Cancer Diagnosis - Extra Questions - Hystersisters Hysterectomy Article

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Cancer Diagnosis - Extra Questions

Cancer Diagnosis - Extra Questions

From the GYN Cancer Articles List

HysterSisters Articles

Options to Hysterectomy
Pre-Op Hysterectomy
Post-Op Hysterectomy
Hormone and Menopause
Intimacy after Hysterectomy
Pelvic Floor
Fitness after Hysterectomy
GYN Cancer
Grief and Loss
Endometriosis
Uterine Fibroids
Hysterectomy Stories
Ask A Doctor

I was recently diagnosed with cancer and don’t know what to ask or do next. Can you help me?

First, we want to offer you hugs as you begin a journey that no one expects to take.

If you haven’t seen a gynecological oncologist we highly recommend you see one since they are the experts in female reproductive cancers. Minimally you would want your gynecologist to have an oncologist in attendance at your surgery to do all the necessary oncology tests and reviews.

Make sure that you write down your questions prior to any visits with your doctors. It can also be extremely helpful to take a person with you as an extra set of ears. Some women even take a personal recorder so they can listen to what they’ve been told after the appointment and once the emotions settle down.

For general pre-op questions a great place to start is the Pre-Op tab of the Hysterectomy Checkpoints.

There are also several videos on overall gyn cancers as well as some related to specific cancers.

As for questions related to your cancer diagnosis and treatment here are a few to start with:

General Questions:
Can you refer me a gynecological oncologist?
Will you be handling all of my care or just the follow-up related to cancer?
If only the cancer care who will help me with other possible items such as depression and hormones?
Is possible for me to have a minimally invasive laparoscopic vs. open surgical procedure?
What are the benefits vs. risks between laparoscopic and open procedures?
What is the difference between standard laparoscopic surgery vs. robotic laparoscopic surgery?
Is there a difference in the chance of recurrence with different types of procedures?
Is this actual cancer or pre-cancer (complex hyperplasia with atypica)?

Overall surgery questions:
What organs will be removed and how will you determine what needs to be removed (prior to surgery, during surgery)? Total uterus with cervix? A portion of the vagina? Ovaries and fallopian tubes?
What is the reason for some organs to be removed and others to remain?
Will a pelvic wash be done? (This is to see if cancer cells have spread to the abdomen).
Will lymph nodes be tested?
Which lymph nodes will be tested? Periaortic and pelvic lymph nodes can be the first lymph nodes that gynecological cancers spread.
If lymph nodes aren’t tested why don’t you consider this to be necessary treatment?
How many lymph nodes will be taken?
What is the risk of my developing lymphedema with the removal of the lymph nodes?
If lymphedema does occur what resources are available to help me deal with it.

Related to minimally invasive laparoscopic procedures for gynecological cancers:
What safeguards are taken in a laparoscopic surgery to prevent spread of cancer cells?
Will all organs be removed in one piece? Will they be bagged prior to removal?
How many laparoscopic surgeries have you done for cancer?
How many of your laparoscopic surgeries have converted to abdominal ones?
Why did your procedures convert?
If we opt to do the surgery using the robotic system what happens if the robotic system is unavailable the day of my surgery? Will the surgery be rescheduled or will it be done via standard laparoscopy or as an open abdominal surgery?

Fertility Preservation:
Are there any non-surgical options for treatment of my cancer or pre-cancer? An example is Megace.
If I choose a non-surgical option how will we determine if my cancer is advancing or is in remission?
Can I do egg harvesting prior to my surgery?
For my type of cancer is it required that I will have my ovaries removed? Why must they be removed?
Can only the cervix be removed and the ovaries, tubes and uterus preserved? (for cervical cancer) What complications, issues or risks would this entail.
If I keep my ovaries but radiation is required is there a way to protect them?

Pathology & Follow-up Treatment:
Do we know what type of cancer it is at this time? (adenocarcinoma, sarcoma, etc.)
Do we know anything about the stage (progression) or grade (deviation from normal cells) about the cancer or will that have to wait until post surgery?
Will pathology be done during or after the surgery?
When will I receive final pathology?
Is there the chance that if something shows up in final pathology that you weren’t expecting we will have to go back in for additional surgery?
When will we determine if additional treatment such as radiation and / or chemotherapy are required?
If my cervical cancer was HPV related will there be ongoing HPV issues following treatment?
If my cancer would recur where is it most likely to recur?
What is your protocol for follow-up for the initial surgery? Long-term follow-up?
For endometrial / uterine cancers do you do a rectal exam during your follow-up procedures? Endometrial cancer usually recurs at the vaginal cuff. Doing a rectal exam gives the doctor a better tactile feel for the cuff since there is less tissue between the intestine and the vaginal cuff.

Family History
Does my cancer increase the risk of my developing breast cancer? Primarily for a question for endometrial cancers.
I have family members who have had breast cancer should I be tested for BRCA? Primarily a question for endometrial cancers.
My family has a history of colon cancer should I have a colonoscopy prior to my surgery to ensure the cancer hasn’t spread?
I have family members who have had colon cancer should I bet tested for Lynch Syndrome?

Sexual Intimacy:
Will radiation, chemotherapy or the surgical procedure affect the size or condition of my vagina? Radiation can damage tissue. A radical hysterectomy for cervical cancer will shorten the vagina.
What are my options for staying sexually active? Will I be allowed vaginal estrogen, since it doesn’t go systemic like oral or patch estrogen? Physical therapy or dilation therapy to prevent vaginal adhesion?
I am pre-menopausal and I have heard that surgical menopause is more difficult and women who have gone into surgical menopause have more sexual issues post surgery? How and who will help me deal with that if it happens?

Other questions:
Do you know of any resources that can help me deal with side effects such as depression that may develop as a result of on-going treatment or surgical menopause?
Would I benefit from a PET scan now or will it be used during my follow-up?
Would I benefit from a CT or MRI now or will it be used during my follow-up?
Will I be allowed to take hormones for any reason?
What drugs or supplements should I avoid prior to surgery?
If I undergo radiation or chemotherapy are there drugs or supplements that I should avoid that might make the additional treatment less effective?
Are there supplements that could make the treatment more effective?
Long-term are there supplements or dietary changes that could reduce the chance of recurrence?

This may not be a comprehensive list but it will get you on the road to understanding your treatment and follow-up.

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Find A Doctor Near You

Kimberly Newman, M.D. 10030 Edison Square Drive Suite 100A Concord NC 28027 704-403-7670	Ruslana Kadze, M.D. 5525 Etiwanda Avenue Suite 228 Tarzana (Los Angeles) CA 91356 818-343-1717	Bruce Pierce, M.D. 2 Princess Road Lawrenceville NJ 08648 609-896-0777
Wilfredo R. Ramos, M.D. 5301 F Street, Suite 210 Sacramento CA 95819 (916) 453-3440	Megan Daw, M.D. Western Carolina Women's Specialty Center 2100 Ridgefield Blvd Asheville NC 28806 828-670-5665	Brad Cohen, M.D. 2477 Route 516 Suite 103 Old Bridge NJ 08857 732-679-6900
James Kondrup, M.D. 161 Riverside Drive Suite 109 Binghamton NY 13905 607-770-7074	Mini Somasundaram, M.D. 4845 Knightsbridge Boulevard Suite 220 Columbus OH 43214 (614) 583-5552	Kym Boyman, M.D. 1775 Williston Rd., Ste. 110 South Burlington VT 05403 802-735-1252

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