Question on chemo / endo recurrance

My rad-onc said recurrance of endo cancer (uterine) is not good. Hard to treat...

If it reoccurs, chemo is the course of action, I think. This leads to my question:

Why is chemo prescribed for some as a preventive (insurance policy, as some have said) after surgery?

It would seem that if it doesn't work that well for recurrances, why do some use it initially after surgery?

From everything that I've read and discussed with my doc, recurrences in people without rads can be treated, some with a full cure, with rads, surgery, and/or chemo. The location (vaginal cuff/pelvis vs. distant mets) of the recurrence has alot to do with treatability and type of treatment is chosen.

If you had rads and experienced a recurrence back in the pelvis or bowel, then rads would be out as a treatment. It might be considered if it came back in the lung, bone, or someplace not in the pelvis. Without that option, you'd be down to surgery which may or may not be doable depending on conditions of tissue and organ condition post radiation. Some people who have had both external and internal rads have problems that render the pelvic area inoperable.

Chemo doesn't work well with all endo cancers, but some kinds are more receptive than others, so that would depend on the type. They have been getting better results with multi-drug protocols rather than single-drug. I have seen some reports listing progesterone as treatment for tumors with progesterone receptors. Tumors without progesterone receptors tend to be more receptive of standard chemo treatment.

I'm sure there's tons more info out there, but that is a quick rundown of what I was able to gleen from my readings and consults.

Hi KC,

Just a quick add on to what Lisa has said...

Endometrial cancer is a slow growing cancer. Chemo works best on fast-dividing cells. Therefore, chemo is not the best choice. Endometrial cancer is more resistent to chemo. However, if Endometrial cancer is initially discovered at a later stage ( say stage 111) chemo is used and has had some degree of success. Perhaps, the aggressivness of a cancer that has reached a stage 111 lends itself to successful treatment with Chemo ?

Size matters in cancer and upon a recurrence chemo is not that effective. It is still often used however.... as even a small chance of remission /cure is important. Sometimes it is given for palliative reasons.

In cervical cancer, chemo is used in conjunction with radiation ....as it seems to enhance the radiation effect. But, cervical cancer behaves somewhat like endometrail cancer in the sense that it does not often respond well to chemo upon recurrence either.

( This is not to say it does not work... just that it is not always successful)

Ovarian Cancer is usually a fast dividing cell ( more activity)...and hence chemo seems to be the standard treatment of choice with varying degrees of success.

Of course, it is all a lot more complicated than what I am saying here. There is a lot of research out there that may help explain it much better than I can...and in more detail. I also think some other sisters may be able to explain it better than I or have some differing opinions. I was just throwing in my two cents....

Hugs, Diane

Hi, I am not sure whether radiation would be totally out if you had a local recurrence. Also, I don't think it's more likely that you'll have a distant recurrence following radiation. It's just that the likelihood of local recurrence has gone down so low that if there is any recurrence it would neccessarily be elsewhere. As for why chemo is sometimes suggested following surgery, I am guessing that it something that is based on each individual case. Is it very common that this is done? Even though chemo isn't perfect perhaps it can give someone an "edge" on the disease. Regards, Blue

Take this with a giant grain of salt but what I remember my gyn/onc saying after surgery was that the radiation was to get any last traces of the endometrial/uterine cancer that weren't "gotten" by the surgery and that the chemo was sort of a full body, "let's flood you with chemo in case there are any cancer cells floating around ouside of that area", treatment. So while chemo may not target endo cancer, by virtue of having it you might avoid a recurrence. Its primary function was just to make recurrence less likely.

Ok, the fact that chemo doesn't work well for recurrance is my point.

If it doesn't work well for recurrance, why does any doctor recommend it as part of the after surgery treatment?

I understand that it is given to "zap the cancer that might be floating around the body outside of the radiation field" but why is it considered to "work" then yet prognosis isn't as good if endo reocurrs?

Logically, it doesn't make sense to me.

Thanks.

KC,

I believe a recurrence is a different set of issues than the initial use of chemo right after surgery. Almost all cancers ( not just endometrial) are very difficult to treat upon recurrence.
Chemo right after surgery may work better because there may be less cells lurking and it is more effective at eradicating them. They may all be in one area not yet spread or big enough to create a larger tumor. However, once there is distant spread it has often progressed though the lymphnodes or bloodstream and in this case is not easily treated with chemo.

I see that you are a stage 111 and chemo is recommended at that stage. I have an article that I can pm you if you like that says there is indeed a benefit of survival at that stage with use of chemo. ( I am a bit computer challanged and do not know how to get it into this post as a web site)

I just wrote this in another post....but I thought I had a local recurrence of endometrial cancer last summer ( at my vaginal cuff)... If the the tumor had been under 2cm it would have been a 70% cure rate.... but over 2cm ( and mine was thought to be 4.2cm's) there was less than a 30% cure rate. I did not have previous radiation so the statistics are based on that fact. But, statisically you can see there was a difference based on size. By the time a tumor is very small it has billions of cancer cells already. So, a recurrent cancer has perhaps many more cells and becomes more than chemo can handle.


Understanding the dynamics of how chemo does and does not work would be fairly involved. I think many Doctors base their recommendations on recent research and studies as to survival benefits vs risks involved in any treatment.

Not everything is a sure fire winner in terms of treatment. But many treatments are based on the fact that they are the best available at the time. Certainly, the battle is not won and we have a long way to go before we have better and more humane treatments than chemo.

I think you need to get your questions answered by your Doctor and maybe a 2nd or even 3rd opinion. I can tell that it is important for you to fully understand ( I don't blame you)...and none of us are Doctors here who are able to give you the indepth understanding I think you are searching for.

Hugs, Diane

I was not given an option of chemo when my radiation and implant ended. There was no evidence of more cancer at that time. But because I had grade 3 cells they were out there going around with their own minds to attach somewhere. And they did...my right lung has a mass, my right hip, lower back and middle back and mediastinum. I started on Taxol/Carbo today.....chemo now has something to attack...wish I didn't have it to give the chance. My nodes and washings had been clean so the protocal was no chemo at that time....this is 1 1/2 years after the surgery. Joy