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Suggest Treatment Of Endometrial Cancer

Posted on Mon, 11 Aug 2014

Question: My mother (age 70 years) had been diagnosed of endometrial cancer FIGO grade IIB. After 25 cycles of External radiation therapy and 5 cycles of chemotherapy, I am asked of two choices now - either finish it off with internal radiation OR hysterectomy. Which one is better choice with an intent-to-treat?

Answered by Dr. Prashant Sharma (2 hours later)

Brief Answer:
Radiotherapy boost

Detailed Answer:
Hi dear XXXX

I don't think you know the right diagnosis. Carcinoma endometrium doesn't have stage 2b, it has only stage 2, no a and b. In fact carcinoma cervix has stage 2a and 2b.

If she has stage 2 carcinoma endometrium, surgery should be done first then radiotherapy.

If it is carcinoma cervix in stage 2b, radiotherapy and chemotherapy should be given first followed by boost. This will be followed by evaluation and surgery only if disease is remaining.

Feel free to ask further.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Prashant Sharma (1 hour later)

Thank You Dr. XXXXXXX

Sir, I have uploaded a couple of reports where one is biopsy report and another is MRI scan report at the time when cancer was detected.

Provided the treatment course has started as mentioned. Still what is the best/corrective steps to take further ?

Waiting for your reply.

Answered by Dr. Prashant Sharma (3 hours later)

Brief Answer:
see below

Detailed Answer:
hi dear.
i saw both reports, the things are bit clear now.
it is a cancer arising from endocervix i.e. a type of ca cervix with variety similar to endometrium. the staging is similar to ca cervix.
as the tumor was extending out of cervix, the option of radiotherapy(RT) was chosen. just adjacent to cervix is ureter (the tube which brings urine from kidney to bladder). as the tumor comes out of cervix it reaches to ureter. now complete removal of tumor mandates removal of involved ureter also. so in such case we try to cure disease without surgery, by means of RT and chemotherapy(CT).
now since already RT and CT are given, its better to give a boost with brachytherapy, so as to kill cancer. this should be followed by reevaluation of disease. if still disease remains, surgery should be done.
simple hysterectomy is of no use for her. there should be complete/ radical removal of tumor/ suspected tumor tissue. at this age, better to avoid surgery. still the decision should be based on present imaging - CT / MRI, and patient's condition.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj