outline your preoperatiive counselling of a 34 year old women who is due to undergo a radical hyster
Posted by Nibedita R.
Aim of pre operative counselling in a patient with carcinoma of cervix is to alleviate anxiety generated due to cancer. This needs a very sensitive and empathic approach to
provide necessary information.
It is essential to make her understand that, although she has a reasonably serious condition, the current stage would be amenable to radical hysterectomy and there is reasonable chance of cure.
Prognosis of stage 1 squamous cell carcinoma of cervix is excellent and 5 year survival rate approximately 95-100%.
She should understand that radical hysterectomy implies removal of not only the uterus and cervix but also the surrounding lymph nodes and tissues. Consideration would be given to conserve the ovaries as at this stage ovaries are not involved in the disease process and moreover because she is in the pre menopausal age group, her psychosexual life would not be disturbed.
I will inform her about the multidisciplinary input required in her care. Team would include a gynaecological oncologist and his team, anaesthetist, specialist oncological
nurse, pathologist, mcmillan nurses as well as any further specialist input.
She should stop smoking, alcohol and ocps before surgery. As there is increased risk of venous thromboembolism, she should be screened for other risk factors before surgery and need for thromboprophylxis should be discussed with the patient. Low molecular weight heparin is preferred form as it is associated with lower incidence of intraoperative blood loss and haematoma formation. She should be explained about the need for general anaesthesia and the inherent risks associated with it.
I will discuss with her the need of blood transfusion and find out any objections
she may have (ex. Jehovah?s witness) as well as explain the possible hazards.
I would like to inform her regarding morbidity and mortality risk associated with the surgical procedure and the role of prophylactic antibiotics and anticoagulant in minimizing the risk. Possibility of inadvertent injury to adjacent structures (vascular, bladder, bowel), which would be dealt with by expert surgical team. She should know that there is 1:200 chance of bladder damage and 1:500 chance of ureteric injury during hysterectomy for benign condition and incidence is higher for malignancy. Radical hysterectomy can be done both by abdominal and vaginal route, although choice will depend on surgeons preference and expertise.
Follow up is the important aspect of her management. The need for adjuvant treatment following surgery will be determined by thee pathologist?s hystopathological findings. If there is wide local clearance of tumour on hysterectomy
specimen and lymphnodes are clear of tumour, any further therapy would not be needed. In the case when lymphnodes are involved, adjuvant therapy in the form of external beam radiation would be considereda. Although radiation causes transient bladder and bowel dysfunction, most of it usually resolves. However, there are several other potential complications including stricture, fistula and vaginal stenosis. The role of chemotherapy in cervical cancer remains to be defined.
She should be provided with written information and informed consent should be taken before operation.
