82. OP#9: Riobamba II

Day 4

Two major cases in the OR today:

Both were potential cancer, which raises a critical issue. The intraoperative diagnosis of cancer requires first a preliminary pathology report and then a decision whether to proceed with a "staging" procedure, basically the removal of lymph nodes, where cancer often spreads first. The absence of cancer in any of these analyses may mean no need for chemotheray. If the staging procedure is not done, the patient and her oncologsit is faced with the difficult decision whether to proceed with potentially life-threatening postop treatments.

Since I do not do these staging procedures, shoud I not do overseas surgery with no pathology on surgical oncologist back-up? But if I don´t do the surgery for these patients, they may not have it done until syptoms increase, whicy usually means that the cancer has spread and chemotherapy less likely to be successful.

Postmenopausal bleeding is often an early sign of uterine cancer. Martha presented with a single episode of such bleeding. Our ultrasound showed a markedly abnormal uterus, increasing the suspicion of cancer. The excised uterus showed a thumb-sized polyp, which is unlikely to be malignant, so she should do okay. I did request that the polyp be sent to a pathologist, but don´t know if that will happen.

Edelma presented with pain and a right ovarian cyst that had doubled in size over two years. This increase and the nature ("septated") of the cyst again suggested a risk for cancer. But operative findings were unequivocal for a benign growth. At the near-menopause age of 48 we had discussed the removal of the other ovary and she so requested. But it was adherent to the bowel, a consequence of her hysterectomy 15 years previously. Thw risks of injury to the bowel during attepted removal of the ovary was judged more of a risk than future ovarian cancer.

Just ten patients seen in clinic but three scheduled for surgery, an efficiency the reflects the the assistance of a nurse midwife who was part of the team and performed invaluable screening as well as excellent care of non-surgical patients. Nurse midwives are trained manage gynecologic conditions.