#Diagnosis of Endometrial Cancer | Explore Tumblr Posts and Blogs

ijcmcrjournal · 2 years

Text

Pathohistological and Immunohistochemical Characteristics of Locally Advanced Papillary Serous Endometrial Carcinoma - Differential Diagnosis, Prognosis and Complex Treatment by Marinova Lena*

Abstract

We present a clinical case of a rarely diagnosed serous endometrial carcinoma (SEC) with infiltration of the cervix, left parametrium, right fallopian tube, with bilateral ovarian metastases and tumor cells in the peritoneal lavage. After extensive pathohistological and immunohistochemical examinatoin, it was proved to be a locally advanced serous endometrial carcinoma - pT3b N0 M0. The publication discusses the importance of immunohistochemical (IHC) differential diagnosis for determining the histogenesis of papillary serous adenocarcinoma. The main pathohistological dilemma is the determination of the histological subtype of this locally aggressive endometrial carcinoma. Another problem is the definition of the primary origin of the tumor, due to the difference between the pathohistological classification in cervical, uterine and tubo-ovarian adenocarcinomas, as well as the radically different postoperative adjuvant treatment. Incorrect differential diagnosis leads to misdefinition of the necessary complex oncological treatment.

Keywords: Endometrial Serous Carcinoma; Papillary Serous Uterine Cancer; Immunohistochemistry; Differential Diagnosis; Prognosis; Complex Treatment

Introduction

Uterine Serous Cancer (USC), although rare, is the most lethal type of uterine cancer. It has distinct molecular features and pathogenetic pathways compared with other uterine cancer types [1]. According to Bokhman’s 1983 model, Endometrial Carcinoma (EC) is broadly classified based on histopathologic features into two categories, type I and type II, which differ in incidence, prognosis, epidemiology, molecular pathology, and clinical behavior [2]. Type II tumors (nonendometrioid carcinomas), such as serous carcinoma, clear cell carcinoma, carcinosarcoma/malignant-mixed Müllerian tumor, are characterized by poorly differentiated histology and deep migration/invasion [1]. Among the most common problems encountered in practice is the distinction between primary endometrial and primary endocervical adenocarcinomas, and the determination of the tumor origin when there is synchronous, multifocal involvement of gynecologic tract sites, for example the endometrium and the ovary [3]. In this article we present a clinical case of locally advanced serous uterine cancer with difficult differential diagnosis both in terms of histogenesis and histological features, as well as in terms of its primary origin, which is extremely important for complex treatment.

Clinical Case

It concerns 51-year-old woman with pain and bloating. After three peritoneal punctures, a metastatic effusion from adenocarcinoma with probable ovarian origin was found. After CT scan of the abdomen and pelvis, bilateral ovarian formations were found. A total class II laparohysterectomy with bilateral adnexectomy, omentectomy and appendectomy was performed. Intraoperatively - In situ- Ascites- 6 liters of clear liquid. Uterus of normal size. Bilateral ovarian formations with a maximum diameter of about 9 and 8 cm. There were no enlarged iliac and paraaortic lymph nodes. Liver - smooth surface without pathological changes. There were no peritoneal metastases. Radical hysterectomy with bilaterally adnexectomy, omentectomy and lymphadenectomy of the iliac lymph nodes were performed.

Histological Result

In the uterus a polypoid tumor mass was found with complex papillary and glandular architecture, infiltrating the myometrium up to 5 mm; the gland-like spaces were without sharp luminal borders, necrotic material was present in the lumens (Figure 2B). In the isthmus (Figure 3A) and in the cervix (Figure 1, Figure 2A) the histological findings were similar - tumor, composed of merging papillary and gland-like structures was observed, infiltrating over ½ of the muscular layer and reaching the orificium externum canalis cervicalis. In the right ovary (Figure 2C) and in the right fallopian tube (Figure 3B,3C), the same tumor, composed of complex papillary and gland-like structures was discovered, papillary structures were found on the outer surface of both ovaries, as well. Among the tumor cells in the uterus, isthmus, cervical canal, and right fallopian tube, psammoma bodies were found, as well as necrotic debris in the lumens of the tumor glands. In the left ovary cysts lined by stratified collumnar epithelium were found. The left fallopian tube was with fibro-sclerotic changes and paratubal cysts. The right parameter was with preserved architecture. The left parameter was invaded by the tumor. Five right pelvic lymph nodes have reactive changes. Seven left pelvic lymph nodes have reactive changes. Omentum - with hyperemia and mesothelial proliferation. The ascites fluid analysis reports erythrocytes, mesothelial cells, tumor cells with large nuclei - single and in small complexes of 3-4 cells. It is about metastatic effusion.

Histological Diagnosis

Рapillary serous endometrial carcinoma (рТ3b N0 M0) with predominantly exophytic growth, infiltrating the myometrium up to 5 mm., with local invasion of the right fallopian tube and left parametrium. Рapillary serous endometrial carcinoma infiltration in the cervical canal with papillary and glandular architecture reaching the orificium externum canalis cervicalis with infiltration above ½ of the muscle layer. Metastases in both ovaries. Metastatic peritoneal effusion.

Discussion

Uterine papillary serous carcinoma (UPSC) is an uncommon form of endometrial cancer that typically arises in postmenopausal women. UPSC is staged like other forms of endometrial carcinoma at time of surgery using the FIGO cancer staging system. In case of infiltration of serosa or adnexa and / or tumor cells into ascites or peritoneal lavage, the carcinoma is classified as stage 3A. The tumor spread in the vagina and/or parametrium (direct extension or metastases) is staged as stage 3B according to the modified FIGO classification on 1/1/2010 and “Pathologic TNM staging of carcinoma and carcinosarcoma of the corpus uteri, AJCC 8th edition and FIGO 2018 update“[4,5]. For patients who undergo surgical staging—consisting of open abdominal exploration, hysterectomy, bilateral adnexal removal, and pelvic and para-aortic lymphadenectomy in the modified FIGO classification, peritoneal lavage cytology is no longer considered in tumor staging. In the presented clinical case, despite the metastases in the ovaries, the tumor is stage 3B.

