Management of stage IB uterine cancer
Dear OncoLink "Ask The Experts,"
I am a 49-year-old premenopausal woman who recently had a total hysterectomy with removal of ovaries and tubes because of a diagnosis of Atypical Hyperplasia with significant bleeding. I have not experienced any signs of sudden menopause as yet. I was just informed that the pathology report from surgery found Adenocarcinoma invading 1/3 of the muscular wall of the uterus. I am told that there is no need to see an Oncologist since I am a Stage IB. He considers me cured with surgery. My question is regarding HRT. My choices are to take Estrogen alone, Estrogen with Progesterone, or to take nothing. Do you have any thoughts on this?
Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:
I would certainly suggest a consultation with a gynecologic oncologist to more accurately determine the extent of the cancer, and the possible need for any additional therapy. Recommendations for post-operative therapy are generally based on the tumor grade (the degree of differentiation as determined by microscopic analysis) and the stage of the cancer. Since your cancer was not diagnosed prior to surgery, there was no opportunity to consider surgical evaluation of the lymph nodes in the pelvic and aortic areas. In some such cases, additional surgery may be needed to obtain the lymph node information, although in many cases decisions can be made based on the hysterectomy findings and radiographic imaging studies. I would defer any decision regarding hormone replacement therapy until after a complete oncologic evaluation.