What does pelvic or leg pain after endometrial cancer mean?

Question

Hello doctor,

I am 45 years old and was diagnosed with stage 1B endometrial cancer about eight months ago. I had a total hysterectomy with removal of both tubes and ovaries, followed by vaginal brachytherapy. My last MRI check-up was normal.

But for the past five weeks, I have had a dull pain in my lower belly. Sometimes it also goes down my left leg up to the knee.

My GP thinks it may be due to post-surgery adhesions and has sent me for physiotherapy. But I still feel worried it might be something else, not just muscle or joint pain. My CA-125 level was 28 U/mL at the last test, and my oncologist said it was normal.

I also noticed some swelling in my left ankle that comes and goes. I had a DVT ruled out last month with a negative D-dimer. However, the combination of pelvic pain and leg symptoms after treatment for endometrial cancer is making me very anxious.

Can pelvic or leg pain in a 45-year-old woman who has been treated for endometrial cancer actually indicate that the cancer has spread to lymph nodes or other structures, even when CA-125 is normal? Is CA-125 alone sufficient for monitoring, or should I request more specific imaging given these new symptoms?

I do not want to be dismissed again and need to understand what warrants urgent investigation versus what is expected after the kind of surgery and radiation I had.

Please guide me.

Answer 1

Hello,

Welcome to icliniq.com.

I am sorry you are feeling this discomfort.

After treatment, for stage 1B cancer, the chance of endometrial cancer coming back is low. It is not zero. A clear MRI (magnetic resonance imaging) is reassuring and a good sign. Your symptoms include pain that goes down your leg and swelling on one side of your ankle. These can often be from causes like adhesions after surgery, nerve irritation, or lymphedema.

Sometimes these symptoms can also be seen if there is lymph node involvement or a pelvic recurrence. So they should be checked properly. Not ignored.

The cancer symptoms and endometrial cancer can go hand in hand. It's good to check them. Also, CA-125 is not a test by itself. Even if your CA-125 test is normal, it cannot fully rule out recurrence of cancer.

I suggest you

Repeat imaging, like an MRI of the pelvis or a CT scan.
A proper check-up (clinical examination) by your oncologist.
More tests, like a PET-CT or CT scan, if the doctor feels it is needed.

This is not an emergency, but it should be checked soon, within a few days or a week. It is not something that can be managed only with physiotherapy.

I hope this helps you.

Thank you.