Pathohistological characteristics of serous carcinoma adenocarcinoma: Complex papillary, solid or glandular architecture; The architecture is papillary with or without appreciable fibrovascular cores; slit-like spaces; gland-like spaces may be observed (but luminal borders are not sharp as seen in endometrioid carcinoma); solid growth. Psammoma bodies may be present in up to 33% of cases. Cytoplasm is usually scant but can be abundant with eosinophilia or clearing. Nuclei are typically high grade with pleomorphism, hyperchromasia, prominent nucleoli and frequent mitotic figures (including atypical mitotic figures) [6-8]. Most type II endometrial carcinomas, especially UPSC, have a complex papillary or glandular architecture, which is similar to serous papillary ovarian carcinomas. In general, densely fibrotic papillae fronds and slit-like spaces are common [1] [Figure 2,3]. Huge, round, undifferentiated tumor cells with a high number of mitotic figures, increased nuclear-to-cytoplasmic ratios, and prominent nuclear atypia are detached and present in the blank spaces. Hobnail cells, clear cells, and polygonal cells are frequently observed. Cilia are also observed in some cases, as in papillary serous ovarian carcinomas [9,10]. Serous carcinoma cells are arranged in true papillae lined with many cells with overlapping nuclei; cells are large, better preserved and with indistinct cell borders; nuclear chromatin is coarse with large prominent nucleoli [11] (Figure 2, Figure 3).

Immunohistochemical stains in papillary serous endometrial carcinoma show that the tumor is positive for p53 (strong and diffuse expression, mutated) and p16 (strong and diffuse expression) (Figure 4), focally positive for ER (Figure 5C) and negative for PR [6]. In the presented case all tumors (in the different parts of the genital tract) demonstrated diffuse/moderate-strong p16 expression (Figure 4), with percentage of positive tumor cells ranging from 90% to 100%. In contrast, endometrial endometrioid carcinomas exhibit less diffuse and less intense expression, with percentage of positive tumor cells ranging from 10% to 90% [12]. In endometrial endometrioid carcinoma, ER and PR are strongly positive; p53 and p16 are weak and patchy [6]. Highly expressed EMA by most adenocarcinomas is associated with poor prognosis [13,14].

Differential diagnosis (DD): Non-endometrioid carcinomas, which account for about 10% of endometrial carcinomas, may pose a great array of problems in differential diagnosis, including their distinction not only from benign lesions but also from endometrioid carcinoma and various tumors that may secondarily involve the uterine corpus [15]. The complex papillary architecture of serous uterine carcinoma causes a number of diagnostic difficulties. The differential diagnosis includes Villoglandular Variant Of Endometrial Carcinoma. Papillary endometrioid or villoglandular adenocarcinoma (VGAC) is a relatively common type of well-differentiated endometrial adenocarcinoma [16,17]. VGAC is characterized by a papillary architecture with delicate fibrovascular stalks lined by cuboidal to columnar cells with minimal cellular stratification and mild nuclear pleomorphism [16]. VGAC only superficially invades the myometrium, being diagnosed at an early stage and thereby having a better prognosis than typical endometrioid carcinoma. To avoid confusion with papillary serous carcinoma, some authors refer to this entity as endometrioid adenocarcinoma with papillary architecture(16). In mixed endometrial adenocarcinomas the tumor has microscopic features intermediate between serous and endometrioid; for example, papillary architecture typical of serous but without classical cytologic features or glandular architecture with epithelial features suggestive of serous (11). Villoglandular Cervical Adenocarcinoma (VGCA) is a rare well-differentiated subtype of endocervical mucinous adenocarcinoma that usually occurs in young women in early clinical stage I-II [18-24]. VGCA is associated with a better prognosis than other adenocarcinomas [18-20,23,25-27] аnd accounts for 5% of cervical adenocarcinomas [28,29]. It is characterized as superficially infiltrative and shows infrequent lymph node invasion and lymphovascular space invasion [30,31]. Serous Carcinoma of the Uterine Cervix (SCUC) is a very rare malignant tumor, while this histological subtype is common in the ovary, fallopian tube, uterine corpus and peritoneum. Because of its rarity, details of the clinicopathological features of SCUC are largely unknown [32]. SCUC has a complex papillary pattern with epithelial stratification. The tumor is characterized by >10 mitotic figures per 10 high-power fields. An intense acute and chronic inflammatory infiltrate is typically present within the cores of the papillae and in areas of stromal invasion [33]. Pleomorphic and macronucleated atypical cells are observed [32]. Occasional psammoma bodies are present, like in the presented clinical case (Figure 1). The tumor cells in SCUC are positive for p16, focally positive for p53 and ER, and negative for progesteron receptor. Age <65 years, stage >I, tumor size >2 cm, tumor invasion >10 mm, the presence of lymph node metastases, and elevation of serum CA-125 were associated with a poor prognosis [33].

