How does tumor grade affect treatment in my 53-year-old aunt?

Question

Hello doctor,

I am writing about my aunt, who is 53 years old and was recently diagnosed with endometrial cancer. The biopsy report states that she has grade 3 endometrioid adenocarcinoma with more than 50 percent myometrial invasion.

She underwent surgery last month, and her oncologist is now discussing multiple treatment options. We are confused and would like to understand them better.

I want to know how tumor grade affects treatment in a 53-year-old woman because her doctor mentioned that the high-grade nature of the tumor changes everything. She also has hypertension, which is managed with Amlodipine 5 mg daily, and her current blood pressure is around 145/90 mmHg.

Her postoperative CT scan showed no evidence of distant metastasis; however, there are two suspicious pelvic lymph nodes. Her CA-125 level was 95 U/mL before surgery and has decreased to 38 U/mL after surgery.

The medical team is discussing both chemotherapy with Carboplatin and Paclitaxel and pelvic radiation therapy. However, she is concerned about potential side effects, especially effects on her kidneys, because her creatinine level is already borderline at 1.3 mg/dL.

Does grade 3 endometrial cancer always require both chemotherapy and radiation therapy? How do doctors decide on the treatment combination for patients like her who also have other health conditions?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I completely understand the fear and anxiety that your family is experiencing following the diagnosis and after beginning discussions about the treatment plan recommended by the oncologist.

The first and most important treatment, the hysterectomy that she has already undergone, was an excellent and very important step. After surgery, we evaluate several factors, including something called myometrial (muscular) invasion.

Since the endometrial cancer extended beyond the inner lining of the uterus and invaded the muscle layer, there is a possibility that microscopic cancer cells, which cannot be seen with the naked eye, may still remain in the pelvis or in the tissues surrounding the uterus.

For this reason, postoperative chemotherapy and radiation therapy are often recommended to help eliminate any potential remaining microscopic cancer cells and reduce the risk of cancer recurrence or distant spread. The surgery has already treated the primary tumor, but chemotherapy and radiotherapy are considered additional protective treatments to help ensure that the disease is fully controlled.

I would also like to reassure you that the side effects of chemotherapy are often temporary and, in many cases, reversible. Once the chemotherapy cycles are completed, patients can gradually return to their normal activities. The side effects of radiotherapy are generally manageable and may include mild diarrhea, fatigue, or some urinary irritation.

She can usually continue taking her blood pressure medication as prescribed. However, kidney function should be monitored regularly during chemotherapy because certain treatments can occasionally affect kidney function. These are standard precautions that oncology teams routinely take.

It is also very important that she receives strong emotional support from her family and understands that these additional treatments are being recommended as preventive measures, not because the surgery failed. The surgery was the primary treatment, and the purpose of chemotherapy and radiotherapy is to further reduce the chance of the cancer returning.

I hope this explanation is helpful.

If you have any further questions, please do not hesitate to ask.

Thank you.