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Possible Cancer?
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Ritu_Nepal posted:
My mother had menopause 20 years ago. However, she have been seeing blood on her underwear recently, nearly soaking wet. She lives in underdeveloped country with poor medical help. Please help understand the cause of it and if it has a possible change of uterus/cervical cancer.
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Jane Harrison Hohner, RN, RNP responded:
Dear Ritu_Nepal: Postmenopausal bleeding can arise from a number of causes:

1. Cancer of the uterine lining or cervical cancer---While the most serious it is the least common reason in the US. If your mother is in Nepal cervical cancer may be more common only because PAP smear frequency tends to be less.

2. Bleeding from a too thin uterine lining--Sometimes when the lining gets very thin (ie older women) it can become unstable and begin to bleed.

3. Vaginal bleeding from very thinned out vaginal tissues due to low estrogen---While more common after intercourse it can still appear in an older woman. However the amount is not usually as profuse as you describe. I had a patient with a prolapsed uterus such that the cervix had "fallen down" to the level of the vaginal opening where its fragile tissues were rubbing and bleeding onto her underwear.

4. Bleeding from fragile tissues around the opening of the urethra--If the woman looks into a mirror she may note a round area of bright red/pink tissue around the urethra. This fragile tissue can also create spotting--but not overt heavy bleeding.

Ritu_Nepal, she needs to have a speculum exam and pelvic exam to establish the origin of the bleeding. A simple PAP smear can be done as well to rule out cervical cancer. If the source of the bleeding is fragile vaginal tissues that can be seen during the exam. If the source of bleeding is suspected to be from inside the uterus she may need a GYN ultrasound and/or uterine lining biopsy or D&C. In a 70 year old with enough bleeding to wet her panties she really needs to be seen by some one especially an OB or GYN doctor, or nurse.

Hope this can be explained by a non-cancer cause.

In Support,
Jane
 
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Ritu_Nepal replied to Jane Harrison Hohner, RN, RNP's response:
Thank you for your response Jane, my mother did get ultrasound and it seems her uterus is dried up, with all negative responses to cancer. However, she is getting biopsy and results are expected this friday. I was wondering if my mother should consider on removing the uterus so that there is no fear of cancer in that area going future. Please advise.

Thank you,
Ritu
 
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Jane Harrison Hohner, RN, RNP replied to Ritu_Nepal's response:
Dear Rita_Nepal: Hopefully that means she is bleeding from a too thin lining (no abnormal cells). If this is the ultimate diagnosis then there is no overt reason for her to have a hysterectomy.

The most worrisome outcome would be a small focus of abnormal cells (eg cancer) existing as an isolated lesion within an otherwise atrophic (thin/dried out) uterine lining. If her uterine lining biopsy finds severely abnormal cells or cancer she will likely require a hysterectomy.

Don't hesitate to keep us appraised after she receives her biopsy results. I can give you more specific information with a biopsy result.

In Support,
Jane
 
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Ritu_Nepal replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

The biopsy result came negative for my mother and the docs recommended her few supplements to take which includes, povidone-iodine vaginal peasaries, betadine, and shelcal-OS. However, due to old medical equipment's at Nepal, I have heard many failure results for other women who went to same clinic and the same gynecologist. So, I have suggested my mom to go visit Bangkok to reassure that everything is alright. I will let u know the results. But, as of now, I have been Praying.

Thank you,
Ritu
 
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Jane Harrison Hohner, RN, RNP replied to Ritu_Nepal's response:
Dear Ritu: So glad the endometrial biopsy was negative (ie no abnormal cells). It sounds like they have concluded that an atropic (very thinned out) uterine lining is the cause. This would be consistent with her ultrasound report. Nonetheless a second opinion in the most medically modern setting (ie Bangkok) is a reasonable option.

The calcium supplement makes sense, but I would ask the Bangkok GYN about the use of both vaginal Betadine, and vaginal Betadine peasaries. That's a lot of povidone-iodine in atropic vaginal tissues where there can be more absorption. The pH of Betadine solution is 4.5-5.5. A healthy vaginal pH is relatively acidic (pH 3.8-4.5).

Yes, do let us about her follow up. Hope she has no further bleeding.

Yours,
Jane


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