Important for the DD between endometrial and endocervical carcinoma is the study which notes that p16 reactivity is mainly limited to areas with endometrioid or nonspecific cell type differentiation and does not occur in areas with normal endocervical mucinous morphology [34]. It is important to recognize special variants such as uterine serous carcinoma and clear cell carcinoma, as these can show extensive staining for p16 [34]. Univariate analysis on the training set identified 6 markers—p16, ProExC, ER, PR, vimentin, and HPV ISH—as performing well in distinguishing between endocervical and endometrial origin. Positive results for vimentin, ER, and PR support endometrial origin whereas p16, ProExC, and HPV ISH support endocervical origin [34,35]. Primary endocervical adenocarcinomas are characterized by CEA positivity, which is usually, but not always diffuse, negativity for vimentin, and negativity or focal weak positivity for ER [35]. Similar to serous carcinomas, all endocervical adenocarcinomas exhibited diffuse/moderate-strong p16 expression, with percentage of positive tumor cells ranging from 90% to 100% [12]. In the distinction between a high-risk HPV-related (usual type) endocervical adenocarcinoma and a low-grade endometrial endometrioid adenocarcinoma, the most useful immunohistochemical markers are p16 and ER and PR hormone receptors [36]. Given the limits of immunohistochemical stains in distinguishing between endocervical and endometrial origin, individual cases should be evaluated in the context of standard clinical, radiographic, gross, and morphologic findings [34]. In the presented clinical case, DD is required between synchronous serous adenocarcinomas, i.e. primary endometrial with infiltration in the uterine cervix and primary tubo-ovarian carcinoma, or serous endometrial carcinoma with metastases in both ovaries. Multifocal tumor distribution is relatively common in carcinomas arising in the female genital tract. Accurate designation of tumor origin is not always straightforward but is important for staging, prognosis and management [36]. In the context of endometrial carcinoma, the most common dilemmas occur in the setting of concurrent endometrial and adnexal/peritoneal high-grade serous adenocarcinoma [3]. High grade serous tubo-ovarian adenocarcinomas are characterized by complex papillary, solid or glandular architecture [6]; Significant nuclear atypia; significant nuclear pleomorphism (>3 x variation in size) with large, bizarre and multinucleated forms [37]. Prominent nucleoli, often large and eosinophilic; High mitotic index: ≥ 12 mitotic figures per 10 high power fields, often atypical; Necrosis is frequent [13]. Positive stains: p16 (~60%), ER (80%), PR (30%), high Ki67 proliferation index (> 75%) [38]. Usually they present as unilateral tubo-ovarian tumor in 80-90% of cases, no tumor infiltration on the surface of the ovary; without invasion into the lumen of the tube; without vascular invasion - 71.4%; without or presence of ovarian endometriosis [39,40]. IHC analysis of ER and PR of endometrioid endometrial and ovarian tumors distinguishes primary tumor synchronicity from hematogenous metastasis. The same levels of ER and PR are found in metastatic endometrial or ovarian cancer (Figure 5C,5D) and different in synchronous primary endometrial and ovarian neoplasms [41,42]. One general principle used in determining tumor origin in pathology is the identification of intraepithelial carcinoma because the presence of such a lesion is considered a strong evidence of tumor development at a particular anatomic site. Occasionally metastases can colonize preexisting mucosal structures and replace the native epithelium, for example, endometrial serous adenocarcinoma may involve the mucosa of the fallopian tube and closely mimic serous tubal intraepithelial carcinoma [3]. Simultaneous endometrioid carcinomas of the uterus and of the fallopian tube are unusual and occur primarily in obese perimenopausal women. These tumors are predominantly well or moderately differentiated with dissimilar endometrial and fallopian tube grades. The carcinoma of the fallopian tube is usually unilateral and located at the distal end of the tube [36]. It is well established that high-grade endometrial carcinomas may present with metastases even when there is minimal myometrial invasion [3].

Conclusions from the IHC panel of the presented clinical case: 1/The positive expression of ER and PR receptors in the tumor cells of the tumor in the cervix proves the primary endometrial origin of the carcinoma with infiltration of the cervical canal (Figure 5A,5B,5D,5E). 2/ Diffuse positive expression of p16 in the tumor cells of the endometrial tumor mass and in the cervical tumor is typical for serous carcinomas (Figure 4). 3 / Positive expression for Vimentin in the tumor cells in the cervical and the ovarian tumors is typical for primary endometrial carcinoma, negative - is observed in primary viloglandular endocervical adenocarcinoma and primary endometrioid ovarian carcinomas. The positive expression of Vimentin in both tumors of the cervix and the ovary proves the local growth of serous endometrial carcinoma to the cervix with bilateral metastases in the ovaries (Figure 6). 4/ IHC analysis of ER and PR of the endometrial and the ovarian tumors distinguishes primary tumor synchronicity from hematogenous metastasis. The same levels of ER and PR in the endometrial and ovarian tumors report bilateral metastatic tumor spread in the ovaries (Figure 5). 5/ Positive EMA expression in cervical tumor cells determines a poor prognosis (Figure 7). 6/ Psammoma bodies are observed on histological examination of the tumors of the cervix, uterine body, fallopian tube (Figure 1,3A,3B,5A,5B). They are typical for malignancies such as serous carcinoma of the ovaries and serous carcinomas of the cervix, endometrium, fallopian tube, peritoneum [43].

By the above immunohistochemical characteristics primary locally advanced serous endometrial carcinoma/ III B class stage is evidenced. Despite the initial tumor infiltration in the myometrium, as well as the superficial invasion of the cervix in the presented clinical case, the typical tumor spread of locally advanced serous carcinoma with unilateral infiltration into the right fallopian tube and left parametrium and bilateral ovarian metastases are observed.

Prognosis

Uterine Papillary Serous Carcinoma (UPSC) is a rare aggressive variant of type II endometrial cancer [44]. The prognosis is unfavorable, as it is an extremely aggressive tumor with a high potential for local recurrences and distant metastases. The recurrence rate of UPSC is high, estimated to be 31%–80% even in its early stages (stage I–II) [45]. Frequent recurrences in UPSC have led to the induction of adjuvant treatment, including systemic chemotherapy or radiation therapy [46]. Prognosis of the UPSC is affected by age, stage, and histology as well as treatment [47]. UPSC accounts for 10% of all endometrial cancer; however, it carries the poorest prognosis, with 5-year survival rates as low as 55% [48,49].

