Reference no: EM133725649
Assignment:
A 58-year-old woman presents for her annual well-woman examination. She reports that she started having (vaginal) spotting about 3 months ago, "I thought maybe I was having one last period," and has had increased urinary frequency over the past 2 to 3 months. She denies any constitutional symptoms and denies pelvic pain. Her past medical history is notable for hypothyroidism, hypercholesterolemia, hypertension, and type II diabetes. Family history is notable for father with lung cancer, mother with uterine cancer, and maternal first cousin with colon cancer. She is obese but is exercising regularly. She reports one abnormal Pap smear about 15 years ago, which was worked up and "normalized" after follow-up Pap smears without any surgery. Her last Pap smear was about 4 or 5 years ago, and she recalls it was negative, and she was told that she didn't have to have any more Pap smears.
She went through menopause at 54 years of age, used combination hormone replacement therapy (HRT) for 2 to 3 years, discontinued 2 years ago. Vital signs: Height 158 cm; Weight 78.0 kg; BMI 31.2; BP 148/88 mmHg; Pulse 84; Respirations 18; Temp 36.6°C. Physical exam notable for normal cardiovascular, respiratory, skin, musculoskeletal; Abdomen obese, soft, non-distended, non-tender; Pelvic exam notable for normal female genitalia, no lesions; Vagina and cervix normal, no discharge or blood in the vaginal vault; Bimanual exam notable for no tenderness on exam; uterus somewhat globular, approximately 10 to 12 weeks size; ovaries non-palpable.
Which diagnostic test/study would you want to obtain first?
- endometrial biopsy
- Pap smear
- CBC
- pelvic ultrasound
Which risk factor contributes most to this woman's risk for endometrial cancer?
- previous HRT
- age
- abnormal Pap history
- obesity
The results of the endometrial biopsy return as endometrioid adenocarcinoma FIGO grade I to II. What will you want to do next?
- Inform the patient of the results and order a pelvic ultrasound.
- Inform the patient of the results and make a referral to a gynecologic oncologist.
- Inform the patient of the results and order a CA-125.
- Inform the patient of the results and order a CT scan of the pelvis.
After your patient is referred to a gynecologic oncologist, she learns that she will be undergoing surgery to remove the uterus, fallopian tubes, and ovaries. She is concerned about whether this will impact her quality of life, and she wants to talk with you about post-hysterectomy issues. She asks you whether she will become less interested in sexual activity and if there is anything she can do to improve her chances for feeling "normal" after her surgery.
What suggestions can you give her to improve her successful post-hysterectomy adjustment?
- Offer time for her to discuss her concerns and provide information about women and cancer support groups, and provide literature on women facing gynecologic cancer.
- Make a referral to a sexuality counselor to discuss her concerns.
- Inform her that since she is already menopausal, she may not notice much difference in her sexual responses and feelings after hysterectomy.
- Inform her that she will be able to take hormonal replacement after surgery, which will likely help her in adjusting to menopause.