Because my cousin is a gyn-onc doc, I called her and got her ideas about whom to see and also made an appointment with my primary care doc's replacement (my regular doc was out on maternity leave -- it was a girl!). The primary care doc's recommendation was to do an ultrasound to see what was happening, so that was scheduled for the last week of May as was the appointment to see the local gyn-onc doc.

Again, my experience with imaging helped me understand what was going on. On the ultrasound, it was clear to me that there was a fairly large area with quite different characteristics than the surrounding tissue. The doctor interpreting it explained that the pulsating area was an area with a fairly large blood volume which was creating the intensified image. What exactly it was couldn't be determined at that point.

Following the ultrasound, I went off to see the gyn-onc who performed the examination and also looked at the results of the ultrasound. When I returned for the followup visit, he was extremely clear that he believed I had developed endometrial cancer, possibly as a result of using tamoxifen, and that the best thing to do would be to have an oophorectomy, salpingectomy, and hysterectomy fairly soon. Whether any additional treatment would be needed afterwards would depend on the pathology report following the surgery. So, we scheduled the third of my annual visits to the ninth floor of the UCLA Medical Center.

Hi Ho, Hi Ho, It's Off to Surgery I Go!

As usual, the rule was no driving, so I made arrangements with a friend to drive me to the hospital, intending that she should go back to work after leaving me off. However, she intended that she'd stick with me until I was actually headed into the operating room. This turned out to be nearly as funny as the blue magic marker with my friend, Kitty, two years earlier!

First, once I got to the pre-op area on the floor where the operating rooms are located, the anæsthesiologist needed to start an IV. But, wrapped around my right arm was a long piece of surgical tape marked in red letters saying: "No needles, IVs, or other sticks in this arm!". That left her my left arm and both legs. Naturally, the legs both got pressure leggings to ensure that I wouldn't develop phlebitis.

 Only my left arm remained for her to use. This wasn't great because my initial chemotherapy for breast cancer had gone through the veins on the back of my left hand. She gave up after two sticks and asked a senior professor to come over and get the IV started. He was unsuccessful as well. So, one of the interns who had a reputation for getting good sticks came over and got it going on the first pass. I later heard that my friend had been getting worried that she'd wind up driving me home because they couldn't get the IV started!

But, the best was yet to come. Just as they were ready to wheel me off to the operating room, a clerk came zooming into the area saying, "She hasn't signed the paper that says she understands this surgery will make her sterile."

My obvious answer to that was, "Not again!"

With the IV started and the jungle juice flowing, my brain was working along on about 2.5 cylinders. When that happens, logic is about the only thing that works. So, of course, I said, "How can I be made sterile again, when I've already been made sterile twice?"

The gyn-onc's fellow looked at me and said, "Virginia, please just sign the piece of paper!"

 I still haven't an answer to that particular question!

Following the surgery, I came to in the recovery room and am said to have inquired whether the sterilization worked or not. ;-)

Once I was back in my room, I was pretty dopey and only wanted some juice or water. But, two primary things after any abdominal surgery that the medical staff want are for the patient to pass gas and to urinate. Until both happen, the answer is no solid food and only limited liquids.

For five days I valiantly tried to do both unsuccessfully. Finally late on day 5 and early on day 6, I managed both so that they would finally let me eat.

 My surgeons came by to explain what they'd found and what the pathologist's report described. The endometrium was covered by a layer of tissue that one of my surgeons described as "moss-like". But, fortunately for me, the moss hadn't penetrated the wall of the endometrium. Additionally, they told me that there was no carcinoma in the ovaries or Fallopian tubes. Finally, they said that the pathologist's report staged my tumor at Stage I, meaning that no additional treatment, either radiation or chemotherapy, would be required.

So, on day 8 following the surgery, I was discharged with the biggest bucket of medications I have ever seen prescribed for one person, several of my "normal" medications for blood pressure and diabetes as well as several different kinds of painkillers.

Getting Out, Again.....

At the time of my followup appointment, I had a number of questions for my doctors.

 First, how could this stuff survive in the face of all the chemotherapy I've had in the past two years?

Second, how do we determine whether this is related to the tamoxifen or not?

The answer to the first question is that endometrial cancer turns out to be pretty insensitive to most of the drugs that I had received for breast cancer. So, if the endometrial cancer had existed before I was diagnosed with breast cancer, it could have survived that chemo just fine.

The answer to the second question is based in my medical history. In 1984, I had a D and C to deal with heavy endometrial bleeding. The pathology report at that time described me as being perimenopausal, i.e., I was in the process of going through menopause. Nine years later, it seemed pretty reasonable that being perimenopausal should mean that I was very likely to be significantly menopausal at the time I started my chemotherapy for breast cancer. In that situation, the endometrium would have naturally become thicker and more susceptible to becoming cancerous in any case.

It is the belief of my onc doc that the endometrial cancer was independent of the tamoxifen use simply because its extent and cytological characteristics would indicate that it had been in place, growing slowly for some time.

So, what happens when you get the second diagnosis?

First, you know you aren't going to die in the next 33 seconds, which a lot of people believe when they get their first diagnosis of cancer.

Second, because my mother was diagnosed with endometrial cancer in 1962, I knew that early detection, diagnosis, and treatment were significant in getting the disease taken care of.

Third, a friend I knew from one of the breast cancer support groups received the same diagnosis about two weeks ahead of me and was going through the same process. Once again, it was like having a big sister or close friend doing something first.

Finally, the term "remarkably sanguine" comes to mind because you know that you've whupped up (as they say in Florida) on one of this sucker's brethern successfully and you know that you have the fortitude to stay the course.

Recovering, AGAIN!

The recovery for this turned out to be remarkably like my recovery from the transplant, except that it was considerably faster. During five days trying to pass gas and urinate, about the only exercise I'd had was walking up and down the hall and back and forth from my bed to the bathroom. I couldn't have patio privileges until I succeeded in the only two tasks my docs really wanted me to accomplish.

In the middle of this whole process, the gyn-onc fellow came by to introduce me to her successor. It turns out that I was her last patient before she went off to become an attending physician. I figured that at least I'd probably wind up seeing her there from time to time, which I have! ;-) She's even been doing some studies on the gynocological effects of tamoxifen! And, best of all for me personally, she came back to UCLA as a faculty member for several years before moving to Seattle.

It took me about two months to work up to my regular walking speed and distance and a further three months to build up my endurance so that I could get back to work without taking huge naps every day. Fortunately, because there was no chemotherapy this time around, chemobrain wasn't an issue and most everything mental worked pretty well from the outset. It was really just a matter of building up my endurance.

I must say, however, it does get pretty old after a while!

In November, 1993, I went back to work, again. And, as they say, the rest is history....... ;-)

Copyright 1998, 2007 Virginia R. Hetrick
Most recent update: 2 May 2007 10:21
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