Stage 2 cancer

[Touchdown99]

After having a vaginal hysterectomy, my Mom (mid 60's) went back to her obgyn for her hysterectomy follow up and was told she had Stage 2 cancer. Here is exactly what the Dr. said: "invasive adenocarcinoma. Invasion into outer half of muscle of uterus. No extension to outside of uterus. Stage 2". He wrote this down for my mom. How does this all sound to you? What does he mean that there is no extension to outside of uterus, yet he also wrote invasion into outer half of muscle of uterus? He said he thinks it can be treated with radiation. Her appointment with the gyn oncologist is in about 10 days. We would really appreciate any thoughts or insight. Thank you so much.

[Annekathryn Goodman, M.D.]

HI there
you should bring this information that I posted with you to discuss with the gyn oncologist
good luck with everything

take care

[Touchdown99]

Thank you very much. Had the D&C showed cancer, the obgyn was gonna have a gyn oncologist do the hysterectomy but because the D&C showed no cancer he did the hysterectomy and left the ovaries because he said new studies showed to leave ovaries for women under 65 to lengthen life expectancy unless the ovaries were "bad". The hysterectomy report came back "invasive adenocarcinoma", "invaded outer half of muscle of uterus; no extension to outside of uterus". He told us that he had spoke with the gyn oncologist he is sending mom to next week and sent him slides etc and the gyn oncologist had told him the treatment would be radiation only. I'm not sure how he could no that. Is the prognosis usually good fis stage and type of cancer? Thank you so much for taking our question.

[Annekathryn Goodman, M.D.]

Hi There
here is additional information from the American College of Obstetricians and Gynecologists (ABOG)

Endometrial cancer is the most common female genital tract malignancy. While it is widely accepted that surgery including a total hysterectomy and bilateral salpingo-oophorectomy is the cornerstone of treatment, the use of systematic surgical staging including the removal of pelvic and paraaortic lymph nodes remains variable from institution to institution and among different practitioners. The Society of Gynecologic Oncologists recently reported that 80% of endometrial cancer patients under the care of a gynecologic oncologist underwent nodal sampling as part of their initial surgical procedure.

The extent of regional lymphadenectomy required to adequately stage endometrial cancer is the subject of continuing debate. The Gynecologic Oncology Group has suggested that the removal of 8 pelvic lymph nodes may be an acceptable representation of the pelvic lymph node basins. This recommendation was based on the theoretical assumption that an adequate representation of nodal status could be obtained by removing 1 node from each of the four main pelvic nodal basins—the common iliac, external iliac, internal iliac, and obturator regions. Similarly, it was suggested that 1 node removed from each side of the lower paraaortic region would be an acceptable representation of lower paraaortic nodal status. Palpation alone is not an accurate method for assessing retroperitoneal nodal involvement.

It has been demonstrated that there is an improved survival in International Federation of Gynecology and Obstetrics (FIGO) stage I–II endometrial cancer patients with high-risk histology (papillary serous, clear cell, or grade 3 endometrioid) when >= 12 pelvic lymph nodes were removed during the initial staging operation. Aside from providing prognostic information, systematic surgical staging identifies occult metastases to allow for appropriate postoperative treatment.

Literature

    American College of Obstetricians and Gynecologists. Management of endometrial cancer. Practice Bulletin 65. Obstet Gynecol 2005;106:413–25
    Kennedy AW, Austin Jr. JM, Look KY, Munger CB. The Society of Gynecologic Oncologists Outcomes Task Force. Study of endometrial cancer: initial experiences. Gynecol Oncol 2000;79:379–98
    Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 2006;102:92–7
    Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, Soper JT, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol 2005;23:3668–75

Key Points

    Surgical staging
    Sampling of pelvic and paraaortic nodal regions
    Determination of occult metastases guides potential post-operative treatment

[Annekathryn Goodman, M.D.]

Hi There,

Cancer of the uterus is treated by removing the uterus, cervix, tubes and ovaries. The standard of care is to also remove lymph nodes in the pelvic and aortic region.

The information from both removing the pelvic organs (uterus, ovaries, fallopian tubes) and checking lymph nodes allows  us to know what stage of cancer she has.

While her surgeon is calling her cancer stage 2, that is not completely accurate unless she had biopsies of lymph nodes to show that there was no sign of spread.

The gyn oncologist will have to make a decision whether your mother should have further surgery to biopsy the lymph nodes or decide on other treatment based on other information (such as a PET CT scan.)

The reason this is crucial is if your mother has any involvement of her lymph nodes (stage III), most gyn oncologists would agree that standard treatment is 6 cycles of chemotherapy followed by radiation and NOT radiation alone.

it is very important that the slides from your mother's hysterectomy are reviewed at the gyn oncologist's institution . Also if it is possible to get a PET CT scan prior to your appointment, that information will add to the consultation an decision making.
Best wishes