UterCa: Cancer staging - when? Has it spread?

What is the order of everything? When do I know what stage the cancer is in and if it has spread? I see the doc again in about a week but I'm looking for some guidelines now.

First, my history:

• Heavy bleeding started about two years ago
• Pap which was normal, so doc ordered an ultrasound which revealed thickening of the lining in the uterus but nothing else
• Doc put me on meds to help with the cramping and said they sometimes have luck with it helping to "sluff off" additional tissue.
• Six or seven months later, bleeding hadn't changed so we did another ultrasound - nearly identical results
• Doc recommended either an ablation or BC pills to help regulate
• I saw a gyn who does ablations in July of 08 and he did a cervical biopsy and a pap which both came back normal
• Because of my age (36 at the time) and the fact that I have no children, he recommended the pill
• After a terrible 29 days of the heaviest bleeding ever, my body adjusted to the hormones and I had "normal" periods 10 or 11 months
• About three months ago, they started getting difficult again
• It was time for a pap again and I was due for renewal on the BC pills
• October of this year, pap came back highly suspicious for malignant cells
• D&C on the 23rd revealed uterine cancer

So, here's where the questions come in . . . is it after the TAH (scheduled for 11/11/09) that I know the stage of the cancer or does the doc already have that based on the D&C? He tells me that at this time, he doesn't expect that I'll need further treatment but that the gyn/onc will be there during the procedure and will take lots of samples and we'll know for sure then.

So, what does he know at this point? Is the no further treatment prediction based on the labs he already has, the fact that we hopefully caught it early or has staging already taken place and I just don't know it?

I'm hearing different stories from different people. Some thing I should know staging now, some think I'll know after the hysterectomy . . . I'm confused!

I'm sorry you have to go through this. Staging will occur with surgery, that is when you will get an accurate staging of your cancer and whether or not it has spread. I hope you have a gyno/oncologist performing this surgery, because they are the only one's qualified to perform surgery when cancer is suspected or in your case already cofrmed. They should also sample your lymph nodes to ensure the cancer has not spread to them. A dr. can give you a guess but no definite answers until surgery is completed as to whether you will need further treatment. BUT PLEASE do not have a regular gyno peform this surgery, get a 2nd opinion from a gyno/onco and have them perform the surgery, you want the most qualified and a gyno isn't qualified to do cancer surgeries.

Hi, Leigh33. I'm pre-op for complete hysterectomy. Here's what my GYN has explained to me and what I've read on the internet. I had a D&C on 19 Oct (by my regular GYN), which confirmed to my GYN adenocarcinoma (uterine cancer). As a result of the D&C, my cancer has been "graded" at 3. What I've been told is grading of the cancer comes with the D&C, but "staging" won't occur until the hysterectomy has been performed and the lab analyzes the tissue. GYN oncologist (who is a different doctor than my regular GYN) who will perform my hysterectomy will take the lab results into consideration with what he observes when doing the daVinci hysterectomy when he "stages" my cancer. I've been told that I'll require radiation treatments with a grade 3 carcinoma. Not sure yet about chemo. Guess that decision will come after my cancer has been staged. You can find lots of information on uterine cancer, grading, and staging on the internet.

Best of luck to you. I don't have a date yet for my hysterectomy, but it will be sometime before Thanksgiving. Radiation will follow. I'm ready to get rid of all this pain and bleeding!

My gyn says that the gyn/oncologist performs the surgery "with him" - I will clarify to find out who does what. The gyn/onc had a cancellation and I managed to scoop up that spot. I've checked him out and he has a fantastic reputation. He's not available again until the first of the year, so I feel pretty lucky to have gotten on his calendar.

Thanks to both of you for the quick reply and the good info.

That is great you will have a gyno/onco in surgery. There have been a few women who have not had a gyno/onco in their surgeries and things were not done correctly and needless to say when cancer is involved, that is not a good thing. It's fantastic that you were able to scoop up that cancellation.

Hi Leigh,

Sorry to hear your news of upcoming surgery. But the good thing is that it sounds like you are in good hands.

I believe that several women on this site had hysterectomies with a gyn/onc present. This is crucial because a regular gyn can do a hysterectomy but not a true cancer staging surgery--only the gyn/oncologist can do that, which involves removal of some lymph nodes for examining. The lymph nodes are the key to knowing whether the cancer has spread beyond the location of the primary cancer site (this is the number associated with Stage). The aggressiveness of the cancer cells is the Grade number.

The correct Stage and Grade of the cancer can be known only after the surgery, from the pathology report. And knowing is critical in recommending the specific treatment (if any) to avoid risk of recurrence.

The best places I know of on the Internet for accurate cancer information are the National Cancer Institute (NCI), the National Comprehensive Cancer Network (NCCN), and the American Cancer Society (ACS).

I hope it all goes well for you! Stay in touch here at HysterSisters.

This is a very "newbie" question but where/what exactly are lymph nodes?

Lymph nodes are located throughout your body. They are part of your body's lymphatic system, which helps to keep you well by isolating invaders, such as viruses, and destroying them. Here is a good link to a diagram of your lymph nodes and your immune system: http://www.mayoclinic.com/health/medical/IM01447.

There are dozens of lymph nodes in your pelvic region and in your groin area, and your doctor will sample some of these nodes, depending on what he/she sees during surgery. I only had six lymph nodes removed from the area around my ovaries, but some hystersisters have had more removed. The lymph nodes that are sampled will then be analyzed by a pathologist to see if cancer has spread to them. The gyn/onc will probably do an abdominal wash, too, and that wash will be analyzed to see if there are any cancer cells in it.

As far as the grading of your cancer, even the grade itself may change after surgery. The grade of my cancer was improved after surgery.

I understand your questions and your fears. I went in for an ablation, tubal and D&C on June 26. The doctor's office called the next day to set up an appointment-I thought it was to check my stitches but it turns out, the D&C revealed I had uterine cancer. My first question was 'what stage is it?' and he said he couldn't tell until after the surgery.

On July 20 I had a TAH/BSO. I also had a pelvic wash and 34lymph nodes removed. Every one of my nodes came back negative for the spread-praise God for that! My pelvic wash was negative too. The pathologist determined my cancer had invaded my uterine wall exactly 50% but it was a grade 3 tumor. I had 25 external treatments and then two internal treatments.

Keep coming here and asking questions. You'll receive a lot of support!

What all the gals said above is true for me too...I was 14 days after surgery before I found out my staging and grade for sure. Mine was stage 1b grade 2. Depending on the aggressiveness (grade) of your tumor and the stage, will determine if any other treatment is needed. I was so fortunate to only have the TAH/BSO, omentum removal, abdominal wash and node sampling. They did 29 nodes, all clear. Good luck from me to you...