A woman went into surgery for a colectomy but woke up with a cancer diagnosis and a hysterectomy
MDlinx Dec 06, 2023
Earlier this fall, a 38-year-old woman, Devlynn Cyr, went into surgery for a colectomy that would, hopefully, repair her ruptured colon. Cyr had been experiencing abdominal symptoms she said others chalked up to constipation, colitis, or Crohn’s disease—and that she’d been made to feel like a hypochondriac.
Cyr explained in one TikTok video that for many years before this surgery, she’d had 15 surgeries due to diagnoses of rectal abscesses and diverticulitis.
In her most recent surgery, the plan was that she’d have her colon repaired and an ostomy placed. However, when she woke up, things didn’t go as planned.
When she woke up, she was told the surgeon discovered stage 3 colon cancer—and that it had spread: “Not only did they cut two parts of [the] colon, and put them back together—thankfully no ostomy bag—but they also had to give me a full hysterectomy because everything was like cement,” Cyr explained in her viral TikTok video.
According to research, colorectal cancer commonly metastasizes to the liver, lung, lymph nodes, and peritoneum, but metastasis to the uterus is uncommon.
Uterine Cervix Metastasis from Rectal Carcinoma: a Case Report and a Review of the Literature. Japanese Journal of Clinical Oncology.
Compounding the news of her cancer, the hysterectomy element of Cyr’s surgery was challenging for her and her husband, as explained in another TikTok video.
She tells People that her husband had to grant the surgeon permission to do the hysterectomy while Cyr was already under anesthesia—a tough choice, considering Cyr and he had talked about having children.
Cyr told People, “My husband gets a phone call halfway through surgery saying, 'Here's the problem. We found a tumor, and it's cemented to my uterus.'” The tumor was the size of a baseball, and in order to remove it, they had to do a full hysterectomy.
Even without the hysterectomy, however, the cancer had damaged Cyr’s fallopian tubes and uterus so much that she wouldn’t have been able to conceive.
After she’d awoken, Cyr told People, “My husband sits on the bed, and he's like, ‘I gotta tell you something,’ and my heart sank. He said, ‘I had to make a decision, and they gave you a hysterectomy, but you have no ostomy bag.’”
The medical dilemma
A 2020 International Journal of Surgery review examining the ethics of incidental findings (IF) during surgery found that instances like these result in ethical and legal dilemmas for healthcare professionals.
Legal & ethical dilemmas in incidental findings during surgery: Review article. International Journal of Surgery. 2020;75:107-113.
These situations, the authors write, call on a complex multitude of elements, including decision-making under stress, the Hippocratic oath, skill and experience, and input from other medical fields.
More so, surgeons must consider the legal implications. For example, they write, “If a surgeon discovers an IF at surgery and his conduct causes the death of the patient, if his actions are grossly negligent, he may be prosecuted for gross negligence involuntary manslaughter.”
Considering all of the above, the authors stress the fact that there are currently no set guidelines for IF during surgery, nor is there a known incidence rate of IF. To correct this limitation, the authors call for creating a surgical IF guidance tool to help doctors make the right choice in cases like Cyr’s. The authors found that only 60% of doctors were “correct in their intra-operative decision-making” according to the authors’ proposed decision-making tool.
“On finding an IF during surgery, the surgeon must balance the ethical dilemmas of autonomy, beneficence, justice, and non-maleficence for the patient. This is further complicated by applying these principles to current civil and criminal laws. By constructing an IF guidance tool [it] may assist in improving patient safety and help the trainee and newly qualified surgeon and his team to come to the correct decisions in the best interests of the patient,” the authors write.
According to Dr. Kyle S. Eldredge, DO, a fellowship-trained colorectal surgeon, the surgeon in Cyr’s case had to make a difficult decision. “The indication is that she went in for chronic constipation and removal of colon…and the diagnosis changed. At that point, you’re in a very difficult situation. What is the best thing to do?” Dr. Eldredge ponders. “In that situation, I’d discuss it with a spouse, family member, or next of kin.”
In Cyr’s case, egg retrieval was a key issue. As she recounted to People, she asked her husband, “Did they retrieve some eggs for me to be able to have children in the future? Like, do they even think of these things?”
Regarding the egg retrieval, Dr. Eldredge says, “If this is someone we knew had cancer to begin with—we’d refer them out to preserve their eggs. In that case, we’d have planned it all out.”
But that wasn’t the case with Cyr. “If you’re unexpectedly finding cancer invading the uterus, I don't know if there's necessarily a right answer, knowing that that patient is of child-rearing age. There’s a lot to consider here. You have to decide what’s better for the patient. It’s case-by-case,” Dr. Eldredge says.
Informed consent is key. If even the patient’s spouse is unsure, Elderedge says he’d consider stopping the surgery and waking the patient up in certain circumstances.
“The other issue is that just proceeding with the surgery as-is may not be the correct thing,” he says, noting that a surgical plan may need to be adjusted depending on the findings, like if a cancer is more invasive than previously realized.
“As a surgeon, you have to try and make the right choice by discussing [IF] with the family and weighing your options,” Dr. Eldregde underscores.
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