In previous posts I have discussed some aspects of endometrial carcinoma (see notes 1 and 2).
In this post I’ll discuss the recommendations that a specific patient whose clinical history follows, was given by her gynecologic oncologist (a surgical specialist in the management of gynecologic cancers).
Patient underwent bilateral salpingo-ophorectomy and supracervical hysterectomy (meaning the cervix was left behind). The uterus was removed by morcellation (meaning in pieces by laparoscopic surgery).
Uterine pathology indicated a FIGO histologic grade 2. “Accurate diagnosis of the depth of invasion is limited due to the fact that this is a morcellated specimen. In examined sections the adenocarcinoma does not appear to invade more than half of the myometrium and will provisionally be staged as IA based on available findings (again accurate depth of invasion is difficult to accurately ascertain in a morcellated specimen, and the cervix is also not available for examination).”
The patient saw the gynecologic oncologist who recommended the following:
“Because of the way the uterus was removed, the doctor is unable to properly stage the cancer, to determine how far it has spread, notwithstanding pathology report that indicates FIGO-2, or Stage 2, a moderate/intermediate level of endometrial cancer. She advised proper staging by removing the cervix and the pelvic and para-aortic lymph system. That surgery would last about 4 hours, and is to be scheduled in a couple weeks, to allow more healing to occur from the surgery last week. The results of the pending surgery will inform us about next steps; chemotherapy probably, and perhaps radiation. Hopefully the pathology reports from the cervix and the lymph nodes will be no worse than the Stage 2 results in hand.”
The procedure that the surgeon recommended, removal of the lymph nodes, is associated with significant side effects. And so the patient’s questions were:
1. Why do I need to have my cervix removed? And the answer to that is–it is necessary to find out if the cancer the cancer has spread to the cervix as appropriate treatment depends on knowing that. If the cancer has not spread to the cervix, then the cancer is Stage 1A.
2. If this is Stage 1A endometrial cancer, will the extensive surgery improve my prognosis (improve my chances of not dying from endometrial cancer)?
The answer to the second question is more complex (that is experts in endometrial cancer differ on what the best treatment for Stage 1A endometrial cancer) See References 3,4, and 5.
Because there was disagreement in the literature of the best treatment of the cancer, should it prove to be Stage 1A, I suggested that the patient get another opinion. And I suggested getting a the second opinion from a medical oncologist (a non-surgical cancer specialist).
The patient went to see the medical oncologist and the scheduled surgery (scheduled by the gynecolgic oncologist) was put on hold for now as the medical oncologist considers the case.
Look for more upcoming posts on this case as it develops.
(1) When the Diagnosis is Endometrial Cancer–Questions to Ask the Doctor, posted Feb 17,2014 on www.tomwademd.net
(2) A Case of Endometrial Carcinoma Removed Laparoscopically–What Should be done? Posted Feb 20, 2014 on www.tomwademd.net
(3) Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Annals of Oncology 2011 Volume 22, Issue suppl 6Pp. vi35-vi39. Full text pdf.
(4) Clinical Study: Systemic Lymphadenectomy Cannot Be Recommended for Low-Risk Corpus Cancer, Hindawi Publishing Corporation,Obstetrics and Gynecology International Volume 2010, Article ID 490219, 5 pages doi:10.1155/2010/490219.
(5) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? A. Mariani, M. J. Webb, G. L. Keeney, M. G. Haddock, G. Calori, and K. C. Podratz, American Journal of Obstetrics and Gynecology, vol. 182, no. 6, pp. 1506–1519, 2000. Abstract