I recently had my sister, Samantha Lee Mulder, admitted for abnormal uterine bleeding. Initially she just wanted to “observe” it, insisting that her hormones were just not working properly and that she thinks she’s approaching menopause. She finally relented when she started getting dizzy and bumping into objects because her hemoglobin had dropped. One of my OB-Gyne friends would do the fractional curettage, also known as “raspa”. In this procedure the cervix is dilated under anesthesia and the lining of the uterus and whatever’s causing the hemorrhage is scraped out. The scrapings are then sent to the laboratory for biopsy. I always try to resist it, but as an oncologist I am doomed to always think of cancer as the first, or maybe the second, most probable diagnosis. Like a headache is most probably the usual tension headache, or even a migraine, but at the back of my mind it can be a late stage glioblastoma multiforme or brain cancer. In this case, while a vaginal bleeding can indeed come from hormonal imbalance or a lowly polyp, in my head the top consideration is any tumor in the female genital tract, like the cervix or the uterus.

Still I assured my sister that she doesn’t really have the risk factors of the majority of patients who usually develop uterine cancer, which includes not having been pregnant, being post-menopausal, or being obese. But then again, being in my line of work, I have many patients who develop cancers without really fitting the usual profile. These are the outliers: lung cancer patients who never smoked, women in their twenty’s developing breast cancer, cervical cancer patients who only had one sexual partner, and so on. And then there are the rare forms of cancer which are so rare that no over-all patient profile has been found to be consistent among patients. For example, a sarcoma or a lymphoma of the uterus.

Anxious but trying to smile through it, Samantha was admitted one day before the procedure. There’s still blood, she texted me, as I was doing chemotherapy on my patients in another building. While having her snacks the customer care representatives of the hospital went into her room and greeted her. They brought her a small potted plant, which was a nice gesture from the hospital. Samantha, who is great at pleasantries, asked them to sit down and partake of the sandwiches.

“We would like to ask if you are willing to join our campaign,” they said. All she had to do was pose for the camera with the potted plant and a cardboard sign. She looked at the cardboard sign and her eyes widened in terror, It says, “CERVICAL CANCER”, and under it, “Awareness Week”. She winced at the camera. At the chemotherapy unit I also started wincing, as I did the chemotherapy of a 35 year-old with stage 4 cancer of the uterus, and a 59 year-old who had cervical cancer 5 years ago, was in remission, only to have it recur after 3 years.

After the procedure I told my mom that there were no complications. She breathed a sigh of relief. I then clarified that there were no procedural complications and that Samantha can go home tomorrow, but we also have to wait for the biopsy results. My mother was washing the dishes as I explained all the details and the things we might expect, but she slowly turned around and grabbed a wash towel. She wiped her hands, clutched the towel near her chest, and suddenly stared blankly into space. I imagined that a dream harp sequence suddenly played in the background as she narrated this soliloquy: “Ako man na-biopsy na nang apat na beses. Dalawang beses sa breast, and dalawang beses din na raspa. Yung sa breast sabi ng surgeon maaaring ma-flat ang breast ko, at magmumuka itong landingan ng eroplano. At alam mo ang mga resulta nilang lahat? No malignant cells. Sana naman ito rin ang resulta ni ate.” She then resumed washing the dishes.

The following day I asked my friend from pathology if the biopsy results were out. The specimen had already undergone gross examination and tissue processing, she said, but the pathologist might finish the microscopic examination later in the day. Of course I chose to panic myself by reading the curettage report again, which contains the findings of the OB-Gynecologist during the procedure. It said there that she was able to procure 100 mL of fleshy, necrotic tissues with blood. And in an act that I always tell my patients not to do, I typed these findings on Chat GPT and asked what the most likely diagnosis is. Cancer, it said.

Luckily the results came out faster than I expected, which said no malignant cells. I breathed a sigh of relief and immediately told them the good news. I treated myself to chicken curry in Coco Ichibanya and a coffee in &More. Anxiety makes you fat.

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Tags: breast-cancer, cancer, health, self-care, wellness