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Friday, March 26, 2010

Peri-menopausal bleeding

Tanong (T): Nag-irregular bleeding ako for 2 weeks. 

Payo ni Doktor (PD): Your age, please?

T: 53 yrs old. I have been diagnosed with fibroids, delikado ba yun? Sabi thick daw yung uterus ko pero ok naman daw yung cervix. Kailangan ko raw ng biopsy. May urgency ba yan?

PD: What are the measurements of the fibroids and how thick is the uterine lining?

T: Here is the result of the ultrasound. The uterus measures 7.8 x 4.8 x 5.7 cm. There is a diffuse involvement of the myometrium. Innumerable small fibroids are noted scattered throughout. The endometrial echo complex is abnormally thickened at 1.2 cm with a heterogenous appearance. The left ovary demonstrates a 2.2 cm predominantly simple appearing cyst. The right ovary appears unremarkable. Note is made of a possible subseptate configuration of the uterine fundus.

PD: It seems that there are benign (non-cancerous) masses within the flesh of your womb. These masses usually disappear with menopause. Both ovaries seem to be normal. The cyst on the left ovary appears to be a normal cyclic pattern.

T:  Good news!

PD: What I am concerned is the thickened endometrial lining that usually should be less than 1 cm in thickness and should appear as homogenous. The abnormal bleeding that you may have experienced reflects this scenario.

T: Makapal ba sobra? Cause for alarm ba?

PD: Hindi naman. The next steps that I suggest are the following: Endoscopy with biopsy to visualize the inner lining of your uterus. The pelvic endoscopy will give a clue whether there is any sign of malignancy or whatever.

T: Ano meaning ng homogenous?

PD: Homogenous appearance means that the inner lining should have uniform appearance. A heterogeneous appearance may mean, but not always, malignancy.

T: Sabi ng doktor ko i-D&C daw ako, tama ba yun?

PD: D&C alone is okay, but with the availability of endoscopy, it should be better since a D&C is a blind procedure and may miss out focal and suspicious areas.

T: Ergo??? Kailangan ko ng endoscopy?

PD: It is better.

T: Ano baga yung endoscopy?

PD: Parang telescope na pinapasok sa katawan ng tao. When performed, the patient needs to be under anesthetics.

T: Under anesthetic nga daw ako eh. Pero no cause for alarm di ba?

PD: Yes, when you will undergo D&C. Considering your age and habitus, there will always be a slight risk.

T: Pwede ko bang i-postpone yang procedure next year?

PD: Better now than later, I think.

T: Sa Nov. 7 ako naka- shcedule eh. Iyan din sabi ng asawa ko.

PD: What u will undergo is just a diagnostic procedure. The histopathology results will guide the succeeding steps to be performed.

T: Para nga lang ma- diagnose daw to rule out cancer. Ano ang worst case scenario?

PD: When the results are suspicious of malignancy (cancer=CA), hysterectomy or removal of the uterus has to be performed.

T: Oo nga, tatangalin daw ang uterus. When that happens, sabi pati daw overies pa tanggal ko na, tama ba?

PD: Depending on the extent of CA spread and degree of malignancy, additional therapy in the form of radiotherapy and/or chemotherapy may be necessary. Yes, the ovaries should be removed because they will be of no use to you anyway.

T: Mismo! Di naman na ako mag-aanak! Di ba kuha sa gamutan yan? Walang tanggalan?

PD: Kailangan tanggalin kasi kung confirmed CA na.

T: Kasi di naman ganun ka significant yung size di ba? Kung CA nga, pero kung hindi? Di ba pwedeng gamutan na lang para lumiit o mawala yung fibroids?

PD: That is why we need to confirm by biopsy. Size is not that important. The more important thing is the appearance of the tissue under the microscope. Iyung fibroids ay hindi naman gaanong problema dahil sabi ko nga, nawawala iyan dahil sa menopause.

T: I get your point, Dr. Now, I am well-informed. Thank you.

PD: You’re welcome. Please update me on this.

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