Is surgery enough for my mother with endometrial cancer at 54?

Question

Hello doctor,

I am asking about my mother, who is 54 years old and was very recently diagnosed with stage IA endometrial cancer. The pelvic MRI confirmed that the tumor is limited to the endometrium, with no myometrial invasion, no cervical involvement, and no lymph node spread. The cancer type is grade 1 endometrioid adenocarcinoma, which the oncologist said is the most favorable type.

Her surgery is scheduled for next week, and they are planning a laparoscopic total hysterectomy.

I would like to ask whether a 54-year-old woman with such early-stage cancer can be treated with surgery alone, without needing radiation therapy or chemotherapy afterwards. She also has type 2 diabetes and uses insulin glargine (20 units at night). Her HbA1c is 7.4%.

She is very concerned about radiation therapy because her neighbor underwent it and experienced significant bowel and bladder side effects.

Her surgeon and oncologist are not completely aligned in their recommendations. The surgeon believes that surgery alone should be sufficient, while the oncologist wants to wait for the final pathology results before making a decision.

Is it common for members of the medical team to have differing opinions in situations like this? Also, what specific pathology findings after surgery would make radiation therapy necessary, even in a case of such early-stage endometrial cancer?

Kindly advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

First of all, one of the encouraging aspects of her case is that the cancer is stage IA, grade 1, which generally indicates a less aggressive tumor. Surgery is the primary and most effective treatment option at this stage.

After the operation, the removed tissue will be sent for histopathological examination because certain findings may not be apparent on MRI (magnetic resonance imaging). For example, there may be myometrial invasion, meaning that the tumor has extended beyond the uterine lining and into the muscular wall of the uterus. This can occasionally be missed on MRI but identified on histopathological analysis.

In addition, although the MRI showed no evidence of lymph node involvement, another important factor is lymphovascular space invasion (LVSI), which refers to cancer cells being present within the lymphatic or blood vessels of the uterus. If LVSI is detected, postoperative radiotherapy may be recommended depending on the overall risk assessment.

I would also mention that, in some cases, an open surgical approach may offer certain advantages; however, if the surgeon believes that a laparoscopic procedure will provide adequate treatment and staging, then it is also a well-established and appropriate option.

The most important factor will be the final histopathology report after surgery, as it will guide all decisions regarding postoperative treatment. There is no need for excessive concern because, if postoperative radiotherapy is required, it is generally well tolerated. The treatment sessions are usually straightforward, and the goal is to achieve optimal local control of the disease while significantly reducing the risk of recurrence.

The priority is to ensure that the cancer is treated as effectively as possible and to minimize the chance of it returning in the future.

I hope this explanation is helpful.

If you need any further clarification or have additional questions, please feel free to ask at any time.

Thank you.