Calling all smarty pants

OK all you smary pants , you all have so much info and I often feel schooled after I read your posts. Thank you, thank you, thank you!!! Here is my question, I have adenocarcinoma of the cervix- 1B2. I am currently getting rads. I had a simple hyster (kept ovaries and fallopians). I had this done emergently following my cone because of internal bleeding. Here's the hitch, no lymph nodes were dissected. I wanted to get them checked-looming worries and all, but they were concerned about undergoing radiation and being post op in terms of another surgical procedure. Any thoughts?? I'm worried. What if???? I was told that more investigation will be done (ie. scans) following radiation. This is just constantly hanging over my head. I just want some input. What do you all know or what can you tell me. What questions should be asked. What can I research. Thanks in advance.

I really am not well educated about this, but I was under the assumptiont hat the lymph nodes get radiated during treatment and wouldn't that help treat the problem?

Or is your concern that it may have traveled?

jj, I had a CT scan and MRI in order to tell if any of my nodes were enlarged. The CT scan showed none, and the MRI showed one borderline suspicious node (it was just under 1 cm, and 1 cm is apparantly suspicious). My doc told me not to worry about it since the rads will blast anything icky that's possibly lurking in the node.
Have you had CT's and MRI's done yet?

I guess my worry is, did it travel. MRI/CT show lymph nodes when they are about 1cm. How large are they usually. There would not be any microscopic evidence because no lymph node dissection was done. I'm just paranoid. Thanks for everyones input.

Cinder - I would share your worry, but then, I'm not a smartypants; I'm a worrywart! Janie and Nell have the best handle on CC issues, so I would assume you'll hear from one of them soon. Just wanted to give a and tell you that I understand that kind of concern! Take care,

Hi Cinder,

I am a worrywart too, but not a smartypants!

I think there really is no way of knowing whether there is microscopic involvement of the nodes or not unfortunately

However, there are many women who also do not get lymph node dissection and they are in the same boat. To be strictly fair, even women who have a lymph node dissection may not really know as the dissection does not necessarily take out every little node.

I think that it sounds as though the gyn-onc is doing the right thing by you though. The trend for 1B2 tumours is solely radiotherapy rather than radical hysterectomy then radiotherapy for these tumours as the survival rate is the same for each, and the radiotherapy alone will reduce the side effects. Although you had a hyst, the extent of surgery is not as great, so hopefully you will be spared the extra side effects.

I would speak to your gyn-onc - find out if the rads treatment you are getting is the full dose for primary treatment (70Gy or thereabouts) or the adjuvant dose (50Gy or thereabouts). You do have a right to ask him/her what is the rationale for the treatment you are getting.

I wish you the best. xxx

Just to clarify, when I said "smarty pants",I sincerely meant you have all been a wealth of information. I value the information that I obtain from all of you. It usually leads me to ask questions I would not have asked for lack of knowledge. By the way Nell, do you know what the survival rate is for adenocarcinoma of the cervix 1B2? And when you say it will reduce the side effects, what does that mean? I know that the pelvic lymph nodes get radiated during my treatments, I just worry about metastisis. I am struggling with anxiety. Maybe this is the thing that I am focusing on just for now. Thanks everyone. Jenn

JJ,
I sure understand the anxiety thing. I was a wreck up until my 9 month check up. At a year I began to relax. I even had a mini celebration.

I had CT scan after diagnosis but no surgery. The CT scan showed no enlarged lymph nodes but we all know that CT scans don't mean much for cervical cancer.

My gyn/onc said that my 1B2 stage squamous cell cervical cancer had a 80% survival rate, 5 years out. My radiation oncologist said the survival rate was was 85 to 90%. Recently my gyn/onc said that 80% of recurrences of cervical cancer happen in the first two years. So once I made 2 years, with no recurrence, my chance of recurrence was reduced to 4%. OR, 96% survival rate.

It is my understanding that squamous cell cervical cancer has the same cure rate as adenocarcinoma of the cervix. SOOOO.......your survival rate, is about the same as mine, somewhere between 80% and 90%.

Do you know the size of your tumor? Are you having chemo (cisplatin) weekly to boost the chemo effects? If your lymph nodes had been sampled, and found to have cancer, would that change your treatment plan?

I never found anything that helped with the worry about about recurrence, except time. After 3 years, I still think about it, but nothing like I did in the first months after treatment.

Big hugs and much comfort,
Janie

	Quote:
Originally Posted by Denton56 but we all know that CT scans don't mean much for cervical cancer.

I didn't know this! Why is that? I had a CT scan and an MRI. The CT scan showed no enlarged nodes but the MRI showed one being slightly suspicious. My doc said that CT's are generally better in showing lymph nodes...

Hey Cinder! Don't worry, I know what you meant

Radiotherapy by itself and radical hysterectomy by itself both have side effects, but if the two are given together then the chances of side effects is higher. This does not mean that everyone who has had both treatments will get the side effects, or that people who only get one treatment will be free from them.

The side effects which might be increased with both rad hyst and radiotherapy include lymphoedema (swelling of the lower half of the body) and bowel obstruction (blockage) which may require surgery. There are others too (like fisutale), but because you did not have such extensive surgery I would hope that your chances of having these are not too high. As I mentioned earlier, sometimes you can get the side effects anyway - there are a number of women who have had bowel obstruction from adhesions (scars) after hyst without having radical hyst or radiotherapy. Similarly, I have lymphoedema and did not have radiotherapy. Then there are many women who have had both treatments and are just fine!

With regard to CT vs MRI, there was a recent multicentre prospective randomised trial which demonstrated that both CT and MRI were approximately equally good as each other to stage cervix cancer, although neither was as good as they had hoped. The new PET/CT hybrid scans appear to have increasing accuracy. Having said that, all the scans are pretty good at determining the status of the lymph nodes. MRI is better than CT at determining the size of the primary tumour and the extent of spread into surrounding tissues before it is removed or treated.

One of the limitations of CT and MRI (but not so much PET/CT hybrid scans) is that only enlarged nodes can be seen, so the nodes which have involvement with tumour but are small cannot be seen. This is a problem common to all tumours, so this is why so many of the women still have the nodes assessed during/after surgery.

Good luck,

Nell xxx