Complex Treatment

With such a dismal prognosis, these patients should be treated aggressively [48]. The primary treatment is surgical. FIGO-cancer staging is done at the time of surgery which consists of peritoneal cytology, total hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy, and omentectomy. After staging and surgery, radiation therapy and/or chemotherapy is recommended to treat patients at high risk for recurrence [50]. Analyses of Gynecologic Oncology Group (GOG) protocol 209 (a noninferiority trial in advanced/recurrent endometrial cancer patients comparing carboplatin and paclitaxel vs paclitaxel, adriamycin and cisplatin) support the favorable side effect profile of six cycles of carboplatin (AUC 6) and paclitaxel (175 mg/m2) [51]. Those who are identified to have residual UPSC in the uterus at the time of surgery, should receive adjuvant carboplatin and paclitaxel chemotherapy, and a strong consideration should be given for vaginal cuff brachytherapy [48]. UPSC’s aggressive features, resistance to chemotherapy, poor prognosis, and extremely high recurrence rate (50% to 80%) contribute to the increase in endometrial cancer-related deaths every year. Currently, surgery together with chemotherapy and radiotherapy (vaginal cuff brachytherapy or external pelvis radiotherapy) remains the dominant treatment option for UPSC [1].

Conclusion

We present a rare clinical case of locally advanced uterine papillary serous carcinoma with difficult differential diagnosis both in terms of histogenesis and histological features, as well as in terms of its primary origin, which is extremely important for complex treatment. Strict pathohistological and immunohistochemical analysis is required for the differential diagnosis of this rare aggressive variant of type II endometrial carcinoma. The prognosis is unfavorable, as it is an extremely aggressive tumor with a high potential for local recurrences and distant metastases. The primary treatment is surgical. FIGO-cancer staging is done at the time of surgery which consists of peritoneal cytology, total hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy and omentectomy. Locally advanced uterine serous carcinomas require adjuvant treatment, including concominant radiochemotherapy followed by systemic chemotherapy.

For more information about Article : https://ijclinmedcasereports.com/

https://ijclinmedcasereports.com/ijcmcr-cr-id-00140/ https://ijclinmedcasereports.com/pdf/IJCMCR-CR-00140.pdf

#Endometrial Serous Carcinoma #Papillary Serous Uterine Cancer #Immunohistochemistry #Differential Diagnosis #Prognosis #Complex Treatment #Marinova Lena*#IJCMCR #clinical studies

0 notes

yrfemmehusband · 1 month

Text

It's endometriosis awareness month! Here's some general knowledge on my condition, as misinformation is constantly spread about it.

Endometriosis is a disease affecting 1 in 10 people with uteruses. A tissue similar to the endometrial lining, of period blood, grows and sheds on the outside of the uterus. As the menstrual cycle comes, the blood has nowhere to go. This causes intense pain and irritation to surrounding organs. It is one of the most painful diseases recorded.

Endometriosis was first discovered in 1860, though it was recognized in the Hippocratic Corpus around 4,000 years ago. Treatments have varied through the years, starting out with bloodletting, leeches, hanging upside down, exorcisms, genital mutilation, and chemical douches. During the Middle ages, the perception of chronic pelvic pain shifted from a recognized condition to something caused by hysteria, promiscuity, or it was made up. In the hayday of Hippocratic practice, Endometriosis was more common than it is today, likely due to the inaccessibility of diagnosis compared to 4,000 years ago. Somehow.

Today, treatments include birth control, surgery, hysterectomy, and pain relief. There is no cure.

It takes an average of 7-12 years for someone to receive a diagnosis.

Anyone can get endometriosis, including cis men

A hysterectomy is not a cure, as endometriosis will continue to grow and spread to other organs

The pain one experiences due to endometriosis does not correlate with staging. Staging reveals how extensive endometriosis lesions are, not pain. Someone with stage 1 could experience excruciating pain, while someone with stage 4 and frozen pelvis can experience no pain.

Endometriosis lesions are not endometrial lining. The tissue is similar, but not the same. Thus, no one actually knows what endometriosis actually is.

It is only diagnosable through laparoscopic surgery. It can be detected via imaging such as ultrasound or MRI, but more often than not, it isn't seen. You can have completely clear tests up until your surgery and still have even the higher stages of Endo (like me!) (this one was for all you undiagnosed people, you're not crazy!)

Endometriosis is comorbid with many things, including pelvic floor dysfunction, adenomyosis, vulvodynia, uterine cancer and fibroids, ovarian cancer, many autoimmune and inflammatory conditions (rheumatoid arthritis, MS, IBD), and cardiovascular disease.

I've provided links in each point and I deeply encourage you to read my sources, whether you have endo or not. Not enough people understand endometriosis so a lot of us who deal with it don't get grace or compassion, be it in our work lives, relationships, friendships, or family. People with endo, happy endometriosis awareness month.

#endometriosis #endo #endometriosis awareness #chronic illness #disability #cripple punk #chronic pain #chronically ill #disability awareness #cpunk #endometriosis awareness month

63 notes · View notes

idontlikeem · 1 month

Text

i'd like to talk about grieving, a little bit. as in the past, discussions of death and cancer below the cut, don't read if this will hurt you, etc....i'm having a bad day and i just need to stream of consciousness for a little bit. sorry.

so my mom died. if you've read my personal posts before or whatever, you probably figured that out. it happened on thursday february 15th around noon. luckily we had a bit of notice that it was coming, so i was able to drive down the saturday prior and spend time with her—three full days where she was pretty much still herself, and part of a fourth.

it's been a really hard month. like, obviously. but i think a part of me still wasn't quite ready for it. i don't know how.

my mom was first diagnosed with breast cancer in fall 2011. she had a mastectomy and went through chemo, and that was hard and scary, but it was i think technically considered stage one—a tumor that was definitely growing fast, but it hadn't spread out of the area, like not to her lymph nodes or anything, and with the treatment she went almost ten years totally symptom-free. right at the start of the pandemic, the cancer came back, but this time it was already stage four, and it was in her abdomen and uterus and intestines.

