Dear OncoLink "Ask The Experts,"
A very good friend and co-worker has just been diagnosed with Endometrial Cancer. She underwent a complete hysterectomy 2 weeks ago. At that time the doctor told us that everything looked "good", but that we had to wait for the pathology reports. Early reports showed no cancer, nothing in lympnodes, but now pathology reports that the "washings" taken from the abdominal cavity show cancer. What does this mean?
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
You have asked a difficult question. "Washings" are used to detect microscopic cancer cells that may be floating around in the abdominal cavity outside of the uterus. If your friend's washings are positive, but all other tests show that disease is limited to the uterus (no spread to lymph nodes), there are several options that should be discussed with the oncologist. First of all, if your friend has certain risk factors such as a high grade tumor, or deep invasion of the tumor into the wall of the uterus, she may be counseled to undergo radiation therapy to the pelvis. This would be true whether the washings were positive or not.
In the case of positive washings and cancer confined to the uterus, the studies are unclear as to whether these patients should have additional treatment just for the positive washings. Some treatments that have been tried have included intraperitoneal radiation with radioactive phosphorus, progestin therapy (like Provera or Megace), whole-abdominal radiation, or no treatment. There is currently no research to support a definite answer; so all options should be discussed carefully with your doctor.