Sterile Straw = Life Extension

Earlier this month I saw a patient, Encarnación (pictured below), who I had not seen in several years.

She and her husband reminded me that back in 2016 she presented with an approximately one year history of irregular vaginal bleeding. She had been seen at several outside facilities prior to presenting to our clinic, but had no definitive diagnosis.

At her initial visit, in under an hour, we were able to accomplish what others had failed to do in the many months prior. Our patient's history of bleeding was not normal. History and physical exam were complemented with point-of-care labs and point-of-care ultrasound (POCUS). POC Hgb was 9.1 consistent with moderate anemia. POCUS revealed a thickened endometrium.

We recommended Encarnación have an endometrial sampling procedure in order to obtain endometrial cells and evaluate for potential malignancy. Endometrial sampling can be performed in office with minimal patient discomfort, a low risk of complications, and little cost. Essentially, a sterile straw, often with a plunger device to apply low pressure, is used to obtain a sample, which is then submitted to pathology for evaluation. We used an Endocell device (pictured below).

Our patient provided informed consent, the procedure was performed, and the sample was sent to pathology. A couple of weeks later she returned to clinic to review her pathology report, which confirmed one of our biggest fears. She had cancer.

"MODERATELY DIFFERENTIATED ADENOCARCINOMA WITH EXTENSIVE NECROSIS."

Prognosis for endometrial cancer, particularly when localized, is quite favorable as evidenced by the table below from the American Cancer Society's website, cancer.org.

We directed our patient to Guatemala's national cancer institute, INCAN. There, per patient report, she received radiation therapy.

That was nearly a decade ago. Encarnación is still alive and well.

She is a shining example of the positive impact we (i.e. you, dear reader/supporter + our local team + in this case, Guatemala's lone comprehensive cancer center) can have in the lives of our patients (and their families) by rapidly arriving at an accurate diagnosis and facilitating timely and appropriate care.

In the case of Encarnación,

Sterile Straw (EMBx) = Multi-year Extension of Healthspan and Lifespan.

Top Photo by Nik on Unsplash