there was a time when we weren't sure she'd live more than a year. endometrial and other reproductive cancers aren't 'sexy' like breast cancer is, they're not widely studied and there aren't a lot of treatment options. when she had breast cancer i hated 'save the boobies' campaigns (and please never donate to susan komen), but now that my family has lived with another type of cancer that doesn't have tits as a draw, i hate them even more.

my mom made it four years, pretty much, since the first diagnosis. she did chemo, and radiation, and went on medication trials, and put her body through hell to try and fight it. she lived longer than i think any of us thought she would.

the problem with that is how long i've been existing in a state of grief.

i've had years to prepare for this. i've thought about it literally thousands of times—how i'd feel, how i'd tell people, what i'd do after. i pictured it, because i was trying to plan. i was trying to get myself ready.

turns out pre-grieving isn't real. turns out you can't get this pain out of the way by experiencing it in advance. much to my chagrin. i'm not sure there was a way to avoid it, though. so here i am, with four years of grief behind me, and not one second of it has made what's going on now any easier.

some days i forget. every time i'm on twitter or instagram, there are posts i want to send her, and then i don't know what to do with myself. for all that my relationship with her had its hard times, she was my mom, she was my best friend. i love her more than anything and i don't know what to do with myself now that she's gone.

i've been sort of just surviving for the last four weeks. my apartment is a mess, i'm barely leaving, i haven't been good at responding to people. so today i thought i'd at least clean up a little. i'd gone to target a day or two before i drove down to my parents', and i figured i would start with those bags, because they were just sitting there.

i'd forgotten that i bought valentine's day cards for my whole family that i wanted to send. one for each of my brothers, one for my dad, one for my mom. i never sent them, obviously, i didn't even bring them with me. i burst into tears when i pulled them out of the bag, and i've been crying pretty much all day since then. i'm never going to pick out a card for my mom ever again.

i also have a notes app file sitting on my phone. she wrote each of us letters, and my dad sent them out to us, but i haven't been able to open mine yet. it's the last new thing she'll ever say to me. how could i possibly be ready for that? how do i know when the right time to read that will be?

one thing my mom wanted was to die at home. she didn't want it to be in a hospital, and i get it. she spent a month in the hospital after christmas, and god knows how much time cumulatively over the last four years. the fact that she was able to push to get home is something i don't understand, because she was so sick—but she did it somehow. she was able to die in her bed.

and i was with her. like. i wasn't just at home, i was with her.

something they don't tell you about having someone die is you have to start arranging stuff before it actually happens. when we woke up on the 15th, we knew it was only a matter of time—her eyes weren't all the way open and her breath was labored, and she couldn't talk, although at first she still tried to say stuff. we sat there with her and kept her company and talked to her. hospice came by around 11 or 11:30, i don't even remember, and said that based on whatever measurements or readings they take (pupils? breathing? i don't know), it would be between 4-8 hours, and he recommended that my dad call the funeral home. because you have to do that first.

so my youngest brother was driving down from where he lives, my middle brother was in his room, my dad was in his room on the phone, and i stayed with her, because....well, of course, right? and i was just kind of talking, and crying, but trying not to...i don't know, beg her to stay? ask for more time? the nurse said she could still hear, they're pretty sure that hearing and understanding what's being said is the last thing to go, and i didn't want her to feel bad or guilty, or to hurt herself in an effort to stay longer even though there's nothing more that i've ever wanted in my life.

so i told her, you know, we'll be okay. it's going to be unbearably sad, and it's going to suck, but all the stuff we did as a family with her—we'll still do it. and we'll be okay. and there's nothing more important to us than her not hurting anymore, not being miserable and stuck and just...not herself. all that matters to us right now is her, and she didn't have to worry about us, because we'd be okay.

and she took in a breath. there was a pause. she took in another one. and she stopped. that was it.

i didn't even realize at first, not right the second it happened. the hospice booklet had talked about a 'death rattle', about how it happens almost all the time, but that it's more distressing for the people with the person dying than them, that they're not in pain. how the fuck would they know that, i'm not sure i believe it, but...it's what i was expecting. that didn't happen, though. she just stopped breathing.

the amount of guilt i felt for my dad being out of the room...i don't know if that will ever leave me. he said it was ok, because he was having to deal with stuff, and he'd spent a lot of time with her and it was fine, but jesus. how do i not feel like i stole that from him?

i've felt like a shell ever since. i'm back where i live, and i'm getting up and going to work and taking care of my dog and trying to stay connected to life, but...i don't know.

how is it that she's gone? how is this possible? how am i supposed to go the rest of my life without her?

i had four years to get ready for this, and i wasn't. i don't think there's any way i really could have been, but still. it doesn't seem fair that it was so hard for so long, and for NOTHING. nothing is easier now.

i'm sick of feeling sad, and hurt. i feel like i should be over it or something? i don't know, maybe just less actively affected? it's been a month. people's parents die all the time, right?

what am i supposed to do?

#personal

35 notes · View notes

shreddedparchment · 11 months

Note

It seems you and I will soon have something in common soon because I'm getting a hysterectomy tomorrow morning. It's because I got a biopsy done a month ago and was diagnosed with stage 2 endometrial carcinoma. I'm getting the full-on hysterectomy, including lymph nodes taken since this is a cancer situation. How has recovery been for you? What should I be expecting? I know we have different reasons for but probably some common issues will come up. Figured I ask.

Do you know what type of surgery you're getting. Recovery is different for everyone and reactions as well. I haven't had a problem with hot flashes or anything like that but will probably have them eventually. As for the actual recovery, even though the doctor said I should be better in 6-8 weeks, I've only just started to feel good enough to move around and lift like normal. I had my surgery back in November so definitely not 6-8 weeks lol I still get a twinge in my naval scar since my surgery was done laparoscopically. Just move very slow, very carefully, and have someone around to help you up out of bed and back in for at least two weeks. Showering was fine for me but I didn't scrub my legs for a while, just let soap kinda flow down over them.

