Stage 1B, adjuvant therapy?

Hello all. My mother has just (as of ten minutes ago) been taken off to hospital for a hysterectomy to treat probable Stage 1B endometrial cancer. The operation should be sometime tomorrow.

I just wanted to ask the group, how common is it for patients at Stage 1B to require adjuvant treatment? We would, of course, prefer to avoid the cycle of radiotherapy and chemotherapy if at all possible. At the same time I realise individual cases are different.

Thank you.

  •    The issues surrounding adjuvant treatment are complex. A lot depends on stage and grade and that won’t be finalised till all the post op histology reports are available. I think there are some ladies here who had adjuvant radiotherapy for that stage/grade. Some doctors may want to keep them in reserve in case there’s any need for them in the future. Your Mum’s team will discuss her case carefully and look at the benefits and risks for her- as you say each case is individual. I had a high grade aggressive cancer staged 3c1 post op so was strongly advised to go down the chemo/radiotherapy route. Having been there, I can fully understand that you would both prefer her not to have to take that route. I’m sure the team will advise her accordingly. 

    Please can I gently encourage you both to try not to second guess anything just now? The best advice I had at this stage cane from my CNS who said to just take things one day at a time. For now, concentrate on helping your Mum through tomorrow and  then focus on her recovery. You can cross the bridge of adjuvant treatment if you come to it, but hopefully it won’t be necessary. If it helps I’d just say for now that adjuvant treatment is tough but doable. 

    Sending your Mum lots of good wishes for tomorrow, that all goes well and that she’ll soon be on the road to recovery, I will remember you both in my prayers x

  • Thank you, Fairycake, that's very informative and helpful.

  • Hi RobeH hot day for operations I hope it all goes ok! Staging is only complete after histology of the womb (sorry if you already know) which will take a could take a couple of weeks. If the cancer is contained and there is no evidence of LVSI (cancer cells in the near lymph system) then that might be all your mum requires. It does vary from hospital to hospital some recommend pelvic/and or brachytherapy to cut the risk of recurrence but the pros and cons are weighed up to decide if the risk is worth it. Also the type and grade of cancer is a deciding factor if it's type 1 the common type and the grade is 1 then the that means the cells are slow growing and don't usually spread, 2 are medium and 3 more aggressive and more likely to come back. So will cancer things are rarely clear cut. The important thing is to take one step at a time and hope your mum makes a quick recovery from surgery.

    kate x

  • Thank you Kate. My mum was diagnosed as 1B so I'm guessing there is a good chance no further treatment will be necessary?

  • Hi, I was diagnosed with grade 1 and after surgery I was staged as 1b. I was told the cancer was all removed by surgery but I was offered brachytherapy (internal radiotherapy) as what they described as belt and braces to further reduce the chances of recurrence. There is an issue over how much radiotherapy anyone can have in a lifetime so I was initially unsure, but the consultant had the view that if brachytherapy at that stage didn't prevent recurrence, then it was unlikely to be of much help if the cancer did come back. She felt that external radiotherapy and or chemo would be more effective in that case. As a result I decided to go ahead at the time. I was given an appointment with the consultant solely to discuss all the pros and cons before deciding so I would advise waiting to see what your team suggest and then asking them all your questions about pros and cons of having any further treatment then.

  • Hi, mine was 1B and my local hospital recommended brachytherapy. I was referred to the specialist cancer hospital in Manchester where i had 4 sessions as an outpatient rather than 2 long sessions as an in patient. I didn't enjoy the treatment but would make the same decision if I had the time over. Hope your mum's surgery has gone well xx

  • Hi RobeH,

    There are 2 criteria, stage ( where has it got to) and grade (how slow or fast growing is the tumour.)

    If its Stage 1B and low grade, it's likely to be just the op and an offer of brachytherapy.

    If it's 1B but  high grade, it would normally be followed by external pelvic radiotherapy  which is very do able and nothing to worry about. 

    With grade 3 she would be probably offered chemo as well and given the pros and cons. Mine was 1B grade 3 and I'm having the chemo too. That is also quite do-able. They give you meds to deal with the side effects.

    So, whichever it is, they are very good at seeing you through it.

    Good luck to your mum , and to you. x

    Mrs Woodentop.
  • Thank you :) So there are three grades to every stage? 

  • Sort of.....The way it was explained to me was that its best to think of the grade as the type of cancer and the stage as how far it has spread. So, grade 1 is the most common and typically the least aggressive. Stage 1 indicates that there is no spread outside the womb and is divided into a and b according to how far through the wall of the womb it is. Have a read of the grade and staging article in the information section of this site for a much better and probably more correct description.

  • Hi RobeH,

    You might find this booklet useful: page 28 to 32 discuss stage and grade and from page 36 it talks about treatment.