"Either cut it!" A 30 -year -old woman unfortunately suffered from "reproductive double cancer" ...

Two important reproductive organs -uterus and ovaries, at the same time, have cancer. The simple thinking is: what else do you want to have, and it is almost cut!

Written article | Zhao Yan

Source | "Medical Community" public account

For women, tumors and fertility seem to be a pair of dead enemies, especially patients with gynecological tumors, and the tumors grow in reproductive organs. Whether surgery, chemotherapy, or radiotherapy, they have a fatal blow to women. In addition, the public seems to be an old set of ideas. Once you suffer from tumors, keep your life tight first. Do not consider what fertility, femininity, and hormone levels, and it is good to survive.

In fact, with the rapid progress of tumor treatment and the efforts of a generation of doctors, the tumor is no longer a "killer", and the doctor has gradually domesticated into "chronic diseases". Many tumor patients can live and live normally with the help of a doctor. Therefore, the quality of survival of tumor patients is becoming more and more important. High -quality and uncomfortable living are the greatest respect and help to tumor patients. The quality of life of women is largely related to reproductive hormones.

As a doctor, I always have some concealment for some young tumors who are facing fertility. For those young tumors who have the opportunity and indicated, choose a "just right" treatment plan, which not only treats the tumor, but also gives them the opportunity to be a mother, and live a quality life like normal women. This is the wish of young tumor patients and the wish of our doctor. But is this possible? On the left is the risk of tumor recurrence, and the right is unknown whether fertility can succeed. Is there a way between the left and right difficulties, how can there be a road that is just right?

Recently, my hospital has been diagnosed with Ms. J. She is only 30 years old. She has a happy family and young baby who is planning a second child. The local biopsy, a few large characters -cervical squamous cell carcinoma. What is more dramatic is that the patient further checked and found that there was a large mass of 15cm in the stomach, there was a large piece of real part, the blood flow was very rich, and he was highly suspicious at the same time suffering from ovarian malignant tumors. When she first entered the clinic, Ms. J and her husband were nervous, pessimistic, hesitant, and expected to be written on their faces.

The patient was completely frightened by the fact that he was at that time, and murmured: "Otherwise, you will cut it, it's all cut ..." When asked, do you want to ask for a child again? The couple nodded frequently. Indeed, the two important reproductive organs -uterus and ovaries, at the same time, have cancer. The simple thinking is, what else do you want to have? It is almost cut completely, and at the same time suffering from cervical cancer and ovarian cancer, it may face the maximum surgery of gynecology.

But for doctors, women who face a 30 -year -old age need to peel the cocoon and find the "just right" treatment method. In fact, there are several interesting breakthroughs in this case:

1. Patients' cervical cancer is only the result of biopsy. A small number of tissue outer hospitals do not report the depth of infiltration for the time being. If the patient is only the earliest earlier cervical cancer with very shallow deep infiltration depth, it can be cured through the cervical cone or cervical resection. You can keep the uterus.

2. What about ovarian tumors? Similarly, if you look at the image data seriously, there are only one side of the patient with large ovarian mass, the other on the other side of the ovary is normal, without pot abdominal effusion, and no suspicious lesions are seen in the rest. Tumors between benign and malignant, patients have the opportunity to retain the opposite ovaries.

After such a preliminary judgment, we need to plan accurate surgical steps to gradually clarify the detailed staging and organizational type of tumor, and strive for her to be a mother's hope for her. Therefore, the planning becomes a cervical cone -cut to clarify the staging of cervical cancer; then the abdominal detection is performed to clarify the nature and staging of ovarian tumors. Gradually pass the cervical paraffin pathology and frozen pathology during the ovaries to determine the scope of surgery; can we conclude whether patients can successfully retain their fertility through final staging surgical resection.

There are many details: the evaluation of the patient's current fertility before surgery, the assessment of tumor logo, the selection of the interval time of the interval between the cervical cone and the opening of the abdominal detection, the possible situation of the cervical cone and the abdominal detection surgery. Different tissue types retain the indication and scope of fertility surgery. The uncertain factors such as shadow are accompanied. How to determine these uncertainty one by one is the process from deep professional thinking to actual landing. Clinical literacy of the doctor team.

