Does stage 1A endometrial cancer need treatment after surgery?

Question

Hello doctor,

My mother is 51 and was recently diagnosed with stage 1A grade 1 endometrial cancer after postmenopausal bleeding that she had for 3 months. Her magnetic resonance imaging (MRI) shows no myometrial invasion and no lymph node involvement.

She just had her surgery, a total hysterectomy with bilateral salpingo-oophorectomy, done 3 weeks ago. Now the oncologist is discussing next steps, and we want to understand when early-stage cancer in a 51-year-old woman needs therapy beyond surgery. The pathology report says the tumor is confined to the endometrium, grade 1 endometrioid type, and lymphovascular space invasion is absent.

She is otherwise healthy, non-diabetic, and her body mass index (BMI) is 26. The oncologist mentioned she might not need radiation or chemotherapy, but wants us to come for a review. My mother is very anxious and keeps asking if surgery alone is enough or if skipping adjuvant therapy is risky for her type of endometrial cancer.

What are the current guidelines on this?
Is there any blood marker or follow-up imaging that needs to be done regularly to ensure the cancer has not come back after this kind of early-stage presentation?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

First of all, congratulations on having the surgery and on discovering the condition at this stage. Based on the histopathology findings you mentioned, the condition does not seem to need any further treatment and only requires close follow-up. We usually do cancer antigen 125 (CA125) every six months and a pelvic and abdominal ultrasound every six months as well, and an abdominal magnetic resonance imaging (MRI), possibly once every year. This is mainly to detect any changes or recurrence early.

She most likely will not need any further treatment. However, if there are additional findings in the pathology report, such as certain aggressive cell types, even if the tumor is grade 1, then radiotherapy after surgery may sometimes be considered, depending on the exact type of cells found in the endometrium. Some cell types can behave more aggressively despite being low-grade. But with lymphovascular invasion absent and the tumor being grade 1, we usually do not need anything more than regular follow-up.

I hope you are satisfied with my answer.

For further queries, you can consult me at iCliniq.

Thank you.