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clinical problemFrom: Natalie Sohn (nsohnob@aol.com)Tue Jan 5 20:05:17 1999
I would like to hear some expert opinion on the following case: 64 year old post menopausal female in good health getsreferred by her primary care doc ( actually the nurse practitioner) for post menopausal spotting. Pap, mammo all normal. My exam reveals a mass which displaces the cervix way upward ( you cant visualize it at all with the speculum--and endo biopsy is impossible. Rectal exam reveals the mass ( and/or uterus?) above the rectum and shes guiac neg. There is no ascities and ca125 is wnl. The radiologist wanted me to order a ct scan but I dont feel this is necessary since this most likely uterine or ovarian neoplasm clearly needs to come out.(Ido these cases with a gyn-onc who can stage these tumors adequately.)I am not sure if this is malignat or benign. r/o colon tumor ?-although this seems highly unlikely. My one reservation about ordering these tests is that the the hmo medical directors might delay my case ruling out distant spread when none exists. ( such a thing happened recently to me and there was a 4 week delay-- that woman had ovarian cancer. Any insights? My point here is how would additional testing in this case alter management?
-- nsohn
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