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Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment?

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OBGYN, Gynecologic Oncology
Practicing since : 1984
Answered : 99 Questions
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Hello there,

there is some health problem with my mother who is 68 years old. She had bleeding yesterday morning. We went to consult one doctor here in Mumbai. There were some tests done and we got to know that she has 4mm cyst. But the concern is that in report it came out that the thikness of ovary is 8MM. My mother is also Diabetise and BP patient. Can someone guide me what can be the cause..... is there anything to worry? Tomorrow we are going for CBC, TSH, CA125 tests.
Posted Mon, 8 Apr 2013 in Cervical and Ovarian Cancer
 
 
Answered by Dr. Manjunath L Ramarajapalli 48 minutes later
Hello,
The doctor has suggested correctly.
Cyst of 4mm and ovarian thickness of 8mm at 68 years along with bleeding is not normal and should be investigated,preferably to know the thickness of endometrium (to rule out cancer) by ultrasound scan.
Please do these tests. Let me know the reports. I can guide you further.
with regards
Above answer was peer-reviewed by
 
Follow-up: Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment? 44 hours later
Hello Sir,
I have got the report of CA-125 test.Below is the highlight. Please go through and suggest .

Test Description
Hormones :TSH(Ultrasensitive),serum by CMIA
Observed Value :1.66

Biological Reference Interval:
0.45 to 4.5 IU/mL
Pregnancy :-
First Trimester: 0.1 to 2.5 IU/ml
Second Trimester : 0.2 to 3.0 IU/ml
Third Trimester:: 0.3 to 3.0 IU/ml
Reference:
Guidelines of the American Thyroid Association
During Pregnancy and Postpartum,2011.


Remarks : 1.4.51 to 15 IU/mL - Suggested clinical
co-relation or repeat the test with new sample as physiological factors can give falsely high TSH.
2.TSH values may be transiently altered because of non thyroidal illness like severe infections,liver disease,
renal and heart failure,severe burns, trauma and surgery etc 3.Drugs that decrease TSH values e.g:L-dopa,Glucocorticoids
Drugs that increase TSH values e.g Iodine,Lithium,Amiodarone


Tumor markers
CA-125 (Cancer Antigen-125), serum by CMIA 20.60
0 - 35 U/ml
(Kit insert)
Elevated CA-125 levels may be seen in
non-malignant conditions.
Kindly note the change in the reference range:

1.Levels are increased in non mucinous epithelial ovarian carcinoma, fallopian tube tumors, cervical adenocarcinoma,
endometrial adenocarcinoma, trophoblastic tumors, Non Hodgkins Lymphoma, squamous carcinoma of cervix/vulva,
carcinoma of pancreas, liver or gastrointestinal tract .
2..Multiple serial levels are best for monitoring status .
3.Levels may be increased in pregnancy, menstruation, endometriosis, pleural effusions, cirrhosis and renal
failure .
4.HE4 assay is a new test which also can be used for therapeutic monitoring as well as for risk stratification of
harboring Epithelial Ovarian Cancer (ROMA value).
 
 
Answered by Dr. Manjunath L Ramarajapalli 4 hours later
Hello,
CA-125 value and TSH value are normal. I have not seen the ultrasound report. Send this report so that I can see whether it is normal. Then I would be able to suggest further course of action.
with regards
Above answer was peer-reviewed by
 
Follow-up: Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment? 54 minutes later
Thanks for the reply..... In ultrasound a syst of 4mm identified in the left side. The thickness of endometrium is 8 mm. Thats all in that report.
 
 
Answered by Dr. Manjunath L Ramarajapalli 9 hours later
Hello,

Endometrial thickness (ET) of >5 mm in the post-menopausal woman is abnormal.

So, your mother's ET is 8 mm and this should be investigated by D & C (Dilatation and Curettage) to rule out endometrial cancer.

Good luck.
Above answer was peer-reviewed by
 
Follow-up: Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment? 18 days later
Hello,
the biopsy report has come. And its positive unfortunately. I have only got the verbal confirmation over phone, will get it tomorrow. What are the optiones we have now? I mean which stage uterus removal surgery can be done? Which hospitals are specialized for this treatment and what will be the total costs for the treatment roughly.
 
