How do they stage uterine cancer? How do they decide whether to sample lymph nodes during a hysterectomy for uterine cancer?
Sue D., Pennsylvania, USA: I was told that they couldn't stage endometrial cancer (find out how advanced it was) until they actually removed the uterus. Based on what they found on that pathology in the operating room, the surgeon decided whether they needed to sample lymph nodes. In my case--stage 1A of a low grade cancer (not too aggressive), they decided they didn't need to sample nodes.
Renee, New Jersey, USA: After a D&C (dilation and curettage) and hysteroscopy, I was diagnosed with endometrial cancer in February 2004, and my doctor recommended a hysterectomy as soon as possible.
My daughter was expecting a baby in the next few weeks and we wanted to go on a much-needed vacation. We hadn't been away for 3 1/2 years and were talking about going away all winter. So I told my gynecologist that I did not want the hysterectomy until April. I had already been diagnosed with breast cancer eight years ago, and felt there was no reason to rush with the surgery.
I started doing a great deal of research and was scared to death of all the complications and long-term side effects that could happen. After the D&C, I had no more watery discharge or bleeding, and was feeling very well. My husband and I both went to help my daughter when she had her baby girl and we went to the Grand Canyon for our vacation. I also interviewed three gynecologic oncologists. They all had something different to say about surgery. I felt my own regular OB/GYN was a fantastic surgeon and wanted him to do the surgery.
April 8, 2004 was my LAVH/BSO - a vaginal laparoscopically-assisted total hysterectomy and removal of both fallopian tubes and both ovaries. The gynecologist left all my lymph nodes in because I refused to let him take any out. When I previously had breast cancer, I had an axillary dissection of two levels of lymph nodes in my left arm. My lymph system was already compromised and I was at risk for lymphedema, so I did not want any more nodes taken.
The pathology report read "well differentiated endometrial adenocarcinoma"; the cells were grade 1, and I was stage 1b. I don't need any further treatment such as radiation or chemo, but will be followed with vaginal vault smears (a Pap smear done of the upper vagina, in the absence of the cervix) every three months for the first year, and every six months for the second year.
It is now six weeks since surgery and I am doing fine and feel good.
Mae, New York, USA: I was scheduled for a myomectomy (surgery to remove fibroids). Cancer was not suspected. During the myomectomy, the surgeon saw a milky substance and immediately sent a specimen to pathology: endometrial cancer. A complete hysterectomy was performed; unfortunately, lymph node sampling was not. My surgeon was not an oncologist and I don't know if he would have known to do this. However, it didn't really make a difference to my treatment - besides the surgery, I had radiation, and then chemotherapy was done as "extra insurance," because the grade of cancer was high and considered to be aggressive.
Are they able to do the pathology right then and there? How did the surgeon know all this about the lymph nodes right away?
Sue D., Pennsylvania, USA: The surgeon called the pathologist into the operating room after the uterus was removed. He did a dissection there to do what they call a preliminary "gross pathology." In the OR he could see how far into the uterine wall the cancer had invaded. If it had gone into the myometrium (the muscle wall), less than halfway, my stage would have been 1B, more than halfway, 1C. If it had spread to the cervix, stage 2. Since the gross pathology showed mine was still confined to the endometrium, I was safely stage 1 and they felt they didn't need to take any nodes for biopsy. They also inspected the bowel for anything ("running the bowel" my doctor said while she pantomimed with her hands actually taking it out and feeling the whole way along it for lumps--one reason the bowel prep is so important).
A few days later after the microscopic pathology was completed in the lab, the full report came in which confirmed the stage 1A, grade 1. (If they had found it was advanced enough to warrant sampling the nodes and had found cancer in the pelvic nodes, it would have been stage 3; if it had spread outside of the pelvis (metastasized) it would have been stage 4.)
The American Cancer Society's Endometrial Cancer Resource Center explains endometrial cancer staging (and a whole lot more). http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=11
The Cancerfacts.com Endometrial Cancer Center has excellent graphics showing the stages of endometrial cancer.