I'm sorry about your diagnosis and hope they're able to clear it all out in one go.

And don't be ashamed to cry in front of your doctors. I wish I'd been less self conscious about it. As women we're drilled intonour heads that having kids or the capability to do so makes us women and as untrue as that is, it was still sad and I wish I'd let myself feel it. I know your surgery will go well. Sending you all of my positive thoughts, vibes, and prayers if that's your thing. 🩷❤️🩷❤️

6 notes · View notes

baytownproject · 1 year

Photo

“I think people sometimes imagine what it would be like to get a cancer diagnosis. I always imagined I would be really upset, and break down and cry. The most upsetting part was talking to my children. But with the actual diagnosis and the prospect of chemotherapy, I just felt determined to do what the doctors and my family advised. I sort of surrendered control of the situation to them.”

The dull ache in her stomach was actually colon cancer. Following surgery, she completed six months of chemotherapy. Because it was a Lynch syndrome cancer that increased her odds of developing ovarian or endometrial (uterus) cancers, a total hysterectomy was next. Unfortunately, her intestine was nicked during that surgery, which led to sepsis. A followup repair procedure, combined with antibiotics, finally resolved that life-threatening issue. But her cancer journey wasn’t complete, as another slow-growing tumor was found in her abdomen. Doctors opted for a recently approved immunotherapy, which ultimately did the trick.

“It’s been three years since I stopped the immunotherapy. No one who has ever demonstrated a complete response like me has had a recurrence. It’s rare to hear about people with stage 4 who actually survive. So I’m still in a little bit of disbelief all the time. It hits me sometimes harder than others. For several years, I wasn’t worried about planning for retirement. I just didn’t think it was going to happen; you know, that I would get that far. It’s kind of like your life’s been given back to you. It’s hard to know how I would be different now, had all this not happened. What I really can speak to is the closeness of my family. My children are so close, and that wasn’t always the case. I think this whole experience really showed them the value of family and the power of family. The other thing is that you’re not as susceptible to getting upset over the small things in life: the day-to-day stresses and squabbles and disagreements. Things like that are now even more insignificant.”

— Laurie Adcox Haffelfinger

#baytown project #cancer #colon cancer #immunotherapy #cancer survivor

2 notes · View notes

tabijozwick · 2 years

Text

Remembering Chester Bennington

Five years ago, we lost Chester Bennington to depression. Since then, many Linkin Park soldiers took his death and turned it into a mission. Some are using the mission to bring awareness to mental health in general while others use it to improve on their own mental health. For me, I am using Chester’s life and death as a way to focus on my mental health. When I was 23, I listed to the Linkin Park album Meteora to process my Asperger Syndrome (a type of autism) diagnosis. Now, add my endometrial cancer (also known as uterine cancer) diagnosis to the list of how my mental health affects my physical health. Just this past week (July 13), I quit my job at McDonald’s because it got too stressful to me. I wrote a note to the general manager and scheduling manager saying that due to both my physical and mental health, that I was resigning effective immediately. I clocked out, took my stuff from the locker, and left a portion of my uniform in the break room, and left at the end of my shift. The following day, I brought the rest of my uniform, dropped it off in the break room, and basically walked off. To me, my mental health is a lot more important than that paycheck. As for mental health in general, I say you should take a break to focus on you, not your job, not your family and friends, focus on you. If you need to, embrace your inner taco and let out a good cry. Tacos fall apart and we still love them.

#Linkin Park #make chester proud #Chester Bennington #depression sucks #depression #mental heath awareness #mental health matters #mental health #autistic experiences #autistic mental health #autistic life #actually autistic #cancer survivor #endometral cancer survivor #uterine cancer survivor

6 notes · View notes

yashodaivffertilitycentre · 20 hours

Text

Introduction

Polycystic Ovary Disease (PCOD), is a common hormonal disorder among women of adult age. It affects the ovaries and causes irregular menstruation cycles, excessive androgen levels, and polycystic ovaries. The overall health and fertility of women can all be severely affected by PCOD. PCOD can be treated with Best PCOD treatment centre in Navi Mumbai.

Causes of PCOD

The combination of genetic and environmental factors leads to PCOD. Hormonal Imbalance, Insulin resistance, Genetic sensitivity, and lifestyle choices such as nutrition and exercise can all contribute to the development of PCOD. Women will face more complication during fertility if PCOD left untreated.

Symptoms of PCOD

The symptoms of PCOD vary from woman to woman and IVF Fertility treatments stimulate the ovaries and manipulate hormones, they may make PCOD symptoms worse.

Below the common symptoms of PCOD,

Irregular periods or no periods.

Hirsutism – Excessive hair growth on the face.

Weight gain or difficulty losing weight.

Acne and oily skin or dandruff.

Alopecia – Thinning hair or hair loss on the scalp.

Darkening of the skin, especially in skin folds.

Insulin resistance symptoms of increased hunger and fatigue.

Infertility – Difficulty getting pregnant.

Mood swings, anxiety, or depression are additional symptoms.

Diagnosis of PCOD

Diagnosing PCOD typically involves a complete medical history and physical examination, along with blood tests to measure hormone levels and ultrasound imaging to visualize the ovaries.

Complications of PCOD

Complications of PCOD includes infertility, type 2 diabetes, cardiovascular diseases, and an increased risk of endometrial cancer due to irregular menstrual cycles.

PCOD Treatment Options at Yashoda IVF

Treatment for PCOD focuses on managing symptoms and addressing underlying hormonal imbalances. Yashoda IVF Fertility and IVF Centre is a leading fertility treatment centre in Navi Mumbai offering comprehensive PCOD treatment options. Their expert team provides personalized care, including medications to regulate menstrual cycles, reduce androgen levels, lifestyle changes, and advanced procedures, ensuring effective management of PCOD for improved fertility outcomes.

