Why does my mom need surgery for endometrial cancer at 63?

Question

Hello doctor,

My mother is 63 years old and was just told last week that she has stage 4B endometrial cancer which has spread to her lungs and some lymph nodes in the upper abdomen. We are still processing this news and trying to understand everything the oncologist is telling us.

One term that came up during the consultation was debulking surgery, and we did not fully understand what it means or why it would be done when the endometrial cancer has already spread so far.

The gynecologic oncologist mentioned cytoreduction and said the goal is to remove as much tumor as possible. Her CA-125 is elevated at 340 U/mL, and her CT scan showed multiple peritoneal deposits. She has hypertension managed with Amlodipine and also has mild chronic kidney disease with creatinine at 1.6 mg/dL, which the nephrologist has flagged as a concern before any surgery. Please tell me,

What exactly happens during debulking surgery for stage 4B endometrial cancer?
Does it actually improve survival in cases like hers?
What is recovery like?
How soon after surgery would chemotherapy begin?
Are there cases where debulking is not recommended at all?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Endometrial cancer is generally diagnosed in early stages; around 80 to 90 percent of diagnoses are in early stages because it presents with bleeding issues or post menopausal bleeding in the elderly.

In your mother's case, the disease has spread beyond the abdominal cavity (into the lungs), so it is a very advanced disease. Stage 4B suggests that her survival is not so great in comparison to a person who would have been diagnosed with a stage 1 disease, who can get completely cured with surgery, and in occasional cases, requires additional therapies in the form of radiation or chemotherapy.

However, the percentage of cases detected in stage 4 for endometrial cancer is very low. Their recovery post-treatment is very low.

There is no single treatment format in such cases. In case the patient is physically fit for surgery, removing the tumor deposits as much as possible during the surgery is the ideal choice. However, as the tumor has already spread to the lungs (metastasis), it is more like a systemic disease.

Sometimes in such cases, one might consider administering a few cycles of chemotherapy followed by attempts to surgically remove the disease as much as possible. Though these things depend on the patient’s response after chemotherapy or surgery.

In your mother's case, she has systemic problems like hypertension and high creatinine as well, which can again be a concern for the administration of chemotherapy. No treatment, whether surgery or chemotherapy. It is also an option when the concerns of damage or risks with the treatments outweigh any benefits from them, given that the patient has an advanced stage of endometrial cancer.

I hope this information helps you.

Feel free to ask further questions.

Thank you.