 
Answered by Dr. Manjunath L Ramarajapalli 9 hours later
Hello,
If the biopsy is positive for endometrial cancer,she should be planned for treatment with other investigations including MRI/CT scan.
The surgery is called as Type 1 hysterectomy with pelvic and para-aortic lymph node dissection (almost all cases surgery is possible except in cases where patient is not fit for surgery).
Staging is done after surgery and pathological examination of the specimen (surgico-pathological staging).
Any hospital treating cancer patients should be o k.
Cost depends on the local practice.
Good luck
Above answer was peer-reviewed by
 
Follow-up: Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment? 11 minutes later
Hello,

Thanks for the reply.
Would it be possible that we can have verbal discussion over phone? I just want to make sure that i have all the relevent information about it.

I can understand that there will be some rules and you may not want to share your contact information. In that case i can XXXXXXX you whereever you want or else i can be contacted on my mobile number 0000.

regards\
 
 
Answered by Dr. Manjunath L Ramarajapalli 40 minutes later
You can contact me at the following address. However without examining the patient specific advise is not possible.

Dr.Manjunath L Ramarajapalli M.D.,Ph.D XXXXXXX Consultant and HOD of Gynec-Oncology
BGS Global Hospitals
Bangalore

Regards
Above answer was peer-reviewed by
 
Follow-up: Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment? 5 hours later
Hello,

Below is the Biopsy report. Can you please guide further based on this report.
Also would like to know whether we can go for surgery after 3-4 weeks (I mean, would it be too late as far as time concern and is there any strong possiblity that the disease would spread till uncurable stage during 3-4 weeks)?

               

CYTOLOGICAL EXAMINATION


Method:
The smear were fixed in equal parts of ether alcohol
Fixative mixture and then stained by papanicoloau stain

CYTOLOGICAL EXAMINATION:
CERVICAL SMEAR:
The smear shows few superficial cells with pyknotic nuclei and acidophilic cytoplasm and intermediate cells with vesicular ncuclei. Background shows fair number of neutrophils and few red blood cells . Dysplastic or malignant cells are not seen.


               
HISTOPATHOLOGY REPORT


GROSS EXAMINATION:
Received in fixative multiple soft tissue bits aggregating to less than 1 cm labeled as endometrial curettage.
MICROSCOPY EXAMINATION:
H&E stain section shows well differentiated grade 1endometrioid adenocarcinoma of the endometrium.
Also seen are fragments of endocervical mucosa with high grade squamous cell carcinoma in situ.


My mother is in Mumbai currently and i am planning her to bring here in bangalore ASAP before visit you

Note: My mother is also Diabetise and BP patient.

Regards
XXXXXX
 
 
Answered by Dr. Manjunath L Ramarajapalli 41 minutes later
Hello,
Your mother should undergo treatment ASAP (As Soon As Possible).
Waiting for 3-4 weeks is not advisable and may lead to up staging the disease.
Take the necessary action ASAP.
With best wishes
Above answer was peer-reviewed by
 
Follow-up: Diabetic and bp patient. Started bleeding, ultrasound showed presence of cyst and thick ovary. Treatment? 3 hours later
Hello,

Thanks for the reply.

As per your advice we are planing this ASAP.

Just to be curious: whether Chemotheropy will be needed before the surgery? And even after ? What's your opinion based on the report?

Regards
XXXXXX
 
 
Answered by Dr. Manjunath L Ramarajapalli 13 hours later
Hello,

Chemotherapy is usually not needed in this situation either before or after surgery.
The role of chemotherapy in the treatment of endometrial cancer is limited as it alone can not cure.; it is only adjuvant. Surgery is the treatment of choice which cures this disease.

If surgery is not possible for whatever the reason then radiotherapy and chemotherapy is used to prolong the life expectancy.

With warm regards
Above answer was peer-reviewed by
 
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