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...do we need hysterectomy to remove the Uterus…? (cervix is totally closed)
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An_254380 posted:
Dear doctor Mary Jane Minkin, MD

My mother is 78 years old. Approximately 5 weeks ago she experienced a heavy bleeding we believed it was with urine with minor pain at lower area of the stomach, and we went to the emergency department at Saint John's Medical Health Center in Santa Monica, CA. They performed tests, including cat-scan and ultrasound, after which was determent that the blood is coming from vagina and found abnormality with a thicken wall in uterus, endometrial thickness 14mm with fluid. Next day per given instructions we went to see my mother's gynecologist. The doctor performed another follow-up ultrasound and observed a few polyps inside her uterus, after that he referred us to the Gynecologic Oncology Specialist at Cedars-Sinai Medical Center / Samuel Oschin Cancer Institute in Los Angeles. During our initial visit with the specialist, she tried to scrub a sample manually to be sent to the lab to determent if it is cancerous. The doctor was not able to reach inside as the cervix was closed (it was closed off of the opening) After the initial manual attempt, the doctor scheduled a surgical procedure, which required preparation and anesthesia to do the required biopsy test within surgical operational room environment. The doctor tried to perform the procedure yesterday, but she said she could not reach inside as the cervix is totally closed ...she used the ultrasound method to find the way in... In response to my question, the doctor said that the medication to force the opening would cause major negative side-affects, so she did not even consider it. Now she recommends hysterectomy to remove the Uterus… and suggests my mother should be able to survive such operation with the full anesthesia…
Currently within last 3-4 weeks my mother has very small amount of bleeding with occasional day or two without any bleeding and no pain complains. Her general health condition is weak due to her age and overweight, she takes a lot of oral medications from blood-sugar diabetics and high blood pressure, she is not very mobile in daily movements and has Arthritis (periodic inflammation in joints), but her heart condition appears to be reasonably OK for the surgery according to her primary doctor… The Gynecologic Oncology Doctor-Specialist says that my mother has 20%-25% chance of having cancer…
My family and I are very concern and don't know what to do… She may not survive the full anesthesia…(?), and I worry about the recovery process even if the surgery goes well. I also feel that it may be not fully justifiable or necessary to go thru with such serious surgery, taking in consideration her current symptoms, age, health condition, and level of risk. I need my mother to stay with us longer, not just for me, but also for my mentally disabled brother and other close family. Please, give us your best advice and possibly recommend a good specialist for the second opinion.
Thank You very much,
YSB
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Mary Jane Minkin, MD responded:
Dear An_254380,
Sorry to hear about your mom's condition. Indeed sometimes we really cannot get into the uterus in an older woman; the cervix is really sealed shut. Unfortunately, the conditions that do make the surgery riskier are unfortunately the conditions that might lead to this being a cancer of the lining of the uterus: namely that she is overweight and diabetic, which are significant risk factors for developing cancer of the lining of the uterus. Fortunately, you are at a hospital that has an excellent section of gynecological oncology: two of my former Yale residents, Dr. Beth Karlan and Dr. Ilana Cass, are excellent gynecological oncologists who practice there-so that I am sure that their department would deliver excellent care to your mom.
The other major medical centers in Los Angeles, such as UCLA, or outside Los Angeles, such as UC Irvine, also have excellent gynecological oncologists.
the good news about having cancer of the uterus is that in most cases, doing a hysterectomy can indeed cure the patient-it tends to present early, with vaginal bleeding, announcing its presence. So I'm sorry to hear that she has had this happen; but she will hopefully do well.
Good luck to you and to her,
Mary Jane


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