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Suggest Treatment For Cervical Stenosis

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Posted on Thu, 25 Jun 2015
Question: My mother has just recieved bad results from the gynocologist. She just turned 76

Pathology came back - it is a cancer.
Her gynecologist believes they found it early.
They're calling it poorly differentiated adno carcinoma. Has cells from lining of uterus that are rapidly dividing. Endometrial adno carcinoma, endometriod type.

The Doctor said she was suprised that the cervix was really stenonic?, She's not sure why she hasn't had any bleeding that she could see. Part of it was down cervix and part of it was the body of the uterus.
Next step is to see the gynecologic cancer specialist. She said that uterine cancer is about 90 percent curable if it hasn't gone anywhere.

My Mom asked if the Doctor thinks it has gone any place or is it hard to tell?

The Doctor said it's hard to tell but she does have a mass back behind the uterus. We don't know what it is until surgery. It could be a fibroid from when she was younger and it's just there or it could be that the cancer has gotten outside of the uterus. The Doctor thinks it's not going to be advanced because the uterus isn't that big. Would have expected advanced to have bigger uterus, more pain and for there to be more bleeding.

This started with my mom having itching a few months ago. She went to her GP who said its her age and gave her a cream. My Mom went back to the Doctor after three weeks because it didnt stop. The GP recommended my Mom see a Gynecologist. The gynocologist gave my Mom a different cream and scheduled a PAP smear, biopsy and ultrasound. The ultrasound saw something so the Gyno scheduled a D&C for 4 weeks out whe she would return from training. My Mom had the D&C a week ago and recieved the results today. The visit with the Gynecologist/Cancer Doctor is scheduled for two weeks out.

Should we be trying to get an earlier appt? What are the recommended steps from this point forward?

Please advise!

Thank you sooooo much!!!!!
doctor
Answered by Dr. Aarti Abraham (46 minutes later)
Brief Answer:
Try and get an earlier slot, rest detailed below.

Detailed Answer:
Hello
Thanks for trusting us with your health concern.
At 72, the cervix ( mouth of the uterus ) gets dried up and shrunken ( Stenotic is probably the word you wanted to type ).
That is why she would not bleed heavily, as it is difficult for blood to get out of the stenosed cervix.
Now, endometrial carcinoma generally has very good cure rates, particularly if it has not spread outside the uterus.
The real prognosis of the disease can be estimated only after surgery, because the complete staging is done after surgery, based on how deep it has invaded the uterus, whether it has crossed the uterine borders, whether nodes are involved, microscopic tumour type etc.
So there are a lot of factors that determine how good her case will be, and those factors can be ascertained only AFTER the surgery is completed.
As such, if the doctor says it has been picked up early, that is a good thing.
But poorly differentiated type is a bad thing.
Such cancers have more of a tendency to spread faster and invade more.
Now, I am worried about the mass behind the uterus.
Scanning / imaging should be able to give a fairly clear idea of what it is .
Could you mail / upload all the workup that has been done so far in this regard ?
That would enable me to provide you with more information, once I go through the imaging / scanning / D and C reports myself.
As such, the next steps from this point are -
1. Get an appointment with an Onco - Gynecologist at the earliest . ( See if it can be earlier than two weeks, since it is poorly differentiated type ).
2. Get thorough surgery done, in the hands of an expert.
3. Based on surgical staging, future treatment ( need for any radiation / chemo ) will be decided.
4. Keep optimistic, try and build up her immunity and hemoglobin levels, as she will bleed during surgery. I know it is easier said than done, but yes, at the end of the day, if you had to choose a cancer ( I know, again easier said than done ) , then uterine cancer is one of the good ones, as it is fairly treatable.
Hope what I have said so far helps you.
Looking forward to hearing from you.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (2 hours later)
Thank you so much! I agree with your logic and I'm trying to get her into Cedars-Sinai next week vs. our local hospital that can't fit her in for two week. I'm not sure if you can make onco-gynocologist recommendtions, but if you can, I'd love to hear them. I will try and get my hands on the records tomorrow, or Monday at the latest.

Thank you!!!s
doctor
Answered by Dr. Aarti Abraham (14 minutes later)
Brief Answer:
Cant recommend unfortunately.

Detailed Answer:
Dear XXXXXXX
THank you for the appreciation.
I am based in XXXXXXX currently, and hence, not able to make recommendations for your use.
Cedars - Sinai however, is a centre par excellence, renowned world over for its medical services.
It is much better to have her there instead of your local centre.
Will await the records.
Keep in touch.
Lots of prayers for you !
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (31 hours later)
Dr. XXXXXXX XXXXXXX

Received documents. I will scan them in this morning and send to you. I will have the ultrasound tomorrow and send those over as well.

We have an appt at Cedar-Sinai on Wednesday!!

Do you have any recommendations for building up immunity and hemoglobin? I am hesitant to take advice from Google.

Thank you Doctor

!
doctor
Answered by Dr. Aarti Abraham (3 hours later)
Brief Answer:
As below.

Detailed Answer:
WIll wait for the documents.
Am glad about the appointment that you have on Wednesday, it is quite in time, keep me posted on what happens.
I assume that your mom is a non vegetarian.
Hemoglobin consists of heme ( iron ) and globin ( protein ).
SHe has to have a nutritious diet consisting of lots of marrow, spinach, fenugreek, poultry, egg white, soya, tofu, curd, legumes, fresh fruits and fresh vegetables.
She can take vitamin C supplements or lots of kiwi, oranges, gooseberry, lime.
Exercise in moderation everyday.
Meditate, as it keeps stress at bay.
Indulge in hobbies, connect with friends and family, soothing music - anything that helps her stay happy.
Stay away from processed foods, smoking, drinking, late nights, anxiety, pollution.
YOu can contact me directly , anytime you wish to, using the following direct link -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
Take care.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Aarti Abraham (45 hours later)
Dr. XXXXXXX

We're feeding Mom well, no more diet sodas, all organic and building up her hemoglobin. Thank you again for everything! This discussion is priceless to me and you have definitely convinced me to keep our membership!!

