Advice please following post-op assessment

Hi Saz26 I was diagnosed with Stage 1a Grade 3 mix Endometroid/Serous in late July last year. The serous element prompted the Grade 3. I had a total abdominal hysterectomy in early October 2022 after which the post op histology showed that the cancer was confined to a fibroid and had not breached the wall of the uterus. At my post op follow up the surgeon explained possible adjuvant options including brachytherapy and chemotherapy. I opted for a referral to an Oncologist from the Weston Park Cancer Hospital in Sheffield who recommended brachytherapy to the vaginal vault. This was to prevent recurrence. I was told I wouldn't need chemotherapy. You will see from this forum that ladies with Stage 1a Grade 3 can be offered different options for adjuvant treatment. I suppose it depends on each individual case and the policy of the hospital. You're understandably concerned so it would be helpful to discuss these concerns, initially, with your CNS (Cancer Nurse Specialist). Were you advised by your surgeon at your post op follow-up appointment that you wouldn't be offered any adjuvant treatment?  I often find that, post appointments, I think of things I wish I'd thought of and/or asked. In these case the CNS have proved very helpful. 

Hi Saz26. I am 9 weeks post op and, like you, have Grade 3 Stage 1A  endometroid adenocarcinoma. I had a total abdominal hysterectomy and the surgeon has removed it all. I have an appointment next week with the oncologist although I am told this is a "tick box" exercise as no further treatment is indicated. As I'm fortunate enough to have gone Private, I suppose this might be the case! I'll let you know what she says.

Hi Saz26

I am almost 9 weeks post hysterectomy and am also grade 3 stage 1a  like you.  I think the adjuvant treatment you get offered varies on the area you live in.  I was offered brachytherapy 3 sessions had my last one this morning actually.  I too asked my CNS to clarify this was all i needed as i know some also have chemo (not that i wanted it) but if was needed i obviously would have had anything to help stop a reoccurrence.

So I think if you can query with your CNS and if you can maybe your consultant.  I was lucky enough to also confirm with my consultant that brachytherapy was all he would suggest.

Keep in touch let us know how you get on xx

It's really good news that the cancer was only found in the polyp and not in any of the other tissues and it suggests that you were diagnosed at a very early stage and recurrence is unlikely. Although it is grade 3, which means the cells look more abnormal and may spread more quickly;  it is still endometrioid adenocarcinoma which is the least aggressive type. I was grade 2 endemetrioid but I did have LVSI and was advised to have RT,  even so my oncologist said she always thought carefully about whether the possible benefit of adjuvant  treatment would outweigh any chance of adverse side-effects. She looked at each patient as an individual before making her recommendation.  The effect of some treatments can be cumulative and the fact that you have previously had chemo and RT may be a factor they have taken into account.  It might be worth asking if this is the case,

Hi Saz26 

I agree with SH53 and that I would contact your CNS. I just wanted to show my support to you as I am Grade 3 endometrioid cancer but mine has a squamous cell element. After ultrasound scan and womb biopsy my cancer was thought to be 1a also. Unfortunately, events transpired and I became stage 4 very quickly. My profile is on if you want to know more. My follow up is 3 month oncology telephone review and 6 monthly CT.

It's reassuring for you to know that it was confined to the polyp. Have they said what your follow up will be? Hope you get some answers.

A x

Hi SH53, thank you so much for replying with your situation and having read your profile, you really have been through a lot over the last few years. I do hope you recovered well from your surgery and brachytherapy. Yes my surgeon told me I would be seen in 6 months at my local hospital as i don't need any adjuvant treatment. It would be every three months if I did have further treatment. I spoke to my CNS at my local hospital yesterday who is lovely and so supportive. She has made an appointment for me to see an Oncologist on 2nd May to go through the histology and rationale behind the MDT decision of no further treatment. I feel so much better knowing I will be able to discuss this in detail with him.

Thank you Rosiexsam, yes please do let me know what your oncologist says. I am seeing mine on 2nd May the week after you so it would be really good to know what yours says before I see him. It's also interesting they have not suggested any further treatment for you either. I hope you are recovering well from your surgery too,

Hi HFF, thank you for replying and yes I agree from all I've seen here and on the two FB groups I am on, adjuvant treatment varies where you live in the UK. I spoke to my CNS yesterday and am seeing an oncologist on 2nd May to understand the MDT decision and my histology in more detail. How did the brachytherapy go? I do hope you recover well from that with no lasting side effects. I'll let you know what I hear too,

Hi Anne, thanks for your reply and yes I had not thought about whether my previous chemo and radio were a factor in this decision. I spoke to my CNS yesterday and she's made an appointment for me to see an oncologist to go through the MDT decision and discuss my histology in detail. I'm so glad you are well and class of 2015! xxx

Hi sistermoon, yes I contacted my local hospital CNS and she's made an appointment for me on 2nd May to see an oncologist to go through the MDT decision and my histology in detail. I'm so sorry your cancer progressed and do hope you are managing. My surgeon said follow up would be an internal every six months, no scans or swabs of vaginal vault like hey seem to do in the US. I guess i have to stay very vigilant but it feels very scary just to be left until October now xxx