New uterine cancer

Looking at vaginas in the ER is not something that appeals to me, especially when they are 73 years old. I had a woman last night who had some sort of drainage and bleeding from her perineal area. She could not tell exactly where it was coming from. An external exam showed what appeared to be vaginal bleeding. The only problem was that she was decades past her last period, and postmenopausal bleeding is often related to some sort of gynecologic cancer.

With a normal external exam, excluding a hemorrhoid, an abscess, a cyst, or some other skin abnormality, the conversation changed significantly. After further workup, her labs were reassuringly normal; she did not have significant bleeding that would make her anemic. However, her CT scan and subsequent ultrasound confirmed that she had abnormalities in her uterus. It could be a polyp, or it could be cancer.

That’s not a great conversation to have with a patient at 3:00 a.m. on Saturday morning. It’s not something that she needs to see a specialist for in the middle of the night. There’s no OB/GYN doctor who’s going to come do a procedure, perform a biopsy, or admit her to the hospital for further testing. But unfortunately, the poor woman had to leave the ER knowing that she may have uterine cancer. The best I could do was order a consult, trust that the system works, that someone would give her a call in the next few days, and that she could see someone soon to discuss what the next steps might be. Fortunately, her CT scan did not show any evidence of metastatic disease, so despite possibly having cancer, it would appear that she at least did not have metastatic cancer.

Although that seems like very small consolation when you’re telling a patient about a new diagnosis like this.