Possible Staging? Ok, now I am nervous.

Hello, first real post here. Having a DaVinci hysterectomy, everything out. This is why: severe, prolonged periods, ovarian cysts that seem to come and go, for lack of a better term,and abnormally thickened endometrium. Also have a past history of abnormal paps. Have had, in order, -vag. ultrasound, -endo biopsy, -D&C w/ hysteroscopy. All of the above came back as "normal", so we tried Provera. Stopped the abnormal periods but could NOT tolerate at all. Irregular periods with flooding came back, last period was 6 weeks long after going about 3 mos. with no period.
Next step, my surgery. I want everything gone for peace of mind, and this is my Doctor's recommendation. He is a Gyn. Onc., highly accomplished, well-repected in the medical community.
Now to the post of my title. In very small print on some pre-surgical paperwork, think it's "for hospital use only" type, says "Robotic XI Assisted Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy POSSIBLE STAGING. What does this mean? I know it is cancer-related. I have pre op testing on the 21st, so can ask questions there, also, can contact my doctor with questions anytime, just thought I would ask here. I am pretty uptight about all of this, but having this site available really helps, lots of good info.
Sorry for the epic-post, made my first a good one!

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Originally Posted by Juniper521 Hello, first real post here. Having a DaVinci hysterectomy, everything out. This is why: severe, prolonged periods, ovarian cysts that seem to come and go, for lack of a better term,and abnormally thickened endometrium. Also have a past history of abnormal paps. Have had, in order, -vag. ultrasound, -endo biopsy, -D&C w/ hysteroscopy. All of the above came back as "normal", so we tried Provera. Stopped the abnormal periods but could NOT tolerate at all. Irregular periods with flooding came back, last period was 6 weeks long after going about 3 mos. with no period. Next step, my surgery. I want everything gone for peace of mind, and this is my Doctor's recommendation. He is a Gyn. Onc., highly accomplished, well-repected in the medical community. Now to the post of my title. In very small print on some pre-surgical paperwork, think it's "for hospital use only" type, says "Robotic XI Assisted Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy POSSIBLE STAGING. What does this mean? I know it is cancer-related. I have pre op testing on the 21st, so can ask questions there, also, can contact my doctor with questions anytime, just thought I would ask here. I am pretty uptight about all of this, but having this site available really helps, lots of good info. Sorry for the epic-post, made my first a good one!

I consented to possible staging as well. Idea is that when you are opened up and they think it is cancer they send in some sample to pathology. If it comes back as cancer they can also remove lymphnodes for example to get an accurate diagnosis of the stage of the cancer ( staging ). Without consent they would not be able to do so and that would mean another surgery to remove lymphnodes. Personally, I was told that my cancer risk was low but just in case to consent to it - which was totally fine with me.

All my pathology came back "ok" - so nothing extra was removed.

This is just my opinion but I think that is in there just in case. They can do every test under the sun but they do not know for sure until they get in there and biopsy the tissue.

Did your regular gyn doc send you to the gyn/onc doc? What doctor ordered all the tests? My regular doc ordered my tests and did the surgery with the onc doctor assisting. If you are seeing an oncologist cancer is what they do.

Thanks for responding, Miriam! So it sounds like they send it to pathology during the surgery? If they do have to remove nodes, any idea what that entails? Can they do that laparoscopically? Lastly, a nervous Nelly thought.....are those words on the form because they suspect cancer or is that just standard? I would think that it would be a good idea to consent, for anyone really, just in case. The less surgical procedures, the better.......

Hi Wink.....yes, my gyn referred me to the gyn onc because of the issues, the thickened endometrium, the cysts, etc.
Onc. did my D&C, and after that I became strictly a patient of his. The D&C did not show cancer. Let me say this, I had a little surge of panic when my gyn said that she was referring me to an ONC!

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Originally Posted by Juniper521 Thanks for responding, Miriam! So it sounds like they send it to pathology during the surgery? If they do have to remove nodes, any idea what that entails? Can they do that laparoscopically? Lastly, a nervous Nelly thought.....are those words on the form because they suspect cancer or is that just standard? I would think that it would be a good idea to consent, for anyone really, just in case. The less surgical procedures, the better.......

I suspect that those words are on the form because you're have a gyn oncologist do the surgery and a gyn onc *can* do staging. Gynecologists aren't necessarily trained to do the sampling procedures associated with staging.

What's done specifically is that the samples are prepared for pathological analysis by a technique called "frozen sections." Frozen sections aren't as high in quality as those prepared by traditional methods, but they can be prepared in minutes vs waiting more than 24 hours. Because of this, frozen sections are used to analyse samples during surgery, and then in addition traditionally-prepared samples are examined after surgery.

Removing lymph nodes is what it sounds like. Your body has clusters of lymph nodes in specific locations. http://www.cancer.org/cancer/cancerb...des-and-cancer has a good diagram. Your surgeon will try to take as few nodes as possible while still taking enough to get an accurate picture of what's going on. You may hear this referred to as lymphadenectomy or lymph node dissection.

The abdominal fat (omentum) is usually sampled as well.

Yes, all of this can be done laparoscopically. :-)

Thank you, Surprised! That was very helpful. Going now to look at the link!

Hi Juniper, welcome to this wonderful community

My paperwork listed a Total Abdominal Hysterectomy, (ovary, fallopian tube and cervix removal as well) along with an omentectomy and possible staging. When the gyn oncologist went in, she did not see any visual signs of cancer so they did not do the omentectomy or staging. When I went to my initial pre op appointment at the cancer clinic, they said that would have to treat me as if I did have cancer so therefore I had a sign papers to allow them to do all procedures necessary before my surgery. The great news is that my pathology report stated that everything that was removed was benign. Try not to get yourself too uptight.

Hugs

Sweetie,
As others have already noted your gyn/onc wants to be prepared to do staging should cancer be found and this would include sampling lymph nodes, possibly the omentum; doing an abdominal wash, etc. You already may be aware that the D&C with hysteroscope is an exellent test to detect endometrial cancer and is about 97% accurate so your chances are very high that cancer will NOT be there. If it is there, I'd think you'd want your doctor to be able to do further checking and proper staging so it is good he has noted this on the info for your surgery and no doubt on the papers you will sign.. If you had no waiver to allow this and cancer were found, you would very likely then need a second surgery.
Good luck and pls keep us updated.

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Originally Posted by Juniper521 Hi Wink.....yes, my gyn referred me to the gyn onc because of the issues, the thickened endometrium, the cysts, etc. Onc. did my D&C, and after that I became strictly a patient of his. The D&C did not show cancer. Let me say this, I had a little surge of panic when my gyn said that she was referring me to an ONC!

I know how you felt. I had all kinds of tests and nothing came back conclusive, so I did not know what to expect. But, every thing turned out fine. I had some precancerous cells just turning to cancer and they got it all, I need no further treatment.

But, all this pre op stuff is nerve racking and is the hardest part. Just not knowing for sure drives you crazy. I think everything will be OK with you. Good luck and let us know how you are doing.