Hello, all readers. It is the second short story in the series Three Gowns and the Doctor's Bag.

It will be the story of the lives of doctors and patients who are happy, sad, fun, and suffering all together.

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too. Thank you.

P.S. Write some fantasy. I've always been writing like the normal world is still evolving. I really want to write something more touching than this.

I have to inform you first that it is not. gynecological cancer doctor Medical knowledge may be outdated and contrary to principles. But I write for fun.

Between 'child' and 'mother', who do you think we will choose?

“Congratulations. Your baby in your womb is healthy. But...the results of the internal examination found cervical cancer cells.” The doctor's voice entered Apasara's ears like an echo that was repeated, but there was something bad about it. She found herself completely motionless, hearing her heart beat faster. Building building..Building building The voice in her heart shouted loudly. 'Cervical cancer, no, it's not true'

“Are the test results wrong?” She spoke the first words, unable to accept the results she heard.

“This is just my first inspection. We still need to send Ms. Apasara to see a cancer specialist to come up with a treatment plan. Let the specialist doctor confirm it again. I'll give you an appointment slip right away."

“What about the child? What will I do with my child?” she said in a trembling voice, both hands clenching tightly on her stomach that had not yet fully bulged.

“I will have to consult with a cancer specialist about what to do next. But now you're three months pregnant and the doctor doesn't dare speak up about what to do.” Dr. Piyawadee is stunned because since becoming an obstetrician, this is the first case of a patient having cervical cancer during pregnancy. She wasn't sure if the child would survive the procedure or not.

"I would like to refer Mr. Apasara to see Dr. Lalin, a specialist in gynecological cancer. As for the results, we will meet again next month." Piyawadee wrote a document requesting a case consultation and sent an appointment form. Quickly before saying goodbye to Apasara "Good luck, see you again." Apasara then raised her hand in greeting and got up and left the examination room drowsily. Then she went to sit and wait for the appointment and to receive the medicine.

While waiting, she thought of her husband. She and Kronchit have been married for more than ten years. Previously, Crunchit was known as A 'Tiger', but when Apasara was twenty-five, he successfully defeated a 'Tiger' who was one round of age apart. The forty-seven year old boy had been waiting for this child all along, but then he had 'Cervical cancer'

came to intervene in the family's joy Apasara didn't know how to tell her beloved husband. After thinking about it for a long time, she decided to tell this 'bad news' after she saw Dr. Lalin and made sure that she definitely 'had' this terrible disease and knew if she could save the child or not. So she kept this bad news to herself.

She had gone from being strong all this time to holding back until she was silently shedding tears, contemplating what sin she had committed that caused such a bad thing to happen on top of such a good thing.

Three agonizing days passed and she kept quiet, still acting as cheerful as a woman who finds out she's having a baby. Without Kronchit being suspicious She came to see Dr. Lalin.

After Apasara had a repeat internal examination and Lalin read the cervical cancer test results in detail. So we sat and talked.

“Can I get treatment?” Apasara asked in a trembling voice, her mind excited and worried about the answer.

“Um, the results of the test were before cancer. It can be treated,” Lalin answered confidently.

“How do you treat it? And what about you?” Apasra asked the question that worried her the most.

"Treatment by

conization 

Or a cone-shaped biopsy of the cervix can be done. But the side effect of doing it is that it can cause a miscarriage. And the chance of miscarriage is very high. The doctor didn't dare give confirmation that the child could be saved.”

“Does that mean that if you're lucky you can continue your pregnancy?”

“Yes, the doctor will try to do it as gently as possible. I hope I can keep the child. Or another way is to 'wait'. From research it is found that from a pre-cancer condition.

precancerous

Until cancer develops, it usually takes more than a year.”

Just Apasra heard that she was able to continue her pregnancy and was very happy. Tears of joy flowed down.

“Now it's up to the patient to choose. I want to cut out the meat and discard it.

conization

which has a high chance of miscarriage Or will we continue to wait and watch the growth of the pre-cancerous condition?"

"How should I choose a star?"