I've attached everything i have so far. I eill have the images today and upload when I get home thos evening.

Thank You!!!

!
doctor
Answered by Dr. Aarti Abraham (11 hours later)
Brief Answer:
As below.

Detailed Answer:
Dear XXXXXXX
Firstly, apologies for a delayed response, I had no internet access for a few hours, so I could view the attachments just now .
I have gone through her history sheet first of all, and picked up some red flags.
Alcohol, wine, caffeinated drinks, cola - all that is strictly off the course now.
Smoking was mentioned in the past so I hope that is not applicable now.
Next I have gone through the hysteroscopy procedure notes.
It is logical that she did not bleed, because the cervix was quite stenotic ( drying and atrophy associated with ageing ).
It was quite difficult to even dilate the cervix enough to perform the procedure so that explains why she did not bleed because of the mass inside the uterus.
The next report attached is the ultrasound scan.
Now somehow, I can only see page 1 of 2 in this particular report.
Page 2 is not attached, and also the biopsy report is not attached.
These 2 are essential for diagnosis.
Can you review the attachments and see what happened please ?
Thank you for taking the time and the effort to upload all these documents.
Also, thank you for your very kind words of appreciation.
Intelligent, perceptive and logical people like you make my work worthwhile.
Will await the ultrasound scan and the biopsy reports, since they are not visible in the 10 attachments that I was able to view on the page.
You can contact customer care for help, and they would guide you in detail regarding the manner in which to upload the remaining files.
Wishing you a very good day !
Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Aarti Abraham (33 minutes later)
My apologies. I was uploading from an iPad. I will log in from a computer this evening and upload the remaining files. The ultrasound went fed ex overnight to Cedars - Sinai along with the pathology slides. I will request another copy tomorrow and if I can get them, I will upload immediately for your review.

Thank you very much and have a good day! :
doctor
Answered by Dr. Aarti Abraham (4 minutes later)
Brief Answer:
Will wait then, take care.

Detailed Answer:
Okay please do that.
Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Aarti Abraham (45 minutes later)
Upload complete. You should see the last three pages which were missing in the original upload.

I would like to accept this question and start a new one with you through the website. Would you still have access to the uploads and previous correspondence?

I will try and get those images first thing in the morning.
Sorry. Clarification to my question. I believe successfully closed questions and good ratings are important. If you would like, I can close this question and start a new one from your direct link. Let me know which you prefer and I will do so.

quick question - can my mom drink coffee or do you mean everything with caffeine is of the menu?

She will drink decaf if needed.

Thank you and have a good evening
doctor
Answered by Dr. Aarti Abraham (13 minutes later)
Brief Answer:
As below.

Detailed Answer:
Hi again.
I am still unable to view the last 3 pages, which were missing in the original upload.
Am still able to view the original 10 attachments, although they have been shuffled about a bit.
You can definitely start a new question thread through the site.
It is much better to close the query, rate it and then address a new question through my direct link.
That way the question does not go to the general pool, where it can be picked up by any doctor, but comes directly tagged to me.
Yes, I will still have access to the attachments uploaded so far, and the original correspondence thread.
But what you could do, is post a direct question to me, through my link, and post the ultrasound scan and the biopsy reports there ( the ones which somehow seem to be missing on this thread, inspite of your best efforts ! ).
Regarding coffee, yes, caffeine in any form is best avoided while preparing for a surgery and anesthesia.
For now, she can mix decaf and caf ( what is known as half - caff ) and then gradually wean over to decaf totally.
Let me know anything else you need to know, while you prepare for the appointment on Wednesday.
Good luck !
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6004 Questions

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Suggest Treatment For Cervical Stenosis

Brief Answer: Try and get an earlier slot, rest detailed below. Detailed Answer: Hello Thanks for trusting us with your health concern. At 72, the cervix ( mouth of the uterus ) gets dried up and shrunken ( Stenotic is probably the word you wanted to type ). That is why she would not bleed heavily, as it is difficult for blood to get out of the stenosed cervix. Now, endometrial carcinoma generally has very good cure rates, particularly if it has not spread outside the uterus. The real prognosis of the disease can be estimated only after surgery, because the complete staging is done after surgery, based on how deep it has invaded the uterus, whether it has crossed the uterine borders, whether nodes are involved, microscopic tumour type etc. So there are a lot of factors that determine how good her case will be, and those factors can be ascertained only AFTER the surgery is completed. As such, if the doctor says it has been picked up early, that is a good thing. But poorly differentiated type is a bad thing. Such cancers have more of a tendency to spread faster and invade more. Now, I am worried about the mass behind the uterus. Scanning / imaging should be able to give a fairly clear idea of what it is . Could you mail / upload all the workup that has been done so far in this regard ? That would enable me to provide you with more information, once I go through the imaging / scanning / D and C reports myself. As such, the next steps from this point are - 1. Get an appointment with an Onco - Gynecologist at the earliest . ( See if it can be earlier than two weeks, since it is poorly differentiated type ). 2. Get thorough surgery done, in the hands of an expert. 3. Based on surgical staging, future treatment ( need for any radiation / chemo ) will be decided. 4. Keep optimistic, try and build up her immunity and hemoglobin levels, as she will bleed during surgery. I know it is easier said than done, but yes, at the end of the day, if you had to choose a cancer ( I know, again easier said than done ) , then uterine cancer is one of the good ones, as it is fairly treatable. Hope what I have said so far helps you. Looking forward to hearing from you. Take care.