EndoCa: Grades of Cancer

Hi everyone, I have a question: When I had D&C I was diagnosed Stage 1, Grade 1 endo cancer. At surgery the stage went to 3. Big difference. How does that happen??

I'm sorry about your diagnosis, but I'm sure you'll find a lot of support on this site. Your grade can be determined by looking at the cells. The closer they are to normal, the lower the grade. The D&C and surgery should have had the same grade. The stage is determined by how far the cancer has spread. This can only be found during surgery and by a gynocological oncologist from what I've heard. They will do a pelvic wash and sample some lymph nodes. Did you find out anything other than stage 3? Usually there is a letter after it, defining the extent of it.

I was Grade 1, Stage IIIC because mine had spread to a lymph node in three different areas. I'm sure many other gals will be by to explain further. Please keep us posted and stay positive.

Jan

BadHairDay, lol, like the name.

Thanks for your reply. My cancer was Stage 1B, Grade 3. Someone told me today that grades don't change and that maybe during D&C she took a sample of an area that was Grade 1 and there were probably other areas that were a Grade 3. Does that make any sense to anyone?

If you wait to have surgery, can the Grade 1 progress into a Grade 3?

I can relate to the change in grade. My initial biopsy and the pathology during surgery both showed grade 2. It was changed to grade 3 due to the final pathology after surgery. The change was due to a very abnormal nucleus which increases the grade by 1.

I went from only needing surgery to looking at 5 weeks of radiation, plus 1 internal, plus 6 rounds of chemo. After much discussion with radiation and chemo docs, I am only doing 3 rounds of chemo.

I don't think witing for surgery changes the grade. It can change the stage of course. Hopefully someone will come along and answer your question.

What options were you given for next steps?

Hi there MorningStar, thanks for your reply. My initial pathology report indicated grade 1 and two docs who referred to it told me I could take some time to find the right surgeon/hospital for me. They said not to take months, but I had a few weeks. Well, maybe I should have suspected something because the bleeding got steadily heavier over the course of eight weeks, from a panti liner a day to sometimes 4 maxi pads a day, though I did tell the doc and nothing was said to indicate there was still any rush. But now with the updated stage and grade I'm considered high-risk for recurrance.

My doc tells me that Stage 1B Grade 3 is a gray area for treatment. He said I could do nothing, or I could do either chemo or exterior radiation. One of the major cancer societies told me that no further treatment was recommend besides being watchful. I am single and self employed so if it's reasonable, I'd like to avoid long term treatment and fatigue. At the same time I want to be good to myself, and take care of myself.

I found two studies on brachytherapy. Rather than do nothing, and rather than 5 weeks of external radiation or 3 rounds of chemo, with both methods causing a lot of temporary and long term side effects, I'm thinking of asking about that. If the cancer recurs I'm told that it's 75% likely it'll be in the vagina. The most annoying side effect is having to have sex 3 - 4 times a week. Anyone have a name and phone number of someone I can call? LOL



Comments on that?

Stinks.

	Quote:
Originally Posted by Hunnah Hi everyone, I have a question: When I had D&C I was diagnosed Stage 1, Grade 1 endo cancer. At surgery the stage went to 3. Big difference. How does that happen??

A D&C only captures a small portion of the cancer. Presumably the cells in that portion looked like grade 1. After surgery the pathologist can examine the entire tumor which is where the higher grade cells were found. While grade 1 cells could progress to grade 3 cells with time, it is more likely that the grade 3 cells were already there when the D&C was done, they just didn't make it into the sample.

Hi Hunnah,

I suggest you first ask your own doctor for his opinion re taking brachytherapy as presumably he should know your case the best and thus if this were a viable option to deter a recurrence. You might even bring him the two studies your read re this possible approach.

Good luck and let us know what he says.

Hi Hunnah
As others have mentioned, the grade can change if they are able to better examine the cancer.
I find it concerning reading your thoughts on recurrence.
While they are very successful at treating endometrial cancer initially, they are much less successful at treating recurrences, even those that occur in the vagina.
Of course the doctors advise is the most important here, but it seems that he has left it up to you, and I just wanted to say that recurrences are much harder to treat.
HUGS
Janet

Hello ARunner, I hear ya. Both the American Cancer Society and the National Cancer Institute quote studies that indicate that whether a woman gets pelvic radiation for this cancer right after surgery or doing it if and when the cancer comes back, it doesn't affect long term survival rate. Then they say that if it does come back, 75% of the time it's in the vagina. So my reasoning is that I will do radiation now, for the vagina. It just makes sense to me. My doc isn't a lot of help. He says I can do one of 4 things: nothing, vagial brachy, external radiation, chemo. I asked him if I were his sister, what would he recommend. He said, "I'd recommend chemo or radiation, but brachytherapy is a good option too." Then he said, sounding a little annoyed, "No matter what treatment you choose, the odds are that you won't benefit." Then he gave statistics citing if 100 women has this cancer and got no treatment, 20 would get recurrance. If they treat those 20 with radiation and/or chemo, 10 would be cured, 10 wouldn't be. Then he said if those 100 women all got the pelvic radiation or chemo right after surgery, the outcome would be the same. 10 will end up not making it. It seems like a crap shoot but since one can get radiation in an area only once per lifetime, why not do the brachy and save the pelvic radiation and chemo as Aces in my pocket for if and when it does come back.

Sucks.

I think your doctor is a cynic Plain and simple.
I think his figures, he has pulled out of a hat.
I will see if I can find something a bit more scientific about Grade 3, Stage 1b endo cancer.
Its kind of funny, MY doctor has told me that there is no use in doing follow up CT scans because when endo cancer recurs there is not much you can do about it anyways.
I do not agree with him either, but there is some common ground here....