"From the doctor's heart. As a doctor, I want to treat patients as quickly as possible. But now that Khun Dao is old, future pregnancies may be even more difficult. Or if it turns out to be advanced cervical cancer, the uterus must be removed. The doctor really can't make decisions for Ms. Dao."

"Then I would like to go back and consult with my husband first."

"Yes, yes." Lalin understood Apasara well and therefore did not force anything. Waiting for the decision of Apasra and relatives.

Apasra then said goodbye and waited for the appointment sheet and left.

After finishing eating at the dinner table of a detached house that covers an area of ​​more than two rai. Today Apasra had the courage to tell Kronchit the bad news.

“P'Ton, Dao has bad news to tell.” Apasara's voice shook in her heart, afraid of Kronchit's reaction.

“It probably has nothing to do with the child, right?” Crunchit was surprised that Apasara had to see a doctor in a row, and he asked with a sigh before swallowing heavily, not wanting to hear any bad news that the young woman had to say.

“Yes and no,” Apasara bit her lip before speaking slowly. Kronchit was silent before nodding for Apasara to continue.

“Dao is a pre-cancerous condition of the cervix.”

Crunchit was stunned. “And can Dao be cured?” It's good that he still thinks about Apasara's health before the child. Apasara was in tears, thinking that Kronchit must ask about the child first, but she heard the deep concern in his voice, so she sighed deeply and continued, “It can be treated, but the treatment comes at the cost of miscarriage at any time.

With the doctor, another option is to 'wait', wait and monitor the symptoms first. Now Dao is just pre-cancerous. But if the cancer becomes more severe than this, then treatment will begin.”

"Does that mean you can choose treatment that will cause a miscarriage or wait for the cancer to become severe before treating it?" Chronchit's voice trembled because the choice was so difficult. "What about the stars? Which one do you choose? I..I..choose the stars." Kronchit replied with restraint, reaching out to squeeze Apasara's hand warmly.

Then he slowly pulled her into his embrace. The young woman sobbed and let the tears fall like a broken embankment, crying loudly against the chest of a monk. "Dao can't choose, Brother Ton. Ha..."

"Dao is afraid. I'm afraid the cancer will spread. But my biggest fear is losing this child. Dao can't choose, P'Ton, ha..."

"But I choose the stars." Kronchit hugged the little body tightly and whispered softly in her ear.

"But...but, Dao is in so much pain, so much pain. Dao wants to use the courage of his whole life to choose to wait. Can we wait for our child to be born?" Apasra raised her head to meet Kruchit's eyes with tears in her eyes and her voice trembling. Decided! She chose her 'child', the child that is the ultimate dream of almost every woman. She knew that if she couldn't keep this child, she probably wouldn't be able to have any more children of her own.

So she used the courage of her whole heart to make this important decision!

The couple is serious about this pregnancy. and must make an appointment for cancer screening and pregnancy examination almost every month It wasn't until the eighth month of her pregnancy that she heard the most unwanted things again.

Lalin said slowly, feeling very sorry for Apasara. “The pre-cancerous condition that I had before has now spread to stage one cancer. indicates that it is a severe type of cell We have to take serious treatment.”

“And...what about the child?” Apasara's mouth trembled, her hands clenching tightly on her large belly.

"We have to remove the cervix, so we'll probably have to give birth to a child first," Lalin said slowly, trying to understand.

“Can't you wait a little longer? Let him give birth himself.”

“Being able to go from pre-cancerous to cancer so quickly Just three or four months. Shows that the cells are of a severe type. We don't want to wait for it to spread even further than this. As for the child in the womb, 34 weeks ago Children's doctors these days are very good. They must be taking good care of you, but the doctor can't tell if the baby will have any side effects from being born prematurely.”

“Wait, wait a little longer. Doctor, couldn't it have been more than nine months ago? It's only been a month." Apasara cried out worriedly.

As 'you', what will you do?

“In the end, it depends on Khun Dao. But the doctor recommends giving birth and then getting treatment quickly.” Lalin understands the patient's concerns, but she is a cancer doctor and wants the cancer to be completely cured. She could only insist on getting the patient treated as quickly as possible.

