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Is A Vaginal Brachy Therapy Helpful In Treating Endometrial Cancer?

Posted on Thu, 12 May 2016

Question: My mom has been diagnosed with Endometrial cancer stage Ia, grade 1 a month ago. She underwent a robotic total hysterectomy with bilateral salphingo-oopherectomy approximately 3 weeks ago. We were told by the surgeon and her OB oncologist (in the Philippines) that everything looks good and clean that removing the lymph nodes were unnecessary. Now they are suggesting a vaginal brachytherapy. Is this treatment necessary and should be done? Is it recommended? If she is cancer-free, why does she still need radiation treatment after surgical removal of the cancer that is supposed to be early stage and non-aggressive?

Answered by Dr. Indranil Ghosh (21 minutes later)

Brief Answer:
can be just observed

Detailed Answer:
Hi,
Welcome to HCM.
Thanks for your query.

I have gone through the biopsy report. It indeed appears to be stage IA, grade 1 endometrioid carcinoma with no other risk factors like lymphovascular invasion. Hence just observation is a reasonable option.

Brachytherapy is usually given if it is IB or grade 2-3 or lymphovascular invasion present. Hence I would not recommend brachytherapy here. But you have to remember that brachytherapy or external beam RT is often given when a patient is apparently 'cancer - free' after surgery. This is to kill microscopic cancer cells. But probably not required in this patient.

So overall I feel observation is ok for your mom.

Hope this helps.
regards

Above answer was peer-reviewed by : Dr. Deepak

Follow up: Dr. Indranil Ghosh (45 minutes later)

Thanks for your quick response. We get conflicting opinions whether to do a lymph node biopsy to make sure that the cancer did not spread. is this unneccessary considering the biopsy result stating "no lymphovascular involvement" identified? Are there other measures we need to do to make sure we are not missing anything? Thank you

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
lymph node biopsy is not indicated

Detailed Answer:
Nowadays, with stage IA grade 1 endometrioid, we do not do lymph node dissection as chances of positive result is very low.

If intra-operatively the surgeons have inspected the whole of pelvis well and everything seemed fine, then nothing more to be done.

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Above answer was peer-reviewed by : Dr. Deepak