49 year old Virginia presented to an outlying clinic with an
abdominal mass that she had first noted about three months ago. A local
ultrasound showed an enlarged uterus due to a 6-7cm fibroid and she was
referred to Baguio General Hospital, and scheduled as my first patient. Had we
not been here, she still would have had surgery, but perhaps weeks or months
later.
After securing the upper uterine blood supply I decided to
cut into the uterus to remove the bulky fibroid from the uterus, the better to
see surrounding anatomy. But it was cancer we found, not a benign fibroid. Endometrial cancer starts at the inner
endometrial lining and then invades the uterine wall, eventually encountering
blood vessels, which allows spread anywhere, and then through the surface of
the uterus (as with the Riobamba patient in previous post). This tumor had not yet
broken through, though so close that metastasis is presumed and chemotherapy
recommended.
Our free care stops once she leaves the hospital; if she
cannot she come up with the 30,000 pesos ($650) needed for minimal chemotherapy,
her prognosis is dismal.
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