Grade 3 stage 3a - no surgery?

Hi Darkshine

Welcome to the Womb group.

I am sorry to hear of your diagnosis of endometrial cancer. 

A hysterectomy is normally the first line treatment for endometrial cancer, however there can be exceptions for different reasons. Normally these seem to be medical reasons- such as co existing medical conditions where an anaesthetic would be more risky. From what you have said, it is difficult to know why they have proposed a referral straight to oncology.  Being a little bit overweight in itself would not normally be a reason in itself. 

There are ladies on here who have not had surgery for different reasons. For some of these hormonal treatment has been used. For others, different treatment has been offered. 

It would not be a cost saving issue. Its more about getting the most effective treatment for your grade and stage. There may be some other genetic markers etc in your biopsy results that are important. 

Sometimes chemotherapy and/or radiotherapy can be given to treat the cancer and then surgery done at a later date. Sometimes the genetic information from the biopsy can show that immunotherapy is an option. 

Did you have a cancer nurse specialist with you in the appointment? I always did and they are perfect for contacting and asking questions. I often did, just to clarify things as it can be hard to take everything in during the appointments. 

The only thing I can think of is that surgery is normally done to remove the cancer where it is possible to do so. If the cancer has broken through to the outer layer of your womb and then reached your ovary I wonder whether the chemotherapy is planned to mop up any stray cancer cells that are in the pelvic area. If these cells are very tiny then they may not be visible during a surgery so could be missed. 

The other thing is that there are different kinds of grade 3 cancer. Mine was carcinoma sarcoma but there are several others such as clear cell, serous etc. Grade 3 cancers are normally classified as a type 2 cancer. Sometimes the treatment can be a little different. Most endometrial cancers are type 1 and slow growing and less likely to spread. A type 2 cancer however can behave a little more aggressively in some people and be more likely to spread/recur. So even a low stage grade 3 cancer would likely be offered chemo and/or radiotherapy. 

I do think you need to talk to your CNS/doctor to ask plenty of questions, to clarify things and to enable you to make an informed choice about treatment. Maybe start by writing a list. I found that helpful. If they are referring you straight to oncology then I would imagine this would be done quickly. 

We do have the Support Line available from 8am-8pm daily if you feel like talking things through would help.

Jane

Thanks for the reply Jane, I will contact the CNS who's very helpful as although I've slept on it overnight, I still can't understand why there's no surgery. 

I wonder if anyone else has had this non surgical approach?

Best wishes to all xx

I had a grade 3 Serous Carcinoma which ended up with a few cancer cells on one of my ovaries as well.  I had a Da Vinci robotic surgery followed by 6 rounds of chemo and 25 external radiation sessions.  I am also overweight.  My treatment was fairly standard for this issue.  I would ask a lot of questions as to why your oncologist is taking this approach.  I would also see if it is possible to get a second opinion if they do not give you a good reason for this approach.  It is possible that they want to shrink the tumour before operating.  Best wishes for you to obtain a lot more info from this doctor.

Mine wasn’t grade 3, but stage 3A like you, a few cells found on left ovary. My treatment was surgery, followed by 25  radio with 2 lots of Cisplatin, and then 4 lots of Carboplatin/paclitaxel. I am also overweight, but other than that told I was healthy, so hitting me with everything. I would ask questions, I suppose it could be due to size of tumour, and as Didi says possibly trying to reduce size before surgery…good luck in getting answers to your questions.

Sorry to hear that you are concerned. It is a very worrying time. 

I was diagnosed in July 2024 with Stage 4b. Same as you no surgery which i didn't understand at the time. Have you had CT or MRI scan yet? Mine had spread to ovaries and lymph nodes. So no surgery just 6 rounds of chemotherapy to attack the cancer everywhere it might be. My way of thinking was, there was no point doing hysterectomy when it has spread elsewhere so it needed attacking everywhere. 

Had last chemotherapy in January and doing good now. 

Speak to your team and ask lots of questions. Good luck with everything. 

Hi Darkshine. 

mine was grade 3 (serous carcinoma) and 3C because there were a few cells in a couple of pelvic lymph nodes and an iliac node. They were discovered on a Pet scan after my surgery.

I ended up having a radical hysterectomy followed by 25 external radiotherapy and 2 brachytherapy with 4 cycles of Cisplatin and then 4 cycles of Carboplatin/Paclitaxel. 

I’m also overweight/obese but that did not seem to be a barrier to the laparoscopic surgery and my oncologist took great pains to emphasise they were throwing everything at me and as she put it it was the gold standard treatment.

As the others have said I would make up a list of questions and ask their reasoning for ruling out surgery.

Best wishes

Ladies, thank you so much for your replies. Yes, I've had both CT & MRI scans. One thing I omitted to say is that I've been told I've had a positive result for Lynch Syndrome which seems to indicate genetic fault, maybe this is also why surgery has not been considered as the primary treatment.

Wishing you all the best...i'm terrified xx