or a cold or >flu. We are talking about a disease that kills over 14,000 women in >this country every year. It is very difficult to diagnose and usually >isn't caught until it is advanced. It has been proven that women who >are optimally debulked and properly staged have a better chance for >long-term survival. Now, do you really expect me to believe that a >doctor who does maybe a few of these surgeries a year has as much >expertise as a doctor who does a hundred? Obviously, the NIH doesn't >believe that. > >Can you honestly say that if it were your mother, sister or daughter who >was suspected of having ovarian cancer, that you would not choose >someone with that kind of experience and expertise (a gyn/onc) to do her >surgery? I think not. This is a question of ethics. I was very >fortunate. My ob/gyn referred me immediately to a gyn/onc after finding >a complex ovarian mass and a CA125 of 400. This is professionalism at >its best. > >You will be hearing a lot about this in the future. Organizations like >the National Ovarian Cancer Coalition and Ovarian Cancer National >Alliance will be working hard to inform all women about this specialty >and their options when faced with a possible ovarian cancer diagnosis. I >would hope that ob/gyns all over this country will show support for >their patients by referring them when indicated. > >This will be my last post. Thank you for allowing me the opportunity to >express myself here. > >You > Jay M. Kulkin, MD MBA Medical Director BCBS of Georgia office 770-386-0640 ext. 17 office e mail-jkulkin@bcbs-ga.com Next message: (no name): "Re: Trial of Labor?" Previous message: Braun, R. Daniel: "Re: Trial of Labor?" Maybe in reply to: Robin: "gynecologic oncologists" Next in thread: Betty Rommel, MD, PhD: "Re: gynecologic oncologists"

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