Failure to Diagnose & Delay in Treatment of Uterine Cancer

Evaluate breaches in the standard of care when determining Failure to Diagnose & Delay in Treatment of Uterine Cancer

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present?
    Post menopausal bleeding
    Irregular menstrual periods
    Prolonged or heavy menstrual bleeding
    Symptoms not elicited
    Answer unknown
    Why is this important?
    Post-menopausal bleeding is the only symptom in a majority of patients with endometrial cancer.
    (2007) 45 ERDCNA 1 167-182

  • With which of the following risk factors did the patient present? Why is this important?
    Answer this question
    Elicitation of risk factors aids in diagnosis.
    (2012) 26 EBPCOG 3 311-324

  • Was annual screening for endometrial cancer advised? Why is this important?
    Answer this question
    The American cancer society screening guidelines recommend that when the women reach menopause they need to be informed about the risks and symptoms of endometrial cancer so that they can in turn alert their physicians. “It is recommended that the screening be considered in those who harbor mutations in the genes associated with the hereditary non-polyposis colorectal cancer syndrome, those who are at greater likelihood of being a mutation carrier, and women with a suspected autosomal predisposition to colon cancer in the absence of genetic testing. Women belonging to hereditary non-polyposis colorectal cancer kindred are at an increased risk of endometrial cancer with a lifetime risk of 42–60%. Such women can be offered annual screening, beginning at age 35, after they have been counseled properly about the risks, benefits, and limitations of screening.”
    (2005) 20 EBPCOG 2 363-377

  • Was a complete physical evaluation performed? Why is this important?
    Answer this question
    The evaluation of a woman with abnormal vaginal bleeding must include a focused physical examination and a thorough pelvic examination. The pelvic examination must also include visual inspection to evaluate for any sources of bleeding such as cervical, vaginal, rectal, urethral bleeding. The uterus and adnexa must be palpated for uterine size and position, as well as for any suspicious masses.
    (2007) 17 EOBGRM 11 318-323

  • Was the patient discharged with a differentential diagnosis and later diagnosed with uterine cancer? Why is this important?
    Answer this question
    Ninety percent of women with endometrial cancer will present with abnormal vaginal bleeding or abnormal discharge. Therefore, any woman presenting with these symptoms must be carefully assessed.
    (2010) 5 EULTRC 2 245-256

  • Was the patient referred to a gynecologist or an oncologist? Why is this important?
    Answer this question
    Primary care physicians are in a position to diagnose and provide some level of care to these patients. Many of them will at one point need to refer the patient for additional specialized care by a gynecologic oncologist.
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  • Was a transvaginal ultrasound prescribed? Why is this important?
    Answer this question
    Transvaginal ultrasound is the first imaging study to be performed in a patient with suspected uterine cancer.
    (2007) 45 ERDCNA 1 167-182

  • Was the endometrial thickness measured? Why is this important?
    Answer this question
    In the postmenopausal woman, endovaginal ultrasonography has been used to assess endometrial thickness in an attempt to identify women who need further invasive testing
    (2009) 23 EBPCOG 5 595-607

  • What was the patient's endometrial thickness? Why is this important?
    Answer this question
    In the postmenopausal woman, endovaginal ultrasonography must be used to assess endometrial thickness in an attempt to identify women who need further invasive testing.
    (2009) 23 EBPCOG 5 595-607

  • Was the patient given guidelines for futher follow-up evaluations? Why is this important?
    Answer this question
    Endometrial cancer most commonly recurs in the vaginal cuff or pelvic sidewall. Follow-up is beneficial for early detection and accurate characterization of the extent of recurrent disease and in identifying patients who might be candidates for local resection, pelvic exenteration, or radiotherapy for non Resectable disease. CT and MR imaging can demonstrate the site and extent of recurrence after surgery.
    (2007) 45 ERDCNA 1 167-182

  • Was an endometrial biopsy recommended? Why is this important?
    Answer this question
    An in-office endometrial biopsy must be one of the first steps in evaluation of postmenopausal uterine bleeding or abnormal peri-menopausal bleeding.
    (2009) 23 EBPCOG 5 595-607

  • What was the result of the biopsy? Why is this important?
    Answer this question
    Up to 90% of endometrial cancers are adenocarcinomas. Depending on the glandular pattern, they are classified as well-differentiated (grade 1) to anaplastic (grade 3) tumors. Prognostic factors include tumor grade and stage, depth of myometrial invasion, and lymph node status.
    (2007) 45 ERDCNA 1 167

  • Which of the following staging methods were used? Why is this important?
    Answer this question
    The international federation of gynecology and obstetrics’ clinical staging system is used for any patients who are not surgical candidates.
    (2007) 45 ERDCNA 1 167-182

  • Was a pre-operative evaluation performed? Why is this important?
    Answer this question
    Patients with endometrial cancer often have co-morbidities such as obesity, hypertension, diabetes, and cardiac and pulmonary dysfunction that make them high-risk or poor surgical candidates. A physical examination and chest radiography are required for preoperative staging.
    (2009) 61 ADVDDR 10 890-895

  • Which of the following treatment methods were initiated? Why is this important?
    Answer this question
    Surgery remains the treatment of choice for patients who are medically fit.
    (2008) 20 CLIONC 6 448-456