"I'd like Dao to go consult with my girlfriend first," Apasra could only say in a sad voice and bid farewell to the doctor.

When Apasra came out of the examination room, Dr. Kronchit, who was waiting in front, hurriedly walked over to join him. He saw a young woman with a sad face and tear stains on her beautiful eyes. He was shocked and hurriedly asked.

“What happened? Why is the star crying?”

"Hi, P'Ton," Apasara rushed over and hugged Kronchit tightly. But he didn't dare cry out loud because he was in the middle of the hospital. Kronchit hurriedly carried Apasra to sit in the patient's seat.

“The cancer has spread. The doctor will give birth to the baby. But the baby will be born prematurely and will not be strong. What should we do, Brother Ton?”

“Wait, can we wait a bit?” Cronchit mumbled softly in his heart, still not wanting to accept the bad news.

“The doctor wanted me to give birth right away because I thought the cancer might be a serious type that would spread this quickly. Brother Ton, what should we do?”

Kronchit was stunned for a long time because he also couldn't decide whether to choose 'his child' or 'her'.

“I choose you! Star The doctor told me the baby could be born. Let him give birth. Then you quickly take care of yourself.” Kronchit gritted his teeth and made the most important decision in his life right now.

“But Dao takes pity on the child. What will I do if I grow up not strong enough?”

"If we're not strong, we can only raise one child. Star will give birth." Apasara was very hesitant, but this time she realized that her luck in life might have all been used up. She hurriedly sought treatment so she could be with her child a little longer. would be better So she decided to give birth.

“Yes.” So she walked to the nurse's desk and asked to see Dr. Lalin again.

Lalin was happy that Apasara made a decision and sent her to Dr. Piyawadee for delivery.

Apasara has been staying at the hospital since then. To give medicine to stimulate the baby's lungs before birth. Then she was delivered by Caesarean section. It was a strong, wrinkled baby girl coming out to see the world. When the child was born, she was taken into an incubator. Apasara, after recovering for a few more days, received treatment by having her cervix removed immediately at the hospital.

She just prayed that this time the cancer wouldn't come back. Before visiting the child in the nursery Her adorable daughter just came out of the incubator. She had done a lot of research on preventing cervical cancer. She found out that there was a vaccination against it. While she was breastfeeding, she bent down and whispered in her daughter's ear.

“I will be vaccinated against it. Mom, I won't let cancer harm me again!!”

footnote

HPV 

Dangerous virus

Today, we know that the leading cause of cervical cancer is viruses.

HPV (Human Papillomavirus) 

It is a virus that is transmitted through skin-to-skin contact. Therefore, sex is the reason why women have an approximately 80% chance of contracting the virus.

There are also other factors that increase a woman's chance of developing cervical cancer. For example, having sex at a young age, changing sexual partners frequently. Many sexual partners smoke or people around you smoke have immune system problems such as autoimmune diseases (

SLE) 

is infected with HIV

Checked every year can make mistakes if not done correctly.

exposure to the virus

HPV 

This does not mean that every woman will have cervical cancer because 90 percent of the time the body can eliminate the infection on its own. while another 10 percent begin to experience changes in the surface of the cervix, called pre-cancerous (

pre-cancer) 

In both cases, there were no abnormal symptoms at all. and the doctor may not be able to detect it with the naked eye

However, the change of cervical tissue from normal to pre-cancerous takes a long time, from 2-10 years, and when combined with the time the disease spreads to become cervical cancer, it takes an average of another 10-15 years. Therefore, women have time. Enough to prevent the progression of cancer. By detecting disease from the pre-cancerous stage in order to cure it. This is an approach that will help reduce the number of new patients.

For prevention of cervical cancer, it can be done by the following methods: vaccination to create immunity against the infection.

HPV 

especially the breed 16 and 18, which are high-risk strains, have a chance of getting cancer up to 70 percent. And also helps prevent viruses.

