Endometrioid adenocarcinoma 30 years after a hysterectomy
Dear OncoLink "Ask The Experts,"
My mother is 81 years old. She had total abdominal hysterectomy and bilateral salpingio-oopherectomy in 1973. Last month she was diagnosed with endometroid adenocarcinoma. The lymph nodes were positive 3 out of 5. If she had the hysterectomy 30 years ago how did the endometroid cancer develop? Could it have remained dormant all those years? What are the treatments/possible outcomes of this sort of diagnosis?
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Your mother's situation is very unusual. You did not mention if the tumor was only found in the lymph nodes, or in other areas of the pelvis. I'm not sure that I have a good explanation for the occurrence of endometrioid adenocarcinoma 30 years after a hysterectomy with removal of both ovaries. As I see it, if there was intraperitoneal disease present at the time of your mother's surgery, there are a few possibilities: 1) an ovarian remnant was left at the time of the initial hysterectomy which eventually developed into an endometrioid-type ovarian cancer, 2) a primary peritoneal carcinoma of endometrioid-type has occurred (these are exceedingly rare, and fewer than 3 cases have been reported), 3) "dormant" endometrial cancer (or endometriosis that became cancer) has persisted for 30 years and finally became clinically apparent. I don't find any of these options particularly likely, so I'm not sure that I have a good explanation for the disease your mother is suffering.
Treatment will depend very much on where the tumor was located. If the tumor was only in her lymph nodes, her doctors may recommend radiation. If the disease was widespread, they may recommend chemotherapy.