The unspoken pain of patients with gynecological tumors

The "unspeakable pain" that gynecological cancer patients bear should attract the attention of society, and their psychological problems need to be effectively addressed.

The unspoken pain of patients with gynecological tumors

Ms. Li, 48, works for a multinational company and her career is on the rise. Her husband has a respectable job and her daughter is doing well in school. However, Ms. Li's wonderful life was disrupted by an unusual menstrual period.

A few months ago, Ms. Li found that her menstruation became irregular, her menstrual flow increased, and her menstrual period was longer than before, but she only attributed these symptoms to the approaching menopause and did not consider the direction of disease at all. After several consecutive menstrual periods, Ms. Li finally began to realize the seriousness of the situation and went to the gynecology clinic for treatment. After listening to her statement, the doctor recommended that she undergo a vaginal ultrasound examination.

The results of the ultrasound examination came out quickly, and a sentence on the report caught Ms. Li's attention: "The endometrium is thickened and the echo is uneven. Further examination is recommended."

Ms. Li felt a little uneasy, and the name of the disease she searched on the Internet made her gasp - endometrial cancer. She immediately took the ultrasound report to see the doctor for a follow-up consultation.

"Doctor, do I really have endometrial cancer?" Ms. Li's voice trembled slightly.

"Based on the results of the vaginal ultrasound, we strongly suspect endometrial cancer, but a definitive diagnosis cannot be made based on the B-ultrasound results alone. We need to perform a hysteroscopy and take a biopsy, and make a diagnosis based on the results of the pathological diagnosis." The doctor said calmly.

"I checked and found that endometrial cancer only occurs after menopause, but I haven't reached menopause yet, so how could I get this disease?"

"It is true that endometrial cancer is more common in postmenopausal women, but this does not mean that it will not occur in non-menopausal women. Hysteroscopy is to rule out this possibility. This examination is invasive, so you need to be hospitalized to do it."

The doctor then told Ms. Li to go to the hospital 3-7 days after her period ended. "Hysteroscopy requires the right timing. The state of the endometrium is best after the period ends."

After two weeks of agonizing wait, Ms. Li was hospitalized for a hysteroscopy. The biopsy specimens were sent to the pathology department for pathological analysis. After another two anxious weeks, Ms. Li received the pathology report.

In the "Diagnosis Opinion" column, she saw unfamiliar terms such as "atypical hyperplasia", "well-differentiated adenocarcinoma" and "FIGO stage 1A". In an instant, the word "tumor" filled her mind.

The doctor did not look surprised after reading the report. He explained to Ms. Li that her disease was indeed endometrial cancer, but it was often in the early stages and the prognosis with surgical treatment was very good, so there was no need to worry too much.

Fortunately, Ms. Li felt relieved. However, when the doctor explained to her the surgery she was going to have, her heart sank again.

The most suitable surgical method for your condition is to remove the uterus, both ovaries and fallopian tubes under laparoscopy.

I can understand that the uterus needs to be removed, but why do the ovaries have to be removed as well? Isn't there something wrong with my uterus?

Endometrial cancer is a hormone-dependent tumor. If the hormone-secreting ovaries are not removed together, the risk of recurrence after surgery will be higher.

This means that if the ovaries are removed, the body will no longer secrete hormones, is that right?

Yes, if the ovaries are removed, endogenous estrogen and progesterone will not be produced, which is equivalent to early menopause for you.

"Oh..." Ms. Li nodded and swallowed back her next question. This question made her feel absurd, but she could not erase it from her mind: "After removing my uterus and ovaries, can I still be considered a woman?"

Ms. Li's mental journey can be said to be a common experience of many patients with gynecological tumors. Like many patients with other types of tumors, gynecological tumor patients generally suffer from anxiety and depression, but gynecological tumors also have their own particularities. Its patients also face sexual psychological problems and body image disorders after the removal of their reproductive organs.

(Note: Body image disorder: objective physical defects cause subjective extremely painful psychological experience)

Why is it difficult for patients to accept oophorectomy?

Patients have difficulty accepting oophorectomy mainly due to the following two reasons:

Concern 1:

What are the effects of ovarian removal on the body?

Although endometrial cancer is more common after menopause, nearly a quarter of patients have not yet reached menopause, and cervical cancer and ovarian cancer can also occur in premenopausal women. For premenopausal patients, surgical removal of the ovaries occurs earlier than menopause, and the adverse reactions are similar to those of menopause.

