Monday, March 11, 2013

Gynae vs pathologist: hysterectomy?

Looking at my description of myself below my photo on this blog, I realise it is all out of date.
Instead of the carefree picture I paint, one which was certainly true at the time, I am now an angst-ridden wreck. I used to worry about my arm because I have borderline lymphedema but now I have a bigger problem, a dilemma really.
I am on tamoxifen and have always known it can cause endometrial cancer but felt the benefits in helping prevent a recurrence of breast cancer were better than the small risk. And, I was informed, it is a slow-growing cancer so we can monitor it carefully.
Sure, now about four years since I have been on tamoxifen, my six-monthly endometrial biopsy, known as a Z-sampler, came back with atypical cells (SEE PATHOLOGIST'S REPORT BELOW). My gynaecologist or gynae (Americans who are reading this, you call them obstetrician-gynecologists, or ob-gyns) phoned me on Friday morning to say that last Tuesday's test showed I had to have a hyterectomy, and my oncologist, The Tango Man, agreed.
Well. Today finally got to speak to The Tango Man who told me there were cells that were suspect but many more that weren't but that the gynae felt it was best to just have a hysterectomy and sort it all out.
However, when I arrived at the gynae today to discuss it further and book my operation for Monday, was almost horrified to discover that the pathologist's report recommended a formal D&C. Not a mention of a hyterectomy.
Suddenly I feel less sure. He says the pathologist didn't know my full history, that the atypical cells are suspect - and true, The Tango Man did say to me that the hysterectomy could find early-stage cancer - and that I could end up with a tumour and then I would be in trouble.
"You are playing with fire," he warned.
But he also suggested getting a second opinion, either from someone of my choice (which I don't have, as he is my gynaecologist of choice) or from the head of obstectrics and gynaecology at Wits University, who is also a cancer expert.
So now this is the situation:
I have booked the hysterectomy for Monday;
I am seeing my gynae on Wednesday midday; and
all my reports etc have been sent to this Wits prof, and I have to phone him on Wednesday at 9.15.
And I am in a hyperventilating state.
I wish my father were alive so I could ask him (he was a doctor). My mother too, for motherly advice. I feel a mess. 

Ag, just spoke to my one sister instead. She made me feel better. Made me feel I am doing the right thing. She also thinks a hysterectomy seems harsh.
"There are scattered groups of markedly atypical endometrial cells present whcih are suspect for underlying endometrial neoplasia....
There are, however, also numerous groups of relatovely normal appearing endometrial cells in the background.
A formal D&C is recommended for further evaluation of the patient.
Endometrial smear:
1. Markedly atypical endometrial cells present.
2. Endometrial biopsy recommended.

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