"You Have Uterine Cancer, Go Home and Make Final Arrangements": An Era Gone By
I am fascinated by how far we have come in women’s healthcare. I love to read old medical books to see how they approached diagnosed and treatment. This entry into my “era gone by” series will explore the treatment of uterine cancer in the early 1900s compared to present day. Enjoy!Reaching up to pin the last corner of the sheet to the rope, Margaret stopped short. Her hand dropped the clothespin as she leaned over, her knees buckling. A hot breeze whipped the laundry, causing it to swing and sway. A sheet blew over Margaret's head, covering her face only to flurry the other direction. Catching her breath, she dropped to her knees trying to calm herself. The pain gradually began to ebb as did the misery on her face. Slowly getting to her feet, Margaret moaned at the pain in her knees. With a sigh she continued to hang her laundry. Whispering to herself, "I'm falling apart." "Mom, are you ok?" asked Mary, Margaret's third child out of seven. "I saw you from the window. I think you should lay down... here, let me take over. I'll finish this." Mary picked up the wicker basket and moved on to the next row of rope to hang the rest of the bedsheets. Margaret watched her for a second, then relented and went into the house to rest. Thinking it was just the heat, Margaret laid down on top of the bedcovers and pulled her skirt up a bit. Fanning herself, she began to cool. The next thing she knew, the laughing and clatter from the kids playing woke her. Slowly sitting up on the edge of the bed, Margaret took a deep breath and stood.
Turning around, she leaned over to pat the wrinkles out of the bedcover. Margaret inhaled sharply, and a squeal escaped from her lips, her eyes fixed on the irregular circle of blood on the bedcover. Three months later, Margaret stepped into the doctor's office. Sweat formed on her forehead in spite of the cool fall air. The next thing she knew, she was standing with one leg up on a chair, naked. Shivering in humiliation, the doctor examined her. Stabs of pain shot up through her abdomen from her vagina. When it was over, the doctor told her to get a husband. "I'm sorry Mr. and Mrs. Townsend, Margaret has uterine cancer. Go home and rest as much as you can and make final arrangements".
Uterine cancer is a concern for women no matter what the era. Margaret lived in the early 1900s when uterine cancer was one of the most "important medical subjects of the day," according to the book Reference Hand-Book of Gynecology for Nurses by Catherine Macfarlane, M.D., F.A.C.S. (47). Cancer is just as mysterious to us now as it was then, however detection and treatment have improved significantly. Macfarlane points out that the focus on uterine cancer was so important because of its frequency, the increasing of that frequency, and curability. The only treatment available in the early 1900s was surgery, and that was when it was caught in the early stages. Women often died at the turn of the century because of lack of medical care due to logistics, or availability.
"Out of 100 deaths among women, 12 are from cancer, and of these, 4 from cancer of the uterus," (47). The American Cancer Society website at www.cancer.org tells us that there would be 757,190 uterine corpus cancer survivors as of January 1, 2016. They go on to state that as many as 60,050 will be diagnosed in 2016. Uterine cancer is the second most common cancer for women, broken down into the two types, endometrial also called uterine corpus (90%), and uterine sarcoma (10%). The average age for uterine cancer patients is 62 in our present time as compared to 40 or over of the early 1900s. In 1859, 840 women lost their lives to uterine cancer in England, in 1908, 1010 died from the same ailment (47).
The latest stats on the ACS website tell us that the 5 - 10 year survival rate is 79% to 82%. Treatment and detection have improved these numbers over the past 100 years. Macfarlane talks about how to reach women, in her time. It was very difficult to reach rural women, and just as hard to educate in a timely manner so that surgery could be performed to save lives. Surgery was the only option at that point, contrasted to the availability of chemo, radiation and surgery now available. Uterine cancer can be detected early in relation to symptoms such as vaginal discharge, postmenopausal bleeding, and irregular bleeding. The annual pap smear most women get, is not good at finding uterine cancer. The doctor or nurse will screen for a family history of uterine cancer and schedule an endometrial biopsy or a hysteroscopy with a D&C. Macfarlane was onto something in her book, campaigning for the education of women. She felt that nurses were the first line in this learning process. I believe she was right then and now. Nurses are the front line for educating patients on disease, treatment and the most important aspect of healthcare: prevention. If you know of some new and fantastic way to treat uterine cancer, please share.
If you have experienced uterine cancer, share with us your experience.
ReferencesAmerican Cancer Society. www.cancer.orgMacfarlane, Catherine M.D., F.A.C.S. Reference Hand-Book of Gynecology for Nurses. 1908, W.B.Sanders Company.Last edit by Joe V on Jun 14
About Brenda F. Johnson, BSN, RN
Joined: Oct '14; Posts: 229; Likes: 837
RN at Gi Lab; from TN , US
Specialty: 25 year(s) of experience in Gastrointestinal NursingJan 19Joined: Jun '17; Posts: 76; Likes: 162Thanks for that great article Brenda. I am an OB nurse who has done a little GYN too. I will definitely share this one!Jan 21Joined: Jun '02; Posts: 2,242; Likes: 5,133I'm curious if pap smears don't detect cancer what is the purpose of a yearly check? I'm not an OB nurse and I'm one of those bad patients that don't get a yearly check up.Jan 22Occupation: allnurses Asst Community Manager, APRN Specialty: 25 year(s) of experience in Nephrology, Cardiology, ER, ICU ; From: US ; Joined: Apr '00; Posts: 53,476; Likes: 26,425Quote from brandy1017PAP smears detect cervical cancer, not endometrial cancer. For endometrial cancer, you most often need an endometrial biopsy which can be done in-officeI'm curious if pap smears don't detect cancer what is the purpose of a yearly check? I'm not an OB nurse and I'm one of those bad patients that don't get a yearly check up.Jan 23Joined: Aug '17; Posts: 44; Likes: 142While caring for patients as a CNA in a LTC facility I had a post-menopausal patient with bleeding. I tried to politely advocate for more care, but the (male) nurses thought it was no big deal. I spoke with our facility's medical director and got that patient an appointment with an OB-GYN. Her uterus was removed and 7 years later she is well and healthy.Jan 23Joined: Sep '12; Posts: 284; Likes: 1,202Quote from brandy1017Pap smears take a small sample of cells from the cervix, and then they are stained and examined for pre-cancerous or cancerous changes to those cervical cells (ie. cervical cancer). Even though the uterus is attached to the cervix, the types of cancer are different, and that's why a pap smear won't detect uterine cancer.I'm curious if pap smears don't detect cancer what is the purpose of a yearly check? I'm not an OB nurse and I'm one of those bad patients that don't get a yearly check up.
Definitely talk to your OB or general family doctor about how often you should get a pap smear!Jan 25Occupation: RN at Gi Lab Specialty: 25 year(s) of experience in Gastrointestinal Nursing ; From: TN, US ; Joined: Oct '14; Posts: 229; Likes: 837Quote from brandy1017A pap smear checks for cervical cancer, as far as uterine, the pt. and Dr. have to go by symptoms and family history
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