Genius FNP takes a novel approach to cancer diagnosis and management

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Clearly, the first-line treatment for vulvar cancer is antibiotics.

Originally posted on Reddit. Lightly edited for grammar and clarity.

I’ve been meaning to type this up for a couple days.

I’m a fourth-year medical student doing a Gynecological Oncology rotation at the moment. A lady is referred to us from an OB-GYN for a suspicious vulvar lesion that was biopsied and found to be invasive squamous cell carcinoma.

So I go in to get this woman’s history. She said she first noticed what she thought was a pimple eight weeks ago at the 11 o'clock position on her vulva. It kept enlarging so she went to see someone about it. I wish I could show you the picture she showed me of what the lesion looked like at that time, because it was just textbook.

So of course she had gone to a (male) FNP. She told me that this dude first said he would “swab it” (WTF are you gonna swab it with to get a sample? Sandpaper?) but he couldn’t because “COVID used up all the swabs” (I’m sorry, what?)

So because of the obvious lack of COVID swabs (duh, how else can we diagnose vulvar cancer?) he instead prescribes her one week of antibiotics and tells her to follow up if things don’t improve. Well surprisingly, it worked!

No, it fucking didn’t. So after a week, she calls back and his genius brain kicks in to finally refer her to a physician.

When we looked at this thing, it had significantly increased in size from the picture she showed me (it had been about 4-5 weeks) and looked awful. This thing grew significantly in the time that she was being jerked around by this dude practicing at the “top of his license.”

Now she needs a larger vulvectomy then she would have needed and it’s gonna take out her clitoris as well, significantly reducing her quality of life. We could have avoided that potentially. We don’t know if we’ll have to take lymph nodes yet (pathology report couldn’t determine depth of invasion) but we’re obviously more likely to do so now than we would have weeks ago. Luckily, we can still probably avoid the urethra.

Anyway, for any Full Practice Authority advocates that lurk around here, these are the people you hurt with your fuckin’ weird combination of insecurity and hubris. You’re dangerous.