However, since this process is artificially induced, the body's reaction will be more obvious than normal menopause, and hot flashes, difficulty sleeping, loss of libido, and vaginal and vulvar atrophy may occur. Long-term effects include an increased risk of osteoporosis, as well as an increased risk of cardiovascular disease and cognitive decline.

However, the good news is that hormone replacement therapy can effectively avoid the occurrence of the above adverse reactions, and there is currently no research to prove that hormone therapy will increase the risk of recurrence of endometrial cancer, cervical cancer and ovarian cancer.

Concern 2:

Psychological stress caused by oophorectomy

In addition to the depression, anxiety and painful experiences that are common among cancer patients, patients after gynecological cancer surgery often have problems with sexuality and body image disorders. Due to concerns about these private topics or due to restrictions in their social background, they will be under greater psychological pressure.

The "unspeakable pain" that gynecological cancer patients bear should attract the attention of society, and their psychological problems need to be effectively addressed.

How to relieve patients' inner pain experience

In order to help gynecological cancer patients adapt psychologically to the physical changes after surgery, how should hospitals do their work better and how should society support these patients?

It seems to be a good idea to bring this group of patients together to support each other and jointly find ways to alleviate their inner painful experiences.

Group psychotherapy

Group psychotherapy is usually led by one to two therapists. Participants often have similar demands. Therapy is conducted regularly in a salon-like manner. Group members discuss issues of common concern, and therapists listen to members' speeches and correct their incorrect cognitions.

Research on related group psychotherapy has been widely carried out among cancer patients, but group psychotherapy specifically for gynecological cancer patients is still rare.

The treatment team of the Rehabilitation Department of Peking University Cancer Hospital paid attention to the special psychological problems of patients with gynecological tumors and designed a group psychotherapy program for patients with gynecological malignant tumors in the recovery period in my country.

The study found that the treatment effectively improved the patients' depression and anxiety and met their psychological and emotional needs. Everyone in the group can get comfort from each other's support, release emotions in free expression, and face the future life with more confidence.

Internet Psychological Support Groups

Sex and intimacy are topics that are better discussed in the anonymous environment of the internet than in face-to-face conversations.

A research team from Canada organized an online forum to provide psychological support for patients after gynecological tumor surgery. The forum is hosted by professionals and discussions are held every week on specific topics, including knowledge of gynecological cancer, emotion management, sexual and image issues, relationships with family and friends, how to deal with early menopause, self-identity issues, vaginal changes and urinary incontinence.

Studies have shown that this type of group psychological support activity conducted online is more easily accepted by patients, and the anonymous format allows participants to talk more freely about private topics such as sex.

After 12 weeks of psychological support, group members generally felt that they had regained their self-confidence, thereby improving their quality of life.

References

[1] Ratner ES, Foran KA, Schwartz PE, Minkin MJ. Sexuality and intimacy after gynecological cancer. Maturitas. 2010 May;66(1):23-6.

[2] Rees M, Angioli R, Coleman RL, Glasspool R, Plotti F, Simoncini T, Terranova C. European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis. Maturitas. 2020 Apr;134:56-61.

[3] Wiljer D, Urowitz S, Barbera L, Chivers ML, Quartey NK, Ferguson SE, To M, Classen CC. A qualitative study of an internet-based support group for women with sexual distress due to gynecologic cancer. J Cancer Educ. 2011 Sep;26(3):451-8.

[4] Li Zimeng, Pang Ying, Li Jinjiang, et al. A randomized controlled trial of group psychotherapy for the improvement of emotions and quality of life in patients with gynecological malignant tumors during recovery period[J]. Chinese Journal of Mental Health, 2020, 34(12): 977-982.

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Author: Wang Yun, Shanghai Mental Health Center

About the Author

Wang Yun

Master of Medicine, Attending Physician, Shanghai Mental Health Center

Has been engaged in clinical diagnosis and treatment of psychiatry and teaching of medical students for a long time

2019 Outstanding Teacher of Shanghai Medical College, Fudan University

Secretary of the CSNP Chinese Depression Researchers Alliance

The first author has published more than ten papers in domestic and foreign journals

Expertise: Clinical diagnosis and treatment of depression and anxiety disorders, neurosis, schizophrenia, and consultation on general psychological issues such as study, work, marriage and love.

Clinic hours: Psychiatry on Tuesday morning, psychological counseling on Thursday afternoon and Saturday morning.

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)