Does endometrial cancer always need radiation at grade 2?

Question

Hello doctor,

My mother was recently diagnosed with FIGO grade 2 endometrial cancer. Her treatment plan includes surgery as the initial step, with possible radiation therapy to follow. We would like to better understand this approach.

Is radiation therapy always necessary for grade 2 endometrial cancer?
If the tumor is limited to the uterus and fully removed during surgery, is radiation still typically advised?

We are concerned about potential side effects and long-term impacts.

We would appreciate clarification on how decisions regarding additional treatment are made.

Thank you for your guidance.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns, and it is natural to feel this way. This is a common area of confusion, and seeking clarity before proceeding is important.

Your mother has been diagnosed with FIGO (International Federation of Gynecology and Obstetrics) grade 2 endometrial carcinoma. Radiation therapy is not always needed solely based on grade. The need for additional therapy is determined by the stage of the malignancy and any risk factors revealed during surgery.

The goal of surgery, which is usually a hysterectomy (surgical procedure to remove a woman’s uterus) with removal of the ovaries and possibly lymph nodes, is to remove the malignancy and assess its stage. Surgery-related information informs decisions concerning subsequent therapy, such as radiation.

Radiation therapy may not be necessary if, after surgery, the cancer is confined to the uterus, has minimal muscle invasion, and has not spread to lymph nodes or blood vessels. In these cases, many people with grade 2 cancer do not require further treatment.

Radiation may be recommended if higher-risk features are present. These include deep muscle invasion (50 % or more), spread to lymph or blood vessels, involvement of the cervix, a higher stage than initially thought, or specific microscopic findings. In such cases, radiation reduces the risk of cancer recurrence, particularly in the pelvic or vaginal area.

If radiation is advised, it typically means all visible cancer has been removed by surgery. The additional treatment aims to lower the risk of recurrence, rather than treat existing cancer.

There are several types of radiation therapy. Vaginal brachytherapy is often used for intermediate-risk patients and usually causes fewer, milder side effects, such as temporary irritation or dryness. External beam radiation may be used for higher-risk cases and can result in fatigue, bowel or bladder irritation, and occasionally longer-lasting effects.

Ultimately, the decision to use radiation involves weighing the risk of cancer recurrence against the potential side effects.

Overall, grade 2 endometrial cancer does not always require radiation therapy. If surgery confirms early-stage, low-risk disease, further treatment may not be needed. The final decision depends on the detailed surgical report.

I hope this clarifies your concerns.

Please feel free to reach out anytime if you need further assistance.

Thank you.