HPV 

Two other species cause up to 100% of genital wart cases. 90, with doctors recommending that women aged 9 - 26 years get vaccinated before having sex for the first time. Or injected in those who have had sex but are not yet infected.

HPV 

To get the most benefit from the Pap smear (

Pap Smear 

or

Pap Test) 

Your doctor will collect cells from your cervix and have them tested to look for abnormal cells that could develop into cancer. However, a Pap smear can miss up to 40 percent of the test, which is why many women find that I myself have cervical cancer despite having a Pap smear every year to check for the virus.

HPV 

It is a biomolecular test to detect viruses.

HPV 

Direct, which is a very accurate test with only a 100% chance of missing. 5-10 and most of them will be done together with the examination.

ThinPrep 

The doctor will collect a sample of cells to send for testing at once. If the examination does not find any abnormalities, it means that the chance of having cervical cancer is very low. and can wait up to 3 years before being screened again

However, even after receiving the vaccine Women should also undergo regular cervical cancer screening. due to virus

HPV 

There are 14-15 high-risk species. Vaccines therefore cannot completely prevent disease. There are also other causes that can cause cervical cancer. Therefore, proper prevention of cervical cancer should use both screening and vaccination at the same time.

Treating is more difficult than preventing.

In the event that an abnormality is detected Women are diagnosed by performing a cervical smear (

colposcopy) 

This gives a magnified image of the cervix 10-20 times, so the doctor can clearly see changes in the cervical surface, such as becoming whiter and blemished. or the appearance of blood vessels has changed The doctor will then take a sample of the abnormal tissue and send it for laboratory testing. To check whether the said abnormality is in the pre-cancerous stage or already cancer. to plan further treatment

Cancer treatment depends on the stage of the disease. That is, the pre-cancerous stage. It is a local treatment, such as destroying abnormal cells with cold or heat. Cutting the cervix with an electric wire loop Most of them only take a short time and are procedures for outpatients who have already had cancer (stages 1 and 2, initially).

The patient needs surgery. Cervical cancer surgery is different from general uterus surgery in that it is a type of surgery. "Extraction," or surgery to remove the cervix All tissue surrounding the cervix, uterus, vaginal opening and lymph nodes in the area are removed to ensure that no cancer cells remain.

This surgery can be done both openly and through laparoscopic surgery, which must be performed by an expert doctor only. Stages 3 and 4 are stages where the cancer has spread outside the cervix. Therefore, treatment consists of chemotherapy along with intra-articular radiotherapy. same time To control the cancer from spreading to nearby organs and the inner tissue surrounding the uterus.

And if the cancer spreads to the lymph nodes and pelvis, it will result in kidney and bladder abnormalities. Especially if it spreads to distant organs such as the liver or lungs, it may ultimately cause the patient's death.

It can be seen that cervical cancer In addition to being a disease that is likely to occur easily, it is also severe. But luckily, this type of cancer can be prevented through screening and vaccination, so don't miss your chance to prevent disease before it's too late.

Compiled by Dr. Wisit Suphakraphongkul Doctor specializing in obstetrics and gynecology and gynecological cancer Bumrungrad Hospital

Cutting the cervix into a cone shape (

conization) 

Assoc. Prof. Dr. Chaiyot Teerapakawong, Department of Obstetrics - Gynecology

Faculty of Medicine Siriraj Hospital 

Faculty of Medicine Siriraj Hospital

This surgery has two main purposes:

1. Helps in diagnosing disease in cases where a cervical biopsy for diagnosis is inconclusive or unable to exclude cervical cancer.

2. Helps in treating disease in patients who are in the pre-cancer stage (

CIN) 

If it can be completely removed, the patient You can often be cured of the disease.

Complications of this procedure aside from blood loss, which may occur during surgery or later, and long-term infection at the surgical site may be caused by narrowing of the cervical canal in some cases. If pregnancy occurs Miscarriage may occur in the 2nd trimester. of pregnancy Including some cases, if the pregnancy occurs until labor pain occurs, the cervix may not open and expand because the cervical tissue has become hard, requiring a cesarean section.