The story of Ms. J's story made us please. After arrangeing the diagnosis and treatment steps for Ms. J in detail, she made a cervical cone early on Monday morning to facilitate the pathological department to judge. Due to the requirements of cone -cut surgery and pelvic surgery interval time, the pathology department also specially adds emergency treatment to this patient, ensuring clinical surgery time. The first good news came out: the patient's cervical cancer was IA1, the earliest, and there was no lesion in each edge, and there were no other high -risk factors. From the perspective of cervical cancer, the surgery of cone cutting solves the problem! Take the first step on the road to retaining fertility!

On Wednesday, we went straight to the ovarian tumor to open abdomen. The tumor was really huge, but the envelope film was quite complete, and the tube ovaries on the side were quickly removed. We were secretly relieved, but the moment of cutting the specimen on the stage was cold again. In the huge tumor sac, after cleaning the mucus, the solid nipples of the big cluster seem to be unhappy, but it seems not that badly with a pliers. Everyone has spoken their thoughts on "the naked eye freezing", benign? Intersection Most of them are the junction! "The naked eye freezing" is an experience reaction, and the facts still depend on pathology. The phone rang: "Ms. J's tumor is judged as ovarian mucus junction tumors!" Ms. J. Ms. J seemed to pass again! Junior ovarian tumor is a tumor between good and malignant, which is more mild but also has the probability of recurrence and metastasis. The important thing is that the border ovarian tumor can consider reserving fertility regardless of staging! The staging of ovarian tumors must be surgical pathological staging, so the next surgery is the staging surgery of the standard preservation of the uterus and the opposite ovaries. Speaking of a wave of twists and turns, when detecting the post -peritoneal lymph nodes, we found that there are enlarged lymph nodes, which are all removed and handed to the pathology to make the final verdict.

Ms. J was completed within 3 days of cervical and ovarian surgery. The two tumors or early or malignant degrees were in line with the retention of fertility. Ms. J and we both know that they have to wait for the final pronouncement of the ultimate pathology. If the nature changes, the possibility of opening the abdominal removal of fertility organs will be faced again.

In the end, the pathological results of the pathological results: border ovarian tumors, but there is a pelvic lymph nodes metastasis, and the metastases of the lesion is also an juncture tumor. There is no lesion in the rest of the other parts. Ms. J is eventually the period of the border ovarian tumor III, which eventually meets the retention of fertility. We instructed Ms. J to recover well. After 3 months, we came back to review. After evaluating the recovery and fertility of surgery, we could arrange for fertility as soon as possible. However, you must do regular follow -up work. Bless Ms. J can get her second baby smoothly. The whole family lives a healthy and happy life!

科 Dr. Zhao Yan, Aiwi Gynecology, Beijing Meizhong Editor:

As a doctor, I really feel the precise treatment of "just right" for each patient. In addition to the years of deep medical knowledge and experience accumulation, the doctor must also test the "mental strength" and "brain power" of each case. After the dense clinical thinking judgment and output of the outpatient clinic every day, I often have a feeling of being "hollowed out". I need to find a quiet place to accumulate energy and continue to help patients.

We will also think about the patient's psychology. This care and communication is not the "explanation" floating on the surface. In the face of uncertainty, the final result can only be promoted step by step. We must consider the patient's mental state and degree of acceptance, and we may not have the details of each clinical thinking at the beginning to the patient. The uncertainty in the process sometimes increases the anxiety and fear of patients, making them overwhelmed. Let's give the patient a direction first and tell them that we are gradually trying to find a solution for "just right" for you. Leave professional uncertainty to yourself, and then gradually communicate with patients, slowly let patients understand the process of disease and establish confidence. Patient's understanding and trust, even "not anxious", will give doctors a great sense of power.

In this case, we thank Ms. J for their trust and cooperation, and thank them for their cognition and acceptance of risks. Let us rest assured that they can find the "just right" point for her!

These inner feelings and efforts behind us want to share, so that more and more people feel the complexity and profound medical, and feel the great responsibility of the doctor and the medical team to help the patients behind. Let more people go with us to fight against the disease and find the "just right" diagnosis and treatment plan.

Source: Medical Community

Responsible editor: Wan Shunshun

School pair: Zang Hengjia

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