When is radiation therapy needed for endometrial cancer?

Question

Hello doctor,

I am 55 years old and was diagnosed with stage 1A endometrial cancer. I underwent a hysterectomy six weeks ago, and the histopathology report indicated grade 1 endometrioid adenocarcinoma, with less than 50 percent myometrial invasion and clear surgical margins.

Now, my radiation oncologist and my gynecologic oncologist have different opinions regarding whether I need adjuvant radiation or if I should pursue just active surveillance. I feel lost because I do not know what criteria are used to make this decision, especially since both doctors are providing different perspectives.

My lymph nodes tested negative, and the report also noted that lymphovascular space invasion (LVSI) was negative. I do not have any other major health issues, except for mild hypothyroidism, for which I take 50 mcg of Levothyroxine daily.

I am concerned about the long-term side effects of radiation, such as bladder and bowel issues, particularly since I am only 55 and hope to have many years ahead.

How can a patient with stage 1A endometrial cancer at my age determine whether radiation is truly necessary, or if it is safe to forgo it?
What specific factors from my pathology report should I discuss with my doctors to make this decision?

I want to avoid overtreatment, but I also do not want to take unnecessary risks with my health.

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I hope you are in good health. I am happy to hear that you are nearly finished with your treatment and that your surgery went well, resulting in a clean outcome.

Based on the information you have shared about the tumor characteristics, it seems that radiation therapy may not be absolutely necessary at this time. It could be reasonable to skip it and continue with regular follow-ups. However, one crucial detail that you didn't mention is the specific type of tumor cells, which significantly influences treatment decisions.

There are several histological types of tumors, including clear cell, serous, endometrioid, and mucinous. Some types, like clear cell and serous tumors, have a higher risk of recurrence, while endometrioid and mucinous tumors generally have a lower likelihood of returning. Therefore, depending on the cell type, it may be acceptable to forego radiation therapy.

On the other hand, if radiation therapy is recommended and you choose to go ahead with it, it can offer extra reassurance that all reasonable preventive measures have been taken. The side effects of this type of radiation therapy are usually mild and often less severe than patients expect. Some may experience mild diarrhea or urinary symptoms similar to those of a urinary tract infection, but these effects are typically temporary and resolve after treatment ends.

In this context, radiation is generally administered as a preventive measure rather than as an intensive high-dose treatment, so it is usually neither dangerous nor particularly difficult to endure.

I hope this clarifies the information and addresses your concerns. Wishing you continued health and a smooth recovery.

Thank you.