Importance of Regular Monitoring and Follow-Up

Regular monitoring of hormone levels and follow-up appointments with healthcare providers are essential for managing PCOD effectively and adjusting treatment plans as needed. In order to receive regular reviews and to get treatment for PCOD, women can schedule appointments with their best infertility specialists in Navi Mumbai.

Support and Resources for Women with PCOD

To cope with the emotional and psychological aspects of PCOD, women can benefit from joining support groups, accessing educational resources, getting help from pregnancy applications and seeking counseling services to manage the condition’s psychological and emotional aspects.

Conclusion

A common hormonal disorder called PCOD which we can have serious effects on a women’s health and fertility. However, with the right treatment and support, women with PCOD can lead fulfilling lives and achieve their reproductive goals. By understanding the PCOD causes, symptoms, and treatment options, women can take control of their health and well-being.

#pcod and pcos treatment #what is pcod #pcod treatment #pcodawareness #pcod #pcod problem treatment #pcod symptoms #pcod kya hota hai

0 notes

bpdbecca · 8 months

Text

Today has been rough. Facing the possibility of the end of your existence is a trip. Nothing makes sense anymore.

Like I don’t wanna spend my days inside staring at a computer screen. I wanna be out in the world enjoying the beauty in nature. I wanna spend time with loved ones. I wanna travel and see new and fun things.

But I can’t do any of those things. I have to work and pay bills, cook dinner and take out the trash.

Life just moves on.

It doesn’t make any sense.

#becca speaks #cancer #diagnosis #sadgirl #endometrial cancer

12 notes · View notes

drshefalibansalmadhav · 5 days

Text

Are Delayed Or Irregular Periods A Sign Of Infertility?

Irregular periods are very common complaints. If your periods are unpredictable, you should see a gynecologist. Though it’s common, it’s concerning. Typically, a menstrual cycle happens at regular intervals. If you find you’ve missed periods with heavy or light periods, consult your doctor. Delayed periods may indicate fertility issues. You might top infertility specialist in Siliguri to get a proper diagnosis and care.

Data show that abnormal ovulation causes 30% to 40% of all cases of infertility. No periods, irregular periods, or abnormal bleeding often indicate that you aren't ovulating. This condition is medically known as anovulation. To determine the reason for anovulation, your doctor may give tests like:

Thyroid tests

PCOS test

Pelvic ultrasound

Hysteroscopy to look inside your uterus to detect abnormality

Your doctor may recommend fertility medication to induce ovulation.It depends on the cause of the illness that makes your period irregular. There are safe and effective medications to correct anovulation.

Some of the reasons for missing or irregular periods:

Polycystic ovary syndrome

Polycystic ovarian syndrome (PCOS) is a common ovulation issue. PCOS affects around 5% to 10% of women in their reproductive years. It’s a hormonal disorder but its cause is unknown.

Untreated PCOS can impair your ovarian function. It causes ovaries to swell and small cysts to develop in and around your ovaries.

Symptoms

No periods

Irregular bleeding

Heavy periods

No ovulation

Irregular ovulation

Obesity

Acne or oily skin

Insulin resistance

Excess hair growth on your body and face (hirsutism)

Thinning hair or male-pattern baldness

High blood pressure

Fertility and PCOS

Untreated PCOS can interfere with your fertility. Plus, if you're overweight, it might be more challenging. Women with PCOS have a higher risk for:

Infertility

Miscarriage

Premature birth

Gestational diabetes

Heart disease

Type 2 diabetes

Endometrial cancer

High blood pressure during pregnancy

About 70-80% chance of infertility increases with PCOS.

Possible causes of irregular or missing periods:

PCOS

Thyroid disorder

Stress

Too much exercise

Having an intrauterine device

Breastfeeding

Uterine fibroids

Uterine polyps

Lifestyle choices can hamper fertility. These include –

alcohol, smoking, processed foods (unhealthy diet), low-quality sleep, more stress, physical inactivity, etc.

Talk to the best infertility specialist in Siliguri for all-inclusive treatment and guidance.

Too much or too little thyroid hormone can cause missing or irregular periods. It may cause your periods to stop for several months. Hypothyroidism and hyperthyroidism can prevent the release of an egg from your ovary. Plus, they can be responsible for pregnancy loss.

Medications, such as contraceptives or antidepressants, can affect menstrual regularity. Conditions like endometriosis or uterine fibroids may cause missing or irregular periods.

If you're concerned about irregular periods, consult your healthcare provider. Doctors check your medical history, perform necessary tests, and provide guidance. Initial treatment options may include lifestyle changes and medications. Further, you might need hormone therapy and fertility treatments. You can consult the best infertility doctor in Siliguri today.

#Infertility specialist in Siliguri

0 notes

discoverybody · 12 days

Text

PCOS Unmasked as a Chronic Health Condition

Polycystic Ovary Syndrome (PCOS) is a chronic hormonal disorder that primarily affects women of reproductive age. It is distinguished by a variety of symptoms, including irregular periods, increased androgen production, and the formation of ovarian cysts. PCOS is associated with a variety of health concerns, including infertility, diabetes, high blood pressure, cardiovascular disease, and endometrial cancer.

The specific cause of PCOS is unknown, however it is thought to be a combination of hereditary and environmental factors. Diagnosis might be difficult due to the resemblance of symptoms to other disorders, but it is usually based on a mix of symptoms, physical examination, and hormone level assessment by blood tests. Treatment is centered on symptom management and risk reduction, and may involve lifestyle changes, weight loss, exercise, and drugs to control menstrual cycles and lower Androgen levels.

There is no cure for PCOS, thus management requires continual treatment. Lifestyle changes, such as exercising and eating a well-balanced diet, can help regulate menstrual cycles and improve insulin sensitivity. A low glycemic index diet high in whole grains, fruits, and vegetables can also help with insulin resistance. Medical therapies and drugs, such as hormonal contraceptives and metformin, can help regulate menstrual periods, lower testosterone levels, and improve insulin resistance. Regular monitoring and long-term management are critical for changing treatment plans as needed.

#pcos #health #good health #healthcare #healthy

0 notes

womenhealthspecialist · 19 days

Text

Uterine Bleeding Specialist in Alexandria VA

Unusual uterine bleeding can cause concern, particularly when you don’t know the cause. Seeking care quickly is crucial when this occurs outside of your regular menstrual cycle. Here’s how you can find the top uterine bleeding specialist in Alexandria, and what you can expect for diagnosis and treatment.

Abnormal Uterine Bleeding: An Overview

The definition of this condition is bleeding that is unpredictable in amount, timing, and duration. It generally happens outside of your regular menstrual cycle, but it can include bleeding during your cycle that is abnormal.

The causes include:

Hormonal imbalances that typically involve excessive estrogen or insufficient progesterone

Irregular ovulation

Polycystic ovary syndrome (PCOS)

Polyps

Uterine fibroids

Cancer

Risk factors such as age and obesity can increase the likelihood of developing abnormal uterine bleeding.

What Exactly Does a “Regular” Menstrual Cycle Mean?

A typical menstrual cycle is an important aspect of your reproductive health, yet it can manifest differently in individuals. It usually spans from 21 to 35 days, though some women may experience variations outside this range. The menstrual cycle comprises four phases: menstruation, the follicular phase, ovulation, and the luteal phase.

Menstruation, which marks the beginning of the cycle, entails the shedding of the uterine lining. This bleeding usually lasts for two to seven days, with an average blood loss of approximately 30 to 40 milliliters (mL).

The flow’s intensity may vary. It may start lightly, gradually increase, and then diminish. A normal menstrual cycle is characterized by regularity, predictable patterns, minimal discomfort, and consistent flow, all of which typically do not signal abnormal bleeding.

How Is Uterine Bleeding Diagnosed?

An exam by an experienced specialist, a gynecologist, is necessary to determine what’s going on. It’s necessary to rule out serious causes and to plan a course of treatment.

Your visit will begin with a discussion about your symptoms. You’ll be asked questions about your medical background, health conditions, and current medications. Be sure to have that information handy.

If you can fill out patient forms ahead of time, do so. It’s easier to do at home than in a waiting room.

You can expect a pelvic exam and a PAP smear. If needed, your specialist may also recommend any of the following:

Pregnancy test: To rule out pregnancy-related causes or miscarriage

Blood tests: To assess blood clotting and get a complete blood count

Thyroid test: To evaluate thyroid function, which can impact ovary function and bleeding patterns

Hormone levels test: To identify hormone imbalances contributing to abnormal bleeding

Hysteroscopic exam: Examining of the uterine lining for fibroids, polyps, or signs of cancer

Pelvic ultrasound: Visualizing reproductive organs for growths like fibroids or polyps

Sonohysterogram, or saline-infusion sonography: A sensitive imaging technique for identifying abnormal uterine structures

Endometrial biopsy: Collection of tissue samples from the uterine lining to detect cancer or precancerous cells.

How Is Uterine Bleeding Treated?

Fortunately, you have options when it comes to treatment. After a comprehensive exam, you can count on the best uterine bleeding specialist in Alexandria to recommend whatever treatment is suitable for your needs.

Depending on your diagnosis, medications may be recommended. These can include but aren’t limited to birth control, hormone therapy, and nonsteroidal anti-inflammatory drugs. In some cases, surgical intervention may be necessary.

You Can Find an Experience Uterine Bleeding Specialist By Following Simple Steps

Finding the right specialist may take time, but careful consideration is well worth the effort.

It’s a good idea to begin by seeking recommendations from your primary care provider. Friends and family may also provide referrals.

If you have insurance, check with your carrier to see which medical professionals are covered under your plan.

Look for specialists in your area using reputable online sources, such as health directories or medical organization websites. Many hospitals and clinics have directories of their medical staff on their websites.

Online patient reviews and testimonials can also offer insights into the experiences of other patients with specific specialists.

Ensure the specialist is board-certified in gynecology or a related field. You can typically verify their credentials through state medical boards or professional organizations.

What To Expect During Your Consultation With A Uterine Bleeding Specialist

Once you have a short list of potential specialists, schedule consultations with them. This will allow you to meet in person, discuss your concerns, and assess your communication style and expertise. Their approach should align with yours.

During the consultation, ask questions about their experience in treating abnormal uterine bleeding, their approach to diagnosis and treatment, and what treatment options they offer.

Remember, specialists with more experience treating uterine bleeding have encountered a wider range of cases and can offer a broader perspective on treatment options.

Choose a doctor with whom you feel comfortable and trust. Effective communication and a good doctor-patient relationship are essential.

Consider where the specialist practices. Hospitals and medical centers vary in terms of resources and services. If they perform surgical procedures outside of the hospital, vet the facility they use.

Ensure that the specialist accepts your health insurance and that you understand the billing process.

If You’re Searching for the Top Uterine Bleeding Specialist in Alexandria Call Women’s Health Care Specialists Now!

Our skilled providers practice a holistic approach and offer personalized healthcare.

We integrate cutting-edge medical advancements with state-of-the-art technology to provide exceptional care. We believe in building lasting patient relationships, emphasizing education and women’s healthcare research.

Dr. Navita Modi and the team enthusiastically welcome new patients to our practice. If you’re encountering any form of abnormal bleeding, please do not delay treatment. Call 301-812-3400 to book your appointment today.

#Uterine #uterine fibroids #gynecologist #Alexandria #